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Question;Question 1. Question;(TCO 1) Why were the first proto-HMOs formed in America?;What were the original driving factors in the HMO movement?;Question 2. Question;(TCO 1) What are the types of plans on the managed care;continuum? Present these in order, from least control to most control of;medical cost and quality.;Question 3. Question;(TCO 2) What is the role of the executive director in a;managed care organization? Could you see yourself practicing in this position;at some point in your career? Why or why not?;Question 4. Question;(TCO 2) What is the role of the credentialing committee in a;managed care organization? And why is this function so crucial?;Question 5. Question;(TCO 3) Discuss pay for performance (P4P) in managed care.;What are the pros and cons of the P4P approach to compensating providers?;Question 6. Question;(TCO 3) Describe the use of evidence-based clinical criteria;in managed care. Why is this process so important in managed care today?;Question 7. Question;(TCO 4) What is meant by pattern review under managed care?;Why do payers conduct pattern review, and what kinds of things might they;identify during such reviews?;Question 8. Question;(TCO 4) Discuss some key general aspects of physician;practice behavior? Include implicit messages from training, and also;environmental factors, in your answer.;Question 9. Question;(TCO 7) What is the purpose of hold-harmless and;balance-billing clauses in managed care contracts?;Question 10. Question;(TCO 7) What is typically covered under ?term, suspension;and termination? of a managed care contract?


Paper#58187 | Written in 18-Jul-2015

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