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Managed care programs come in several varieties. HMOs (health maintenance organizations) and PPOs (preferred provider organizations) are two of the most common. The majority of others combine the two. With the exception that each managed care plan’s duties differ significantly from the next, the fundamental role of governance and control in HMOs, PPOs, and other plans are the same as those in any other organization.
The use of a provider network with discounts, prior approval of procedures, utilization management of treatment guidelines, utilization review, case management, peer review and second opinions, prospective, concurrent, and retrospective audits, and grievance procedures are just some of the cost-controlling strategies employed by managed care programs.
Review the resources listed in the weekly resources to prepare for this week’s assignment(s).
“Identify a local non-profit health care organization that uses a managed care model. You can either conduct an interview with a senior leader of the organization (this may be the CEO, COO, a Senior Vice-President, Vice-President or other such position) OR research about the organization itself. A useful example can be found in many issues of the Journal of Healthcare Management, which often publishes interviews with health care leaders, including on this topic. Interview the individual or research on their managed care model, challenges, its advantages and disadvantages, and why their system does not use other models of managed care. You may also include other interview questions of your choosing, as long as they are relevant to the overall topic of the paper.”
Once you conduct your interview or research, summarize your findings on the main managed care model utilized.
Requirements:
Submit ONE (minimum) to TWO-PAGE (maximum) PAPER by Sunday 11:59pm. Ensure that the paper is formatted as a single page without exceeding the page limit.
Use Times New Roman or Arial, size 12.
Set 1-inch margins on all sides of the paper.
1.15 space the entire document.
Use concise language and avoid unnecessary words or phrases.
Provide a minimum of three references in APA format. Lists all sources cited in the paper on a separate references page.
Provides accurate and properly formatted in-text citations for all sources referenced in the paper.
Save the document in a commonly used file format (e.g., Microsoft Word, PDF) and save it as “your last name” dash week1. Example: Wongkargut-week2
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