Health care mid term. BEst Gide is assigned to this .

Health care mid term. BEst Gide is assigned to this .

Why were the first proto-HMOs formed in America? What were theoriginal driving factors in the HMO movement? Describe thepreferred provider organization (PPO) model of managed care. Why doyou feel that this is the dominant form of managed care today? Whydo managed care organizations have a board of directors? What isthe function of the board of directors? What is the role of adenial-of-coverage appeal committee in a managed care organization?And why is this function so crucial? What are meant by outliersĀin hospital reimbursement? How do outlier cases impactreimbursement to a hospital? (Points : 20) What are the three basiccategories of utilization management? Provide a brief descriptionof each category. What is meant by large case management (LCM)under managed care? Provide some specific examples of this type ofcase management. Discuss tools for changing physician behavior.Provide specific examples and perspectives on what will work bestfor changing behavior. What is meant by flow-down clauses inmanaged care contracts? Provide some specific examples. What is arisk-sharing arrangement in a managed care contract? Why might suchan arrangement be beneficial to the parties? Cite and reference ifuse APA format.


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