HSM 420 DeVry Complete Week Discussions Package

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HSM 420 DeVry Complete Week Discussions Package

HSM420

HSM 420 DeVry Complete Week Discussions Package

HSM 420 DeVry Week 1 Discussion 1

Indemnity Versus Managed Care (graded)

Early models of health insurance in America were what we call “indemnity plans” or traditional health insurance plans. What is meant by an indemnity plan, and how is managed care different from traditional indemnity insurance?

 

HSM 420 DeVry Week 1 Discussion 2

Managed Care Impacts (graded)

There can be no doubt that managed care has impacted everyone involved with healthcare delivery in America. What do you see as some of the most significant impacts of managed care for patients?

 

HSM 420 DeVry Week 2 Discussion 1

Provider Networks (graded)

Why do managed care organizations seek to establish a provider network? What are the primary reasons for contracting with providers?

 

HSM 420 DeVry Week 2 Discussion 2

Legal Issues in Provider Contracting (graded)

Describe and discuss the key issues associated with provider payment that should be addressed in any managed care contract.

 

HSM 420 DeVry Week 3 Discussion 1

Utilization Management (graded)

What are the primary categories of utilization management (UM)? How does UM determine medical necessity through the use of evidence-based guidelines?

 

HSM 420 DeVry Week 3 Discussion 2

Case Management Versus Disease Management (graded)

What are the key differences between conventional case management and disease management? Provide some examples of diseases that seem to benefit from a disease management model of care.

 

HSM 420 DeVry Week 4 Discussion 1

Managed Care Pharmacy Benefits (graded)

What are the most important elements of a managed care pharmacy benefit program? And how are patient prescription benefits typically different under managed care?

 

HSM 420 DeVry Week 4 Discussion 2

Managed Behavioral Healthcare (graded)

What factors surrounding behavioral health create special challenges and special considerations for managed care programs? How is managed behavioral healthcare different from managed acute medical or managed acute surgical care?

 

HSM 420 DeVry Week 5 Discussion 1

Managed Care Accreditation (graded)

Discuss the main elements of the managed care accreditation process. For each main element, explain why it is important.

 

HSM 420 DeVry Week 5 Discussion 2

Managed Care Marketing (graded)

Discuss how managed care sales and marketing have evolved over recent decades, and how these may possibly evolve over the decades ahead.

 

HSM 420 DeVry Week 6 Discussion 1

Fraud and Abuse (graded)

Discuss fraud and abuse in healthcare. Provide at least three specific examples of fraudulent practices that have taken place in U.S. healthcare, and describe ways to prevent these in our modern healthcare environment.

 

HSM 420 DeVry Week 6 Discussion 2

Underwriting and Rating (graded)

Explain the difference between underwriting and rating. What are the key elements that typically go into rate development formulas?

 

HSM 420 DeVry Week 7 Discussion 1

State and Federal Regulation (graded)

What are the most critical components of state regulation for managed care organizations? And which federal regulations also bring specific requirements for the operation of such entities? Discuss state and federal regulation of MCOs.

 

HSM 420 DeVry Week 7 Discussion 2

Patient Protection and Affordable Care Act (graded)

Study the provisions of the Patient Protection and Affordable Care Act (PPACA) in your textbook. What will be the primary impacts of PPACA on managed care organizations. Consider both positive and negative impacts in your answer. This section lists options that can be used to view responses.