Current Trends and Issues in Managed Care Compensation and reimbursement models

Question

Current Trends and Issues in Managed Care Compensation and reimbursement models are another method of controlling access, cost, and quality in a managed care environment. An MCO doesn't have direct control over physicians or hospitals but through contractual agreements that set incentives for meeting agreed-upon standards, it can exert influence.

This week, you are required to write an essay on the following topics:

•Managed care hospital reimbursement

•Managed care provider reimbursement

Using South University Online library (e.g. CINAHL) or the Internet, review at least two articles for each topic and write a review for each source of information. Use the following guidelines for developing your essay:

•Write a summary for each topic tying together the information learned about that topic.

•Analyze the market forces that would favor using one reimbursement method over another.

•Evaluate the key differences between different types of payment methodologies from the provider and hospital point of view.

•Evaluate the advantages and disadvantages of the payment methodologies reviewed from the provider and hospital point of view.

•Evaluate new payment methodologies resulting from the Patient Protection and Affordable Care Act (PPACA) and discuss future changes in reimbursement methodologies.

Based on your understanding, create a 3- to 4-page Microsoft Word document that includes the answers to the questions for the above topics. Support your responses with examples. Cite any sources in APA format.

Thank you in advance for any help. (please include citation or website)

Explanation / Answer

Managed care is a health care delivery system organized to manage cost utilization and quality. Managed care hospital reimbursement is a system of healthcare delivery that aims to provide a generalized structure and focus managing the use access cost quality and effectiveness of healthcare services links the patient to provide services. Payment regarding healthcare and services provided by a physician medical professional or agency. Capitation,carve out,case rates,diagonsis related group,fee for service,global fee,per diem,risk sharing.Fee for service models discounted fees,limited provider network,case management,pre certification,concurrent view of service utilization,benefit limitations,financial incentives,disincentives.Information system,utilization management,prior authorization and reimbursement limits.Both the concepts are the same phenomenon which is used in the hospital to reimburse the finances. The information learned about the topic is clear in simplier terms stating that the reimbursements are part of ensuring that the genuiness in providing the finances to the concerned.

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