Class Description - Class
ELEMENTS OF Systems Based Practice: HOW HEALTH CARE IS MANAGED
This class will examine how health care is managed by insurance entities and
managed care organizations. It will give an overview of various components and
parameters used by the managed care industry and examine how different methods
of compensation affect providers. Also, this class will identify certain
business aspects for providers to consider in their medical practice.
Class 2 Topics: ELEMENTS OF
Systems Based Practice: HOW
HEALTH CARE IS MANAGED
COMMON LANGUAGE OF SERVICES PROVIDED
II. COMMON AND
COMPARABLE COSTS PER TYPE OF SERVICES PROVIDED
PREFERRED PROVIDER ORGANIZATIONS
STANDARDS OF CARE
BUSINESS ASPECTS OF MEDICAL PRACTICE
|1. Examine concepts underlying managed care.|
|2. Synthesize how the managed care organization
payment mechanism effects the provider.|
|3. Identify business aspects of practice and
cost-effective, appropriate, quality care.|
|1. Describe the managed care components,
parameters, and delivery vehicles.|
See: Gloria J. Bazzoli, Ph.D., Robert H. Miller, Ph.D., and Lawton R. Burns,
Ph.D., "Capitated Contracting Roles and Relationships in Healthcare," Journal
of Healthcare Management, 45:3 (May/June, 2000): 170 - 188.
|2. Explain the evolution of the method of
See: Thomas Bodenheimer, "California’s
Beleaguered Physician Groups - Will They Survive,"
The New England Journal of Medicine (April 6, 2000): 1064 - 1068. Lisa
Scott, "After the Fall; New Tactics Offer
Hope for Battered California Physicians," Modern Physician (May 1,
|3. Analyze what "risk" means to a
provider in managed care. Also, list at least three factors that effect a
physician’s financial performance in a HMO contractual arrangement.|
See: Gloria J. Bazzoli, Ph.D., Robert H. Miller, Ph.D., and Lawton R.
Burns, Ph.D., "Capitated Contracting Roles and Relationships in
Healthcare," Journal of Healthcare Management, 45:3 (May/ June,
2000): 170 - 188. Frances M. Prescott, "Improve - Rather Than Lose - Your
Risk-Taking Entity," Healthcare
Financial Management (February, 2000): 39 - 41. Joseph M. Kemka, "
New Risk Management Paradigm for Managed Care,"
Healthcare Financial Management (June 2000): 41 - 42.
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topic for Class 2 CME
Test - Class 2