Investigate Strengths and Weaknesses of Local Managed Care Systems

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There are different types of managed care plans. Two of the most common types are Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs). Most others are hybrids of the two. The basic functions of governance and control in HMOs, PPOs, and other managed care plans are similar to those in any business except the responsibilities vary greatly from one plan to another.

Managed care programs use several functions to control costs: use of a provider network with discounts, prior approval of procedures, utilization management of treatment guidelines, utilization review, case management, peer review and second opinions, prospective, concurrent, and retrospective audits, and grievance procedures.

Week 2 Assignment: Investigate Strengths and Weaknesses of Local Managed Care Systems

Activity Description

Managed health care is available throughout the United States, either through private or public supported systems.

Begin this assignment by investigating your local managed care systems. You may visit them directly or thoroughly research them.

Then, reflect upon this experience in a paper. Include the following in your report:

  • Provide an overview of objectives of the task and reflect on your experiences.
  • Analyze the managed care systems, including strengths and weaknesses.
  • Based on your experiences, provide recommendations and insights for future application.

Support your paper with a minimum of five scholarly sources within the last five (5) years APA format. In addition to these specified resources, other appropriate scholarly resources, including older articles, may be included.

Length: 5-7 pages, not including title and reference pages

 
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