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.