Discuss the below:
1. How has the relationship between government and managed care evolved over the years? What factors have driven this changing relationship?
2. Describe the preferred provider organization (PPO) model of managed care. Why do you feel that this is the dominant form of managed care today?
3. (Why do managed care organizations have a board of directors? What is the function of the board of directors?
4. (What is the role of the Peer Review Committee in a managed care organization? And why is this function so crucial?
5. Describe the calculation of capitated payments. How are these rates determined in managed care organizations?
6. Describe the use of evidence-based clinical criteria in managed care. Why is this process so important in managed care today?
7. What is meant by transitional case management (TCM) under managed care? Provide some specific examples of TCM functions.
8. Discuss tools for changing physician behavior. Provide specific examples and perspectives on what will work best for changing behavior.
9. What is the purpose of hold-harmless and balance-billing clauses in managed care contracts?
10. What is the purpose of the declarations in managed care contracts?