Preview

Describe The Role Played By Managed Care In Case Management.

Satisfactory Essays
Open Document
Open Document
423 Words
Grammar
Grammar
Plagiarism
Plagiarism
Writing
Writing
Score
Score
Describe The Role Played By Managed Care In Case Management.
Week Three Quiz

Georgiana Jackson

BSHS/402

July 28, 2013
Kelly Germino

1. Compare client-driven goals and provider-given goals.

Client driven goals are goals that the client has made. These goals are address with their thinking in mind without help from a professional if he or she sees if they can follow through. Provider given goals are goals that the professional has made for the client. These goals are address with normal thinking with guidance of the professional. This guidance will keep the client on the right path to achieve the goals.

2. Describe the role played by managed care in case management.

Case management plays varies of roles in managed care. Manage care is a collaborative process that assesses,

You May Also Find These Documents Helpful

  • Powerful Essays

    Cassie Thorne of Mackinaw Administrators Insurance Company referred this file for medical case management. Instructions were given to meet with Timothy Blackmore and assist with coordination of appropriate and related medical care, and identify needs to facilitate recovery.…

    • 666 Words
    • 3 Pages
    Powerful Essays
  • Good Essays

    As a resolution analyst at UnitedHealthcare (UHC), over ninety percent of my decisions are based on evidence provided by providers’ and members’ health policy contract and UHC reimbursement policies. The health policy contract provides payment regulations on how to correctly make a decision of either a claim is to be denied, paid or if additional steps are required. In a case where a member is asserting that an out-of-network provider should be reimbursed in-network based on their research involves investigating beyond the member’s contract and UHC reimbursement policies to justify an overturn. If the member provides proofs such as a copy of the participating provider listing on UHC's website or the provider proper Tax ID to support their…

    • 286 Words
    • 2 Pages
    Good Essays
  • Satisfactory Essays

    I agree with the statement, because CNL is a provider and manage at the point of care to individuals and associates of patients anyplace healthcare is delivered. The main and important features of CNL practice include, responsibility for assessment and enhancement of point-of-care outcomes and also sign to assess and accomplish best results. As a lateral integrator of care, CNLs work across and within the interdisciplinary and extraprofessional limits to present evidence-based practice, evaluate clinical interventions, and work in their role as co-coordinator of care.…

    • 85 Words
    • 1 Page
    Satisfactory Essays
  • Good Essays

    The local case management ought to as well improve the understanding of subjects along with pressure points to reassure the shared inventiveness to increase efficiency as well as effectiveness in case management of numerous groups. The cooperative working groups on certain matters of significance furthermore assist in improving communications, nurturing a sense of ownership as well as responsibility and building relations through zones in the systems. Therefore, when the case management systems are changed in support of cooperative working groups, there is a guarantee of objectivity in all special…

    • 868 Words
    • 4 Pages
    Good Essays
  • Satisfactory Essays

    Managed Care Case Study

    • 167 Words
    • 1 Page

    Managed care contributes a vast amount to the healthcare system. Without managed care systems I don’t think health facility, insurances agencies and companies would manage. Agree, professionals are to adapt and accommodate changes based on contracts between managed care systems and other agencies. In my opinion, the technology advancement within the health care system has improved tremendously in a positive way. For example; when I switched my daughter primary doctor around shot time, me being old fashion handed her the paper shot record. She replied “ma’am it already imported into the system; we don’t use the paper anymore.” This is totally a successful and less stressful outcome on a person if it was to get lost or misplaced. These…

    • 167 Words
    • 1 Page
    Satisfactory Essays
  • Good Essays

    One of the biggest hesitations would have to be cost to build an implement such a system. The technique depends on an organization having "clean" data to analyze, which requires data being scrubbed and moved to data warehouses. Many payers lack the money and manpower to build and maintain these warehouses. (Kongstvedt, P., Capagemini). In addition, internal politics and the numerous constituencies within a managed care organization can make it difficult to focus data mining efforts, says Scott Kozicki.…

    • 447 Words
    • 2 Pages
    Good Essays
  • Good Essays

    A clinical case management nurse coordinates nursing care, which includes patient assessment, education, counseling and treatment. It also involves the delegation of appropriate tasks to other health care team members. These case management nurses are usually members of interprofessional collaborative practice clinic teams. They maintain standards for professional nursing practices in clinical setting by properly assessing and implementing nursing care.…

    • 541 Words
    • 3 Pages
    Good Essays
  • Better Essays

    All Americans regardless of their economic standing in the community deserve access to essential and quality preventative, and primary healthcare. Those Americans who currently fall under the “publicly insured” category (Medicaid), and the medically uninsured, are at similar risk for delayed or non-existent required medical care. Establishing a free, 24 hour accessible Shelby County Primary Care Clinic would eliminate patient medical care delay, and result in large scale overall savings in projected annual medical care costs. (So You Want to Start a Health Center?, 2011)…

    • 854 Words
    • 4 Pages
    Better Essays
  • Good Essays

    Managed Care Case Study

    • 792 Words
    • 4 Pages

    For the past several years, the health care and insurance industries in America have been undergoing significant reform in order to rein in the high cost of delivering health care services. Managed care has become a cornerstone of this process (Strickland, 1995). The case management industry (with its focus on cost containment, managed competition, and quality care) is playing an increasingly important role in the managed care environment (Owens, 1996). According to Mullahy (1995a), the number of case managers has risen astronomically in recent years. These individuals come from diverse professional backgrounds and practice settings that include nursing, rehabilitation counseling, and social work.…

    • 792 Words
    • 4 Pages
    Good Essays
  • Satisfactory Essays

    From these chapter I have gain the knowledge of know, the delivery of health traditionally evolved around the individual relationship between the provider and patient/consumer. The payment was either provided by a health insurance company or paid out of pocket by the consumer. This fee-for-service system or indemnity plan increased the cost of healthcare because there were no controls on how much to charge for the providers service. As healthcare costs continued to spiral out of control throughout the decades, more experiments with contract practice and prepaid service occurred randomly across the U.S. healthcare system (Shi & Singh, 2008)…

    • 290 Words
    • 2 Pages
    Satisfactory Essays
  • Good Essays

    Case management

    • 923 Words
    • 4 Pages

    Case management has become the standard method of managing health care delivery systems today. In recent decades, case management has become widespread throughout healthcare areas, professionals, and models in the United States; and it has been extended to a wide range of clients (Park &ump; Huber, 2009). The primary goal of case management is to deliver quality care to patients in the most cost effective approach by managing human and material resources. The focus of this paper is on the concept of case management and how it developed historically, the definition of case management, the components of case management, and how it relates to other nursing care delivery models.…

    • 923 Words
    • 4 Pages
    Good Essays
  • Good Essays

    Introduction: According to Terence Shea in an article published by HR Magazine (2005), in the last fifty years, employers' health cost have soared as coverage has expanded and medical care has been revolutionized. Since the early 1980s, there have been a number of governmental and corporate attempts to slow this dramatic rise in health care expenditures. Most health plans in the U.S. today involve some form of managed care. Nearly 90 percent of Americans with health insurance are covered by HMOs and other managed-care plans. The reason for the shift from the traditional to managed care plans was to hold down healthcare costs. As HMOs grew physicians in private or small group practices have become…

    • 821 Words
    • 4 Pages
    Good Essays
  • Better Essays

    “Managed care embodies an effort by employers, the insurance industry, and some elements of the medical profession to establish priorities and decide who gets what from the health care system.” (JAMA.2001; pg. 285:2622-2628). Manage Care is part of the Health Care system since 1973 is known as the system that finances and delivers health care to individuals enrolled under their plans. Manage care is intended to reduce the unnecessary health care cost in America through a variety of mechanism that includes medical necessity review programs, economic incentives for physicians, beneficiary cost sharing, control of patients lengths of stay just to name a few. The regulations and stipulations for cost control have made it very difficult for some individuals to get the care they need. Manage is established as a for profit establishment that has a bigger interest in saving cost and making profits than providing quality healthcare.…

    • 1151 Words
    • 5 Pages
    Better Essays
  • Good Essays

    Your discussion mentions that a risk of managed care to the payer is that physicians are paid a fixed amount for services on a monthly basis regardless of how much service is used. This risk is with hopes that physician will utilize the minimal amount of service ultimately decreasing health care costs. Physicians who participate in managed care plans also experience potential risk. In managed care plans, physicians can jeopardize relationships with patients (Chan Hong Kit, Abul Rasid, & Md Husin, 2016). Managed care has impacted the way that physicians and patients interact. Doctors are held more accountable with value-based requirements, and patients are engaging more in their healthcare decisions.…

    • 468 Words
    • 2 Pages
    Good Essays
  • Best Essays

    Graded Unit

    • 2060 Words
    • 9 Pages

    |Each service user in the organisation has his key worker, who creates an individual care plan based on assessments and taking into |…

    • 2060 Words
    • 9 Pages
    Best Essays