Mgd Care: Reimbursement Methodologies
This course discusses financial management, the central thread that interconnects the various elements of managed care. It explains various reimbursement methodologies commonly used in managed care and the underlying assumptions and risk management funding mechanisms that are responsible for these reimbursement methodologies. This course describes basic and advanced reimbursement methodologies used for hospital services and basic reimbursement methodologies used for physicians and other professionals.
Mgd Care: Overview of Managed Care
This course provides an overview of the state of managed care today and discusses how and why it has evolved. It also identifies major initiatives that are currently affecting managed care and will continue to do so in the future, as the U.S. continues to implement the reforms associated with the passage of the Patient Protection and Accountable Care Act (ACA) in March 2010. The course offers a solid foundation of knowledge that will provide necessary context for the more detailed information presented in subsequent courses in this series.
Mgd Care: Trends in Healthcare Policy
This course explores trends in the ongoing development of state and federal healthcare policies and covers topics related to the national healthcare debate. It also discusses increased employer and consumer awareness and its impact on healthcare policies, outcomes-based reimbursement approaches, and improved outcomes and increased value through coordination of care. The course examines the key issues behind healthcare reform and the main elements of the 2010 law.
Mgd Care: Healthcare Delivery Systems
This course discusses the healthcare delivery system in the U.S. and describes how various managed care models affect the quality and cost of care. It also describes the various relationships between providers and payers. Finally, it addresses cost-sharing mechanisms such as copayments, coinsurance, and out-of-pocket maximums that managed care models use to direct their members' choices of providers and services.