Midtern

1. (TCO 1) How has the relationship between government and managed care evolved over the years? What factors have driven this changing relationship? (Points : 20)

Question 2.2. (TCO 1) Describe the preferred provider organization (PPO) model of managed care. Why do you feel that this is the dominant form of managed care today? (Points : 20)

Question 3.3. (TCO 2) Why do managed care organizations have a board of directors? What is the function of the board of directors? (Points : 20)

Question 4.4. (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)

Question 5.5. (TCO 3) Describe the calculation of capitated payments. How are these rates determined in managed care organizations? (Points : 20)

Question 6.6. (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)

Question 7.7. (TCO 4) What is meant by transitional case management (TCM) under managed care? Provide some specific examples of TCM functions. (Points : 20)

Question 8.8. (TCO 4) Discuss tools for changing physician behavior. Provide specific examples and perspectives on what will work best for changing behavior. (Points : 20)

Question 9.9. (TCO 7) What is the purpose of hold-harmless and balance-billing clauses in managed care contracts? (Points : 20)

Question 10.10. (TCO 7) What is the purpose of the declarations in managed care contracts? (Points : 20)