Current Trends and Issues in Managed Care

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Compensation and reimbursement models are another method of controlling access, cost, and quality in a managed care environment. An MCO doesn’t have direct control over physicians or hospitals but through contractual agreements that set incentives for meeting agreed-upon standards, it can exert influence.

This week, you are required to write an essay on the following topics:

  • Managed care hospital reimbursement
  • Managed care provider reimbursement

Using the South University Online library (e.g. CINAHL) or the Internet, review at least two articles for each topic and write a review for each source of information. Use the following guidelines for developing your essay:

  • Write a summary for each topic tying together the information learned about that topic.
  • Analyze the market forces that would favor using one reimbursement method over another.
  • Evaluate the key differences between different types of payment methodologies from the provider and hospital point of view.
  • Evaluate the advantages and disadvantages of the payment methodologies reviewed from the provider and hospital point of view.
  • Evaluate new payment methodologies resulting from the Patient Protection and Affordable Care Act (PPACA) and discuss future changes in reimbursement methodologies.
  • Compare and contrast each article to the information discussed in the course textbook.

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