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HSM/420 HSM420 HSM 420 WEEK 4 Midterm

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HSM 420 WEEK 4 Midterm 1. Question : (TCO 1) Explain why is it so crucial that managed care organizations demonstrate the quality of care they provide. Question 2. Question : (TCO 1) What are the types of plans on the managed care continuum? Present these in order, from least control to most control of medical cost and quality. Question 3. Question : (TCO 2) Why do managed care organizations have a board of directors? What is the function of the board of directors? Question 4. Question : (TCO 2) What is the role of the Peer Review Committee in a managed care organization? And why is this function so crucial? Question 5. Question : (TCO 3) Describe the calculation of capitated payments. How are these rates determined in managed care organizations? Question 6. Question : (TCO 3) Describe the use of evidence-based clinical criteria in managed care. Why is this process so important in managed care today? Question 7. Question : (TCO 4) What is meant by transitional case management (TCM) under managed care? Provide some specific examples of TCM functions. Question 8. Question : (TCO 4) How should managed care organizations address noncompliance by individual physicians? Provide some specific examples of approaches to this problem that may be effective. Question 9. Question : (TCO 7) What is meant by flow-down clauses in managed care contracts? Provide some specific examples. Question 10. Question : (TCO 7) What is typically covered under “term, suspension, and termination” of a managed care contract?

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