Managed Care
Please also review the attached Paper Proposal for information that should be included in this paper.
Include an Abstract which is a synopsis of the overall paper.
1. Managed Health Care Quality should address such factors as whether or not patient health care needs and even preferences are being met; the care is right for the illness, care is timely, and unnecessary test and procedures are not ordered.
2. Provider Contracting is when doctors and health care practitioners have a contract agreement through a third party payer to accept a specified payment for services provided to patients.
3. Cost Containment deals with managing the costs of doing business within a specified budget while restraining expenditures to meet a specified financial target.
4. Effects on Medicare and Medicaid in managed health care appear to be moving in a direction where both types of recipients will be enrolled in some type of managed health care plan in the near future.
5. The Future Role of Government Regulations, to include ERISA and HIPAA health care policies.
6. Include Three Recommendations each, related to quality and change in Medicare and Medicaid managed health care plans.

Must include an introductory paragraph with a succinct thesis statement.
Must address the topic of the paper with critical thought.
Must end with a conclusion that reaffirms your thesis.
Must use at least eight scholarly and /or peer-reviewed sources, published within the last five years, including a minimum of three from the Ashford University Online Library.
Must document all sources in APA style, as outlined in the Ashford Writing Center.
Must include a separate reference page, formatted according to APA style as outlined in the Ashford Writing Center.

Topic: Managed Care

Order Description
No references needed. Single spaced.
1. Please identify three provisions of a typical contract between an HMO and a medical group or hospital and briefly discuss why you think these provisions are important.

2. The Board of Directors of a typical medical group is composed of physicians who are often employed by that medical group. How does this relationship affect the role of physicans who may not be on the Board of Directors? How does the physician controlled Board of Directors impact the role of the group’s non-physician administator?

3. In the days before managed care, most surgeries were performed in acute care hospitals. Managed care has encouraged the development of ambulatory surgery centers as a more cost-effective method of providing surgical services to many members. Some would argue that this trend has compromised quality and put patients at risk. What do you think?

4. California has a law which prohibits non-physicians from employing physicians, except under specific circumstances, one of which is a Medical Care Foundation. Briefly describe and discuss a Medical Care Foundation. (Please note that this is different from the California Foundation for Medical Care located in Riverside which is a PPO organization). See Cedars-Sinai Health System or Huntington Medical Care Foundation as local examples of Medical Care Foundations.

5. Under traditional health care insurance, hospitals have historically been paid based on their billed charges. HMOs usually reimburse hospitals based on any one of four methods: discounted fee-for-services (charges), per diem, case rates (DRG), or capitation. Discuss the pros and cons of each method.