Nursing M3.L7: Managed Care Study Questions Assignment

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Home>Homework Answsers>Nursing homework helpHOMEWORKassignment is attached2 years ago27.11.20236Report issuefiles (1)StudyGuideChapter91.pdfStudyGuideChapter91.pdfHIM 1300 – Health Care Facilities/Delivery

Assignments Complete
Read chapter 9 Managed Care of textbookRead materials and complete the following in order for Managed Care:
o Managed Care Introduction
o Managed Care PowerPoint
o Health Insurance (video)
o Medicaid (video)
o Pay for Performance
o Genetic TestingComplete Study:1. In the managed care arena, what is capitation? Who are the “Gatekeeper” and their
duties?2. What are the alternative(s) to managed care? For Americans, what issues does
managed care raise?3. How do PPOs differ from HMOs?4. Provide information on the HEDIS abbreviation, purpose, its responsibility to consumers,and its effects on quality in healthcare. Surf the Internet.5. Continue your search to report on HEDIS to offer information and compare managedcare providers. Go to: http://www.ncqa.org Search the website to learn about the data
elements. Your goal will be to access performance for HEDIS Measures Effectiveness of
Care:
a. Use the 2016-2020 Quality Measurement Report to briefly summarize the chronic
diseases measured for:• Adult BMI Assessment• Lead Screening• Cervical Cancer6. Research Internet for Outpatient Clinical Documentation Improvement Program.
Provide a brief overview. (Hint: You will be asked to research for discussion posting)7. Search the Internet to determine the steps Managed Care organization are doing to
prevent fraud and abuse among patients and health care providers. Address each party
(patients and providers). You must list and explain at least three fraud and abuse tactic.8. Determine the role of managed care in the health information exchange (HIE).
Search the Internet to enhance your knowledge. Briefly discuss your understanding of
HIEs. (Do not copy and paste)9. Access the “Insurance Ranking” website on the Managed Care Websites listed in the
lesson. Submit grid below and required data with Study Guide questions. On the last
line, you choose a health plan located in Florida and submit findings in the Discussion
Forum (specify why you choose the health plan):Rank Plan Name Type Score Consumer
SatisfactionPrevention TreatmentAvMed Health Plans HMOCigna HealthCare South FL HMOHumana Medical Plan HMOYour selection10. Now that you have completed #9. Review the HEDIS Report Card for the patient
listed below:http://www.ncqa.org/https://www.ncqa.org/hedis/measures/https://www.ncqa.org/hedis/measures/Your 73-year-old Uncle Henry lives in Pennsylvania and is looking for a Medicare PPO
to join. It is open enrollment and he has asked for your help. Uncle Henry knows that
you work as a Health Information Technician and you have knowledge about health
plans. He has several chronic diseases including diabetes, hypertension, and
Parkinson’s disease. In particular, he wants to join a PPO that is highly rated for helping
individuals live with their illnesses. Help Uncle Henry create a report card on the HEDIS
website to evaluate the health plans.
Search the website: https://www.ncqa.org/report-cards/health-plans/Which health plan would be the best selection and why?11. Case Study – Read case study below. Your goal will be to research on the Internet
“Quality Management in health care”, understand the role of a Quality Manager in the
healthcare arena. Make recommendations to resolve the issues.12. Go to https://www.uhc.com/understanding-health-insurance/common-terms . Select
“Terms to Know”. Review terms and watch video. Learn more about health insurance
and their terms. Write a paragraph on this website contribution to lay persons
understanding health insurance. Add a second paragraph on one or two terms you did
not understand. Discuss how the terms will assist you in becoming more knowledgeable
when referencing health insurance.13. Post to Discussion area #1 your choice of the health plan selected in question #8.
Go to the Health Plan Report Card (Hint-become familiar with accreditation status levels) add the HEDIS,
CAHPS score and accreditation status. Offer classmates a paragraph why you choose
the health plan with rational. Use the grid below (copy and paste) to share findings withCase StudyYou are the newly appointed director of quality management at a
medium-sized MCO that was originally a group model but now have
about half of its members cared for by physicians in a network model
arrangement. NCQA has recently adopted and promulgated a new set
of measures for quality of care of diabetics and you know that the
results will be publicized, with customers encouraged to use them to
choose plans. Much of the information needed is available in your
administrative data a set, which includes frequency of visits, laboratory
tests, etc. You note with both interest and concern that the
performance of the network physicians is nowhere near as good as
that of the large group practice that is the out-growth of your old staff
model arrangements. You are also very aware that patients must be
active partners if your plan is going to do well on these measures,
since so many of the events are ones in which patients must choose to
receive care.1. What steps would you take to improve quality in this area?
2. Should you use financial incentives or other means with thedoctors?
3. What will you do with respect to patients known to be diabetic?
4. Is there any use you could make of the difference in baselineperformance between the two sets of doctors?https://www.ncqa.org/report-cards/health-plans/https://www.uhc.com/understanding-health-insurance/common-termshttp://reportcard.ncqa.org/plan/external/PlanSearch.aspxclassmates:Rank Plan
NameTypeScore Consumer
SatisfactionPrevention Treatment HEDIS CAHPS AccreditationYour reason:14. Post findings to the Discussion area #2. Provide information of your findings and
respond to at least two of your peers. Go to http://floridahealthfinder.gov . Allow screen
prompts to rotate. Access the screen prompt for Take the website tour. Then, select
links to Compare prices of surgery and medications. For the surgery, list the common
disease and its etiology for which the surgery is performed. For the medication, offer the
common disease the drug is prescribed.15. Post findings to the Discussion area #3. Picture yourself as working in a physician’s
group practice. The physicians in the practice have tossed around the idea of signing up
for the Outpatient Clinical Documentation Improvement Program offered through
Medicare and Commercial Insurance carriers. Research the Outpatient CDI topic, the
responsibilities of the office physician(s) and office staff. Discuss how the program will
affect the work of the physician, the staff, the quality of care of patients, and
reimbursement. Address Outpatient CDI and all three aspects of questions. Your initial
response must be 150 words or more. Respond to peers.16. Complete Pre-test of Managed Carehttp://floridahealthfinder.gov/StudyGuideChapter91.pdfHIM 1300 – Health Care Facilities/Delivery

Assignments Complete
Read chapter 9 Managed Care of textbookRead materials and complete the following in order for Managed Care:
o Managed Care Introduction
o Managed Care PowerPoint
o Health Insurance (video)
o Medicaid (video)
o Pay for Performance
o Genetic TestingComplete Study:1. In the managed care arena, what is capitation? Who are the “Gatekeeper” and their
duties?2. What are the alternative(s) to managed care? For Americans, what issues does
managed care raise?3. How do PPOs differ from HMOs?4. Provide information on the HEDIS abbreviation, purpose, its responsibility to consumers,and its effects on quality in healthcare. Surf the Internet.5. Continue your search to report on HEDIS to offer information and compare managedcare providers. Go to: http://www.ncqa.org Search the website to learn about the data
elements. Your goal will be to access performance for HEDIS Measures Effectiveness of
Care:
a. Use the 2016-2020 Quality Measurement Report to briefly summarize the chronic
diseases measured for:• Adult BMI Assessment• Lead Screening• Cervical Cancer6. Research Internet for Outpatient Clinical Documentation Improvement Program.
Provide a brief overview. (Hint: You will be asked to research for discussion posting)7. Search the Internet to determine the steps Managed Care organization are doing to
prevent fraud and abuse among patients and health care providers. Address each party
(patients and providers). You must list and explain at least three fraud and abuse tactic.8. Determine the role of managed care in the health information exchange (HIE).
Search the Internet to enhance your knowledge. Briefly discuss your understanding of
HIEs. (Do not copy and paste)9. Access the “Insurance Ranking” website on the Managed Care Websites listed in the
lesson. Submit grid below and required data with Study Guide questions. On the last
line, you choose a health plan located in Florida and submit findings in the Discussion
Forum (specify why you choose the health plan):Rank Plan Name Type Score Consumer
SatisfactionPrevention TreatmentAvMed Health Plans HMOCigna HealthCare South FL HMOHumana Medical Plan HMOYour selection10. Now that you have completed #9. Review the HEDIS Report Card for the patient
listed below:http://www.ncqa.org/https://www.ncqa.org/hedis/measures/https://www.ncqa.org/hedis/measures/Your 73-year-old Uncle Henry lives in Pennsylvania and is looking for a Medicare PPO
to join. It is open enrollment and he has asked for your help. Uncle Henry knows that
you work as a Health Information Technician and you have knowledge about health
plans. He has several chronic diseases including diabetes, hypertension, and
Parkinson’s disease. In particular, he wants to join a PPO that is highly rated for helping
individuals live with their illnesses. Help Uncle Henry create a report card on the HEDIS
website to evaluate the health plans.
Search the website: https://www.ncqa.org/report-cards/health-plans/Which health plan would be the best selection and why?11. Case Study – Read case study below. Your goal will be to research on the Internet
“Quality Management in health care”, understand the role of a Quality Manager in the
healthcare arena. Make recommendations to resolve the issues.12. Go to https://www.uhc.com/understanding-health-insurance/common-terms . Select
“Terms to Know”. Review terms and watch video. Learn more about health insurance
and their terms. Write a paragraph on this website contribution to lay persons
understanding health insurance. Add a second paragraph on one or two terms you did
not understand. Discuss how the terms will assist you in becoming more knowledgeable
when referencing health insurance.13. Post to Discussion area #1 your choice of the health plan selected in question #8.
Go to the Health Plan Report Card (Hint-become familiar with accreditation status levels) add the HEDIS,
CAHPS score and accreditation status. Offer classmates a paragraph why you choose
the health plan with rational. Use the grid below (copy and paste) to share findings withCase StudyYou are the newly appointed director of quality management at a
medium-sized MCO that was originally a group model but now have
about half of its members cared for by physicians in a network model
arrangement. NCQA has recently adopted and promulgated a new set
of measures for quality of care of diabetics and you know that the
results will be publicized, with customers encouraged to use them to
choose plans. Much of the information needed is available in your
administrative data a set, which includes frequency of visits, laboratory
tests, etc. You note with both interest and concern that the
performance of the network physicians is nowhere near as good as
that of the large group practice that is the out-growth of your old staff
model arrangements. You are also very aware that patients must be
active partners if your plan is going to do well on these measures,
since so many of the events are ones in which patients must choose to
receive care.1. What steps would you take to improve quality in this area?
2. Should you use financial incentives or other means with thedoctors?
3. What will you do with respect to patients known to be diabetic?
4. Is there any use you could make of the difference in baselineperformance between the two sets of doctors?https://www.ncqa.org/report-cards/health-plans/https://www.uhc.com/understanding-health-insurance/common-termshttp://reportcard.ncqa.org/plan/external/PlanSearch.aspxclassmates:Rank Plan
NameTypeScore Consumer
SatisfactionPrevention Treatment HEDIS CAHPS AccreditationYour reason:14. Post findings to the Discussion area #2. Provide information of your findings and
respond to at least two of your peers. Go to http://floridahealthfinder.gov . Allow screen
prompts to rotate. Access the screen prompt for Take the website tour. Then, select
links to Compare prices of surgery and medications. For the surgery, list the common
disease and its etiology for which the surgery is performed. For the medication, offer the
common disease the drug is prescribed.15. Post findings to the Discussion area #3. Picture yourself as working in a physician’s
group practice. The physicians in the practice have tossed around the idea of signing up
for the Outpatient Clinical Documentation Improvement Program offered through
Medicare and Commercial Insurance carriers. Research the Outpatient CDI topic, the
responsibilities of the office physician(s) and office staff. Discuss how the program will
affect the work of the physician, the staff, the quality of care of patients, and
reimbursement. Address Outpatient CDI and all three aspects of questions. Your initial
response must be 150 words or more. Respond to peers.16. Complete Pre-test of Managed Carehttp://floridahealthfinder.gov/Bids(61)Miss DeannaSheryl HoganDr. Freya WalkerDoctor.Namirafirstclass tutorProf Double RDemi_RoseIsabella HarvardMUSYOKIONES A+Dr CloverJudithTutorSTELLAR GEEK A+Jahky BProWritingGuruColeen AndersonDr. Everleigh_JKBrilliant GeekTutor Cyrus KenTeacher A+ WorkAshley EllieShow All Bidsother Questions(10)Inventory Analysis” Please respond to the following:Financial RatiosIdentifying Deductive & Inductive Fallacies10-2Need help with financial analysis exercisePrevention of Substance Use Disordersi have homeworkWhat are the current ownership patterns in the book industry? How do they affect the kinds of books that are…BUS 323 Week 4 DQ 1 ( Property Coverage ) ~ 2 Different Answers ~ Perfect Tutorial With References (Scored 100%)Avoiding common mistakes

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