Text: Kongstvedt, P. R. (2007) Essentials of managed health care: (5th Ed) Jones & Bartlett Publishers
a. Chapter: Physician Networks in Managed Health Care
i. This chapter will focus on hospital-based physicians, recruiting, and the types of contracting situations, credentialing, and network maintenance.
b. Chapter: Basic Compensation of Physicians in Managed Health Care
i. This chapter will focus on the basic models of reimbursement, capitation, fee-for-service, legislations and regulations applicable to physician incentive programs.
c. Chapter: Hospitals, Facilities, and Ancillary Services
i. This chapter will focus on hospital network development, maintenance, tiered networks, types of reimbursement arrangements, single-specialty hospitals, outpatient procedures, and ancillary services.
d. Chapter: Performance Based Incentives in Managed Health Care Pay-for-Performance
i. This chapter will focus on the basic approach to pay-for-performance and how it is applied in the hospitals and with physicians.
e. Chapter: Managing Basic Medical-Surgical Utilization
i. This chapter will focus on demand management, measurements of utilization and the role of electronic connectivity, authorization and precertification systems. In addition, this chapter will focus on physician services, management of instructional utilization, the emergency department and alternatives to acute-care hospitalization.
Articles:
1. Brook, R. (2010). Physician compensation, cost and quality. JAMA: Journal of the American Medical Association, 304(7), 795-796. Retrieved from the EBSCOhost database.
i. This article reflects on physician compensation, cost and quality in the U.S. It also explains three ways to reimburse physicians for services rendered, including salary, capitation, or fee for service.
2. Casalino, L., Elster, A., Eisenberg, A., Lewis, E., Montgomery, J. & Ramos, D. (2007). Will pay-for-performance and quality reporting affect health care disparities? Health Affairs, 26w405-w414. Retrieved from the EBSCOhost database.
i. This article describes ways in which P4P and public reporting programs may increase disparities and suggests ways in which programs might be designed that will make them likely to reduce, or at least not increase, disparities.
3. Reschovsky, J., Hadley, J. & Landon, B. (2006). Effects of compensation methods and physician group structure on physicians’ perceived incentives to alter services to patients. Health Services Research, 41(4P1), 1200-1220. Retrieved from the EBSCOhost database.
i. This article examines how health plan payment, group ownership, compensation methods, and other practice management tools affect physician perceptions of whether their overall financial incentives tilt toward increasing or decreasing services to patients.
4. Sinaiko, A. & Rosenthal, M. (2010). Consumer experience with a tiered physician network: Early evidence. American Journal of Managed Care, 16(2), 123-130. Retrieved from the EBSCOhost database.
i. This article analyzes consumer awareness, use, and trust of a tiered provider network, which differentiates copayments by provider cost-efficiency and quality.
2. Paper Proposal and Annotated Bibliography
Assignment is designed to guide you as you start your research for the Final Paper. Use the following guide as you write your proposal and bibliography:
I. Paper Proposal: For the Final Paper, you are to choose a topic related to the future of managed health care delivery.Topic:( Managed Health Care Delivery and the Healthcare Reform act.) Describe the topic that you will be covering. Explain why you chose it and how it relates to the future of managed health care delivery systems.
II. Annotated Bibliography: Provide an annotated bibliography of at least five of the required eight to ten scholarly sources you will be using to write your Final Paper. An annotated bibliography for this purpose is one that is in APA format and is followed by a brief description of how the resources are relevant to the topic of your paper.
Your Assignment:
1. Must be three pages in length and formatted according to APA style. Must have a cover page that includes:
a. Title of paper
b. Student’s name
c. Course name and number
d. Instructor’s name
e. Date submitted
2. Must have a Paper Proposal
3. Must have an Annotated Bibliography
4. Must document all sources in APA style