Project #43039 - DSQ#

 

1.       Discuss the differences between Capitation and Fee-For-Service models that compensate physician services. Include a detailed account of the benefits and risks of having these physician compensations types and what is your recommendation for one vs. the other? Utilize a minimum of two scholarly and/or peer-reviewed sources that were published within the last five years.

 

2.       How does Pay-for-Performance impact the patients, providers, practitioners and hospitals in regards to overall managed care and quality? Are there incentives, risks, or common components found? In your post, incorporate two examples from real life. Utilize a minimum of two scholarly and/or peer-reviewed sources that were published within the last five years, to support the ideas you express in your post.

 

3.       What are the new demands on disease management programs? Which regulatory agencies are responsible for these demands? Are there risks to the demands and are there behavior limitations to these management programs? In your discussion, provide examples of two successful Disease Management Programs from real life. Why were these programs successful? Can they be replicated in other settings? What are the challenges to replication? Utilize a minimum of two scholarly and/or peer-reviewed sources that were published within the last five years, to support the ideas you express in your post.

 

4.       Discuss the human/behavioral and economic impact of preventable diseases in the U.S. and how disease management programs may be beneficial in these cases. Discuss how disease management programs may help to guide in the care of chronic disease and improve quality of care of patients. Utilize a minimum of two scholarly and/or peer-reviewed sources that were published within the last five years, to support the ideas you express in your post. Respond to at least two of your classmates’ posts. Describe the impacts of consumerism in regards to information technology, claims management, and member services when dealing with healthcare providers.

 

5.       What tools and value added quality will be expected of health care providers? What changes will health care providers need to make to be competitive and gain consumers and maintain existing members? Watch The Role of IT in Public Healthcare Service video and discuss your opinions on information technology and Health care. Utilize a minimum of two scholarly and/or peer-reviewed sources that were published within the last five years to support the ideas you express in your posting.

 

6.      
Describe the employer-sponsored sales process? What is the goal of this process once it is completed? Why is accreditation important? What is the difference between rating and underwriting and how is it used? Identify and discuss any ethical issues that could arise in the underwriting process. Utilize a minimum of two scholarly and/or peer-reviewed sources that were published within the last five years to support the ideas you express in your posting.

 

7.       Discuss state licensure requirements that an organization must comply with in order to become a Medicare Advantage Plan, any exceptions to the State licensure requirement, and any cases in which special consideration is given to particular types of entities. Utilize a minimum of two scholarly and/or peer-reviewed sources that were published within the last five years to support the ideas you express in your post.

 

8.       Discuss strengths and threats to the survival of the military health system. Summarize the Tricare program and detail its options for enrollees. What is Tricare’s greatest threat and how can it be avoided? Utilize a minimum of two scholarly and/or peer-reviewed sources that were published within the last five years to support the ideas you express in your post

 

9.      
What is the purpose of a provider contract? What intentions are enclosed in a provider contract and why is it important to detail party relationships, services, obligations, and objectives? Explain why the “definitions” section of a contract is important and why it should be carefully reviewed or drafted? Detail the repercussions that can result if the definitions section is not carefully drafted. Identify a real life health care case that relates to inadequate/poorly written definitions. Utilize a minimum of two scholarly and/or peer-reviewed sources that were published within the last five years to support the ideas you express in your posting

 

 

 

10.   What are the privacy requirements under HIPAA? Explain why confidentiality of health information has been a controversial public policy issue. Give a real world example. How can health information be better protected? Research and present two real life strategies that have been successfully implemented within the last five years. Utilize a minimum of two scholarly and/or peer-reviewed sources that were published within the last five years to support the ideas you express in your post.

 

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Due By (Pacific Time) 10/15/2014 12:00 am
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