cme tests / vocabulary / common language / costs / PPOs / HMOs / standards of care / risk management / business side / history of medicare / social determinants of health / resources / current events

Class Description:

ELEMENTS OF SYSTEMS BASED PRACTICE: HOW HEALTH CARE IS MANAGED

This class will examine how health care is managed by insurance entities and managed care organizations. It will give an overview of various components and parameters used by the managed care industry and examine how different methods of compensation affect providers. Also, this class will identify certain business aspects for providers to consider in their medical practice.

Topics:   

ELEMENTS OF SYSTEMS BASED PRACTICE: HOW HEALTH CARE IS MANAGED

I. COMMON LANGUAGE OF SERVICES PROVIDED

II. COMMON AND COMPARABLE COSTS PER TYPE OF SERVICES PROVIDED

III. PREFERRED PROVIDER ORGANIZATIONS

IV. HEALTH MAINTENANCE ORGANIZATIONS

V. COMMON STANDARDS OF CARE

VI. RISK MANAGEMENT

VII. BUSINESS ASPECTS OF MEDICAL PRACTICE

Key Objectives:

  1. Examine concepts underlying systems-based practice.
  2. Synthesize how systems-based practice payment mechanism effects providers.
  3. Identify business aspects of practice and cost-effective, appropriate, quality care.

Review:

  1. Describe systems-based practice components, parameters, and delivery vehicles.
  2. Explain the evolution of the method of provider reimbursement.
  3. Analyze what “risk” means to a provider in systems-based practice. Also, list at least three factors that effect a physician’s financial performance in a systems-based practice contractual arrangement.