Homework answers / question archive / 1)What are some of the key differences between traditional indemnity insurance and managed care?       What are the three main payment mechanisms managed care uses? In each mechanism, who bears the risk? Explain how the fee-for-service practice of medicine led to uncontrolled utilization

1)What are some of the key differences between traditional indemnity insurance and managed care?       What are the three main payment mechanisms managed care uses? In each mechanism, who bears the risk? Explain how the fee-for-service practice of medicine led to uncontrolled utilization

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1)What are some of the key differences between traditional indemnity insurance and managed care?

2. What are the three main payment mechanisms managed care uses? In each mechanism, who bears the risk?
3. Explain how the fee-for-service practice of medicine led to uncontrolled utilization.
4. How do MCOs achieve cost efficiencies by integrating the quad functions, risk sharing with providers and care coordination? What are some of the inefficiencies created by managed care?

5. Discuss the concept of utilization monitoring and control.
6. How does case management achieve efficiencies in the delivery of health care? How does case management differ from disease management?
7. Explain how MCOs engage in pharmaceutical management. How does utilization review apply to drug management?
8. Describe the three utilization review methods, giving appropriate examples. Discuss the benefits of each type of utilization review.
9. What is an HMO? How does it differ from a PPO?
10. Briefly explain the four main models for organizing an HMO. Discuss the advantages and disadvantages of each model.
11. What is a point-of-service plan? Why did it grow in popularity? What caused its subsequent decline?
12. What role is managed care expected to play under the Affordably Care Act?
13. To what extent has managed care been successful in containing health care costs?
14. Has the quality of health care gone down as a result of managed care? Explain.
15. What is organizational integration? What is its ultimate aim? Why did health care organizations integrate?

16. What is the difference between a merger and an acquisition? What is the purpose of these organizational consolidations? Give examples.
17. When would a joint venture be considered a preferable integration strategy?
18. What is the main advantage of two organizations forming an alliance?
19. State the main strategic objectives of horizontal and vertical integration.
20. What is antitrust policy? What type of business practices does antitrust law prohibit? How might antitrust policy play out in the formation of accountable care organizations?