cme tests / vocabulary / models / employers / mcos & insurers / providers / patients & consumers / telehealth / medical groups / unions / considerations / resources / current events

Class Description:

PERSPECTIVES REGARDING SYSTEMS-BASED CARE:  (1) CONSUMERS; (2) PATIENTS; (3) PROVIDERS; (4) PAYORS (SUCH AS GOVERNMENTAL PROGRAMS AND EMPLOYER GROUPS; (5) HEALTH PLANS SUCH AS MANAGED CARE ORGANIZATIONS AND INSURERS; AND (6) LAWS & PUBLIC POLICIES ENCOMPASSING ANY AND ALL OF THE ABOVE PERSPECTIVES

This class explores the systems-based care organization and employer perspective regarding systems-based care. It is important to understand the employer perspective because it was the employer who typically bought or offered the health insurance benefits to its employees and their dependents. The MCO’s set the guidelines for all of the other things covered in the previous chapters. This class will examine four different modes for paying for U.S. health care, employer perspective, and three stages of managed care.

Topics:   

PERSPECTIVES:     (1) EMPLOYER GROUPS; (2) MANAGED CARE ORGANIZATIONS/ INSURERS; (3) PROVIDERS; AND (4) PATIENTS/CONSUMERS PERSPECTIVES REGARDING MANAGED CARE

  • IV.  PROVIDER’S PERSPECTIVE
    • A.    TELEMEDICINE
    • B.    UNIONS
    • C.    PATIENT RELATIONSHIPS
    • D.    MEDICAL MALPRACTICE ISSUES
    • E.    NEED FOR FLEXIBLE BEDS FOR AGING “BABY BOOMERS”
    • F.    AUDITING MANAGED CARE CONTRACTS AND RELATIONSHIPS

Key Objectives:

  1. Distinguish various basic modes for paying for health care.
  2. Examine systems-based practice from an employer’s perspective.
  3. Examine systems-based practice from perspective of insurers or managed care organizations (such as HMOs or PPOs) creating/offering health insurance benefits.

Review:

  1. List four basic modes of paying for health care and list one disadvantage created by each such financing mode.
  2. List three major factors large company employers will look at in selecting which providers they will contract with to render care to their employees.
  3. Analyze the status of systems-based practice in the United States. Also, describe the evolution of pricing policies as it applies to physicians, hospitals, and employer groups.