HSM 420 All Discussions Week 1 - 7 + Week 4 Midterm Exam

HSM 420 Managed Care and Health Insurance (DeVry)

HSM 420 All Discussions Week 1 - 7 

HSM 420 Week 1 DQ 1 Indemnity Versus Managed Care
HSM 420 Week 1 DQ 2 Managed Care Impacts
HSM 420 Week 2 DQ 1 Provider Networks
HSM 420 Week 2 DQ 2 Legal Issues in Provider Contracting
HSM 420 Week 3 DQ 1 Provider Networks
HSM 420 Week 3 DQ 2 Legal Issues in Provider Contracting
HSM 420 Week 4 DQ 1 Managed Care Pharmacy Benefits
HSM 420 Week 4 DQ 2 Managed Behavioral Healthcare
HSM 420 Week 5 DQ 1 Managed Care Accreditation
HSM 420 Week 5 DQ 2 Managed Care Marketing
HSM 420 Week 6 DQ 1 Fraud and Abuse
HSM 420 Week 6 DQ 2 Underwriting and Rating
HSM 420 Week 7 DQ 1 State and Federal Regulation
HSM 420 Week 7 DQ 2 Patient Protection and Affordable Care Act

HSM 420 Week 4 Midterm Exam

1. (TCO 1) Why were the first proto-HMOs formed in America? What were the original driving factors in the HMO movement? (Points : 20)
2. (TCO 1) What is meant by indemnity coverage, and how does it change in managed indemnity? (Points : 20)
3. (TCO 2) What is the role of the executive director in a managed care organization? Could you see yourself practicing in this position at some point in your career? Why or why not? (Points : 20)
4. (TCO 2) What is the role of the Peer Review Committee in a managed care organization? And why is this function so crucial? (Points : 20)
5. (TCO 3) Describe the calculation of capitated payments. How are these rates determined in managed care organizations? (Points : 20)
6. (TCO 3) Describe the use of evidence-based clinical criteria in managed care. Why is this process so important in managed care today? (Points : 20)
7. (TCO 4) What is meant by pattern review under managed care? Why do payers conduct pattern review, and what kinds of things might they identify during such reviews? (Points : 20)
8. (TCO 4) Discuss some key general aspects of physician practice behavior? Include implicit messages from training, and also environmental factors, in your answer. (Points : 20)
9. (TCO 7) What is the purpose of hold-harmless and balance-billing clauses in managed care contracts? (Points : 20)
10. (TCO 7) What is typically covered under “term, suspension, and termination” of a managed care contract? (Points : 20)