Before starting this assignment, please view these short videos:

Before starting this assignment, please view these short videos:

6 Dimensions of Healthcare Quality
https://www.youtube.com/watch?v=QexTk38euzY

Thompson, B. & Robbins, A. (n.d.) Understanding managed care. Washington State DSHS. Retrieved from: https://www.dshs.wa.gov/sites/default/files/BHSIA/dbh/Integration/Webinar%20Understanding%20Managed%20Care.pdf

Case Assignment

Managed Care. Here we will have you consider challenges existing for insured consumers. Your goal is to identify indicators of quality from consumer and administrative bodies.

You are the hospital administrator and members of the board are calling upon you to explain what is going on in your facility with reference to managed care. Some members of the board are not pleased with the budget, patient satisfaction, and rumors that quality care is not being given due to negative surveys they have read. You need to show the board answers in a slide presentation.

For this assignment, you are to submit a PowerPoint and answer the following. Submit at least 20 slides (not counting the cover slide and reference slide), and include speaker's notes for your slides.

  1. Why patients are having difficulty accessing care (issues of access and referral to be included).
  2. What your facility is doing to assure that quality care is being given.
  3. In at least two slides, show how managed care is affecting your budget for the hospital.
  4. In at least two slides, show how quality is determined from a patient perspective and administrative body.
  5. What is your facility doing to bring these patient surveys into a better light?
  6. Present slides that show at least four to five recommendations for improvement of the managed care system

Assignment Expectations

  1. Support your assignment with peer-reviewed articles, with at least 3-4 references. Use the following link for additional information on how to recognize peer-reviewed journals: http://www.angelo.edu/services/library/handouts/peerrev.php.
  2. You may use the following source to assist in formatting your assignment: https://owl.english.purdue.edu/owl/resource/560/01/.
  3. For additional information on reliability of web sources, review the following document: https://www.edb.utexas.edu/petrosino/Legacy_Cycle/mf_jm/Challenge%201/website%20reliable.pdf.
  4. LENGTH: At least 20 slides (excluding cover slide and reference slide).

REQUIRED READINGS: 

Blumenthal, D., Chernof, B., Fulmer, T., Lumpkin, J., & Selberg, J. (2016). Caring for high-need, high-cost patients—an urgent priority. New England Journal of Medicine, 375(10), 909-911.

Bridger, C. M., Smith, S. E., & Saunders, S. T. (2017). Saving lives and saving money: The role of North Carolina health departments in Medicaid managed care. North Carolina Medical Journal, 78(1), 55-57.

Cleverley, W. O., & Cleverley, J. O. (2017). Essentials of health care finance. Jones & Bartlett Learning.

Hines, A. L., Raetzman, S. O., Barrett, M. L., Moy, E., & Andrews, R. M. (2017). Managed care and inpatient mortality in adults: Effect of primary payer. BMC Health Services Research, 17 doi:10.1186/s12913-017-2062-1

Keast, S. L., Skrepnek, G., & Nesser, N. (2016). State Medicaid programs bring managed care tenets to fee for service. Journal of Managed Care & Specialty Pharmacy, 22(2), 145-148.

Mahmoudi, E., Tarraf, W., Maroukis, B. L., & Levy, H. G. (2016). Does Medicare managed care reduce racial/ethnic disparities in diabetes preventive care and healthcare expenditures? The American Journal of Managed Care, 22(10), E360.

McGinnis, T., Houston, R. & Brown, D. (2013) The balancing act: Integrating Medicaid accountable care organizations into a managed care environment. Center for Health Care Strategies: Issue Brief. Retrieved from: https://www.chcs.org/media/ACO111313_Final.pdf

Richard, D. (2017). What is next for behavioral health in managed care? North Carolina Medical Journal,78(1), 30-32. doi:10.18043/ncm.78.1.30.

Schafer, J., Galante, D., & Shafrin, J. (2017). Value tools in managed care decision making: Current hurdles and future opportunities. Journal of Managed Care & Specialty Pharmacy.

Thompson, B. & Robbins, A. (n.d.) Understanding managed care. Washington State DSHS. Retrieved from: https://www.dshs.wa.gov/sites/default/files/BHSIA/dbh/Integration/Webinar%20Understanding%20Managed%20Care.pdf

Uriarte, J. (2015, August 10). 6 Dimensions of Healthcare Quality [Video file]. Retrieved from https://www.youtube.com/watch?v=QexTk38euzY

Walters, T., Parcher, B., Kravetz, A., Campbell, C., Shah, M., & Hale, T. (2016). Appraising the value of digital health technologies from the managed care perspective: Insights for evidence assessment and reimbursement in the United States. Journal of Medical Internet Research, 18(12).

Wang, Tze-Fang; Shi, Leiyu; Nie, Xiaoyu; Zhu, Jinsheng. (2013). Race/ethnicity, insurance, income and access to care: The influence of health status. International Journal for Equity in Health, 12(1), p.29