Insurance and Managed Care

1. Managed Health Care has significantly affected the Health Care Delivery system in the United States. In your own words, describe Managed Health Care. What were some of the factors that influenced its development, and describe the advantages and disadvantages of managed care from the perspective of the Patient and Provider?

2. Managed Health Care Organizations administer many functions. Payment is a key element. Please describe the difference between Reimbursement and Payment how do these affect provider behavior? Explain risk based versus non-risk based payment methods and provide some examples of each?

3. Managed Health Care manages several components which include medical services, costs and quality of care. Describe utilization review, its purpose and three utilization methods and functions employed by managed care organizations. Describe Case management and Disease management, compare by providing some examples of each.

4. A Managed Care payer organization uses several managerial and operational functions to accomplish its goals. Describethe difference between Governance and Management and provide examples of each. Describe the difference between sales and marketing and provide some examples of each.

5. What would you say are the four most important lessons you have learned about managed care and Why?