• March 31st, 2016

Managed Care

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1. One of the most common complaints about HMOs concern the hurdles required to obtain an authorization to see a specialist or be admitted to the hospital for a non-emergency condition. Recently CIGNA was fined by the Federal Government for excessive restrictions or delays in referring Medicare patients. Discuss the authorization process, including your thoughts as to why this process may be necessary and some suggestions for improvement.

2. The cost of treating chronic disease is estimated at 75% of total health care expenditures annually. Identify three chronic diseases and discuss what health care professionals, especially those working in managed care, can do to reduce cost and improve quality of care.

3. Discuss several basic differences between case management and disease management.

4. Many health care organizations have adopted or are in the process of adopting Electronic Health Records. Some experts are critical of EHR due to a potential threat to confidentiality, while others praise EHR for a number of reasons. What is your view on this issue?

5. Althought quite common today, the concept of a Hospitalist has not always been accepted by other physicians or patients. What is a Hospitalist, what does this specialist do, and what are some pros and cons of this form of patient care.

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