HSM546 Course Discussions Week 3

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HSM546 Course Discussions Week 3
explain contracting approaches for physicians and hospitals under managed care plans..

SKU: HSM 546 Provider Networks Federal Regulations Discussions Week 3 Categories: , Tags: , , ,

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HSM546 Course Discussions Week 3

HSM546 Course Discussions Week 3

All Students Posts – 92 Pages 

Provider Networks – 44 Pages 

In your own words, explain contracting approaches for physicians and hospitals under managed care plans.  This week we discuss TCO C and for our first main question we look at provider networks. Ever heard of “narrow network”? What is this?  The main question this week talks about contracts and the text poses the question of why contract? So, now please consider – you are the business manager for a large medical group and it is time to renegotiate the contract with an HMO. What details would you want to look at more closely this time?  Contracts of adhesion. What is this and how might the business manager avoid such a contract?…

Federal Regulations – 47 Pages 

In your own words, discuss one of the federal regulations and acts to regulate health maintenance organization plans.  It will be interesting to see what happens in 2019. In Tennessee the ACA has caused a reduction in the choices of insurance companies providing products in some counties. My sister lives in Davidson County (Nashville) and must buy individual coverage. BCBS has pulled out of Davidson County for individual coverage. So she has had to buy  Oscar insurance which was founded in 2012. Comments?

Recall the serial killer who was found by the DNA of a family member? Does this raise privacy issues?  Every state now has a law requiring MCOs to offer their members internal grievance and appeals procedures. Do you know what your state law includes?…