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- Discuss the different types of managed care plans.
- Compare and contrast HMO versus PPO. What are their pros and cons?
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- Discuss current funding sources (e.g., PACE, TRICARE, SCHIP, Medicare, Medicaid, private insurance) and mechanisms (e.g., DRG, Cost-Plus, ICD-10) of healthcare financing and their importance. In transitioning to value-based care or value-based reimbursement what are the most significant challenges to providers and payors?Explain the key components and constructs of the PRECEDE-PROCEED Model and the steps involved in the intervention mapping approach. Describe an example of how each of these models has been applied in public health practice. What similarities and differences exist between the intervention mapping and PRECEDE-PROCEED models? Which approach do you favor and why?#Nursing Question.. "Adverse selection"as applied to health insurance, means: Group of answer choices the practice by the healthcare insurers to deny coverage to people with pre-existing conditions. those who are more likely to require health insurance purchase the insurance while young and healthy people who are less likely to need the insurance opt out. people make poor choices of healthcare insurance programs because they don't have sufficient information. those who are more likely to require health insurance in the future are adversely impacted by the fact that health insurer does not have as much information about their healthcare needs as they do..
- Objective: Identify risk management strategies to address ethical concerns within the healthcare setting. Scenario: Cultural Bias and Inflexibility Impedes Communication and Contributes to Poor Outcomes. Address what are the financial implications of the issue, and what could have been done from a risk management perspective to prevent the issue from happening? What can be done in the future? Explain your rationale.Managed care has had an impact on the healthcare industry since its inception. It introduced different managed care models as well as different payment systems. More directly, managed care has changed patient and provider behavior in terms of what they can and can’t do. Healthcare providers have been directly impacted in the way they are reimbursed and the factors that lead to maximum reimbursement. Conduct research on how the role of the physician has changed with the advent of managed care. Write a 4-5-page paper that addresses the following: Explain how managed care has changed the healthcare landscape. Discuss how managed care impacts provider reimbursement. Describe how the relationship between physician and patient has changed through managed care. Explain whether, in your opinion, the new focus on healthcare outcomes is better or worse. Discuss who benefits from the new reimbursement approach. Describe the relationship between first, second, and third-party in a managed care…Define and discuss what a continuum of care is and where do long-term care services fit in that continuum. Identify four factors that have led to the development of the long-term care system as it currently exists. Identify four strengths and four weaknesses of the long-term care system
- Managed care organizations compete with each other on quality and low cost provision of services. exclude health maintenance organizations. exclude preferred provider organizations. exclude closed-panel HMOs. are often run by the federal government.Discuss design principles used to facilitate heuristics in a clinical decision support process. Provide a workplace example and offer suggestions to improve the clinical decision support? Provide a rationale for why you made those suggestions. include ReferencesWhy are long term care providers subject to so much external control by government agencies? Provide examples
- Q: What distinguishes a preferred provider organization (PPO) from a traditional health maintenance organization (HMO)? A. There is no distinction, both HMOs and PPOs are focused on costs and outcomes and are considered managed care organizations B. Both are similar to POSs (point of service plans) C. HMOs are generally more restrictive when it comes to standards and cost controls on providers and enrollees D. All of the above E. A and C onlyWhy is it important that healthcare workers understand the limitations of STM? How can you use this knowledge to provide better healthcare? How can understanding the information processing model help you to be a better nurse? Give a specific example of how you can improve health care delivery by understanding this model. Choose a health education topic and a target audience (children, the elderly, smokers, people with diabetes, new parents, etc). Show how you can teach a lesson using the information processing model. Be specific in your discussion. Be sure to discuss each stage in the model, what acquisition strategies you will use to assure a deep level of processing, how you will help to assure motivation and attention, and how you will assess if the information made it into LTM.Discuss quality measures established by governing bodies and data sources that help improve patient outcomes and reduction in cost. Provide examples to support your discussion. Preventive care Readmission rates how preventive care could be a win-win situation for both patients and health care organizations ?
