Managed Care Models

Managed care’s level of control and relationships with medical service providers has been described on a continuum of control from the least controlled managed care model to the most restrictive as:

Tighter elements of control over health care delivery
More direct interaction with providers
Increased overhead cost and complexity
Greater control of utilization
Increased control on quality

The continuum of managed care models helps to understand the level of control for access, quality, and costs for each model. It is also true that managed care models are influenced by the market they serve. The geographic region impacts the design of managed care models. On the basis of what you learned in your readings of this week and the information provided in this assignment, answer the following questions:

Examine the importance of the continuum in understanding the differences among managed care plans.
Identify an MCO functioning in both your area and in some other parts of the country (for example, BCBS of California and BCBS of Georgia). Compare the organizations relative to the type of managed care products each offers.
Compare and contrast your findings with what you learned in readings this week.
If you were an employer looking for a managed care product for your employees, which of these three: HMO, PPO, or CDHP would you choose and why?

After answering the above questions, read the following information:

There are several key elements required in a physician’s contract with an MCO. A typical contract between an MCO and a physician specifies the types of services offered, the number of members or lives covered in the plan, the standards and credentials needed to be maintained by the provider, and, of course, compensation. Utilize your readings and search the South University Online library or the Internet to answer the following questions:

Explain the key elements of the physician’s contract.
Examine the common clauses and provisions of the physician’s contract.
Explain the contract negotiation and credentialing process.
please cite all sources

Managed Care Models

Managed care’s level of control and relationships with medical service providers has been described on a continuum of control from the least controlled managed care model to the most restrictive as:

Tighter elements of control over health care delivery
More direct interaction with providers
Increased overhead cost and complexity
Greater control of utilization
Increased control on quality

The continuum of managed care models helps to understand the level of control for access, quality, and costs for each model. It is also true that managed care models are influenced by the market they serve. The geographic region impacts the design of managed care models. On the basis of what you learned in your readings of this week and the information provided in this assignment, answer the following questions:

Examine the importance of the continuum in understanding the differences among managed care plans.
Identify an MCO functioning in both your area and in some other parts of the country (for example, BCBS of California and BCBS of Georgia). Compare the organizations relative to the type of managed care products each offers.
Compare and contrast your findings with what you learned in readings this week.
If you were an employer looking for a managed care product for your employees, which of these three: HMO, PPO, or CDHP would you choose and why?

After answering the above questions, read the following information:

There are several key elements required in a physician’s contract with an MCO. A typical contract between an MCO and a physician specifies the types of services offered, the number of members or lives covered in the plan, the standards and credentials needed to be maintained by the provider, and, of course, compensation. Utilize your readings and search the South University Online library or the Internet to answer the following questions:

Explain the key elements of the physician’s contract.
Examine the common clauses and provisions of the physician’s contract.
Explain the contract negotiation and credentialing process.
please cite all sources

Health
Buy Cheap Essays, Nursing health

Details:

In this assignment, you will be writing a 1,000-1,250-word essay describing the differing approaches of nursing leaders and managers to issues in practice. To complete this assignment, do the following:

Select an issue from the following list: nursing shortage and nurse turn-over, nurse staffing ratios, unit closures and restructuring, use of contract employees (i.e., registry and travel nurses), continuous quality improvement and patient satisfaction, and magnet designation.
Compare and contrast how you would expect nursing leaders and managers to approach your selected issue. Support your rationale by using the theories, principles, skills, and roles of the leader versus manager described in your readings.
Identify the approach that best fits your personal and professional philosophy of nursing and explain why the approach is suited to your personal leadership style.
Use at least two references other than your text and those provided in the course.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment.

You are required to submit this assignment to Turnitin. Refer to the directions in the Student Success Center. Only Word documents can be submitted to Turnitin.

RUBRIC

Benchmark – Effective Approaches in Leadership and Management
1
Unsatisfactory
0.00% 2
Less than Satisfactory
71.00% 3
Satisfactory
79.00% 4
Good
89.00% 5
Excellent
100.00%
80.0 %Content
40.0 %Compare and contrast how you would expect nursing leaders and managers to approach your selected issue. Support your rationale by using the theories, principles, skills, and roles of the leader versus manager described in your readings. The comparison and contrast of how you would expect nursing leaders and managers to approach your selected issue is not provided. The comparison and contrast of how you would expect nursing leaders and managers to approach your selected issue is provided; however, relevant information is missing, such as not providing support for your rationale by using the theories, principles, skills and roles of the leader versus manager described in your readings, or not providing at least two references beyond your text. The comparison and contrast of how you would expect nursing leaders and managers to approach your selected issue is provided and meets the basic criteria for the assignment as indicated by the assignment instructions. The comparison and contrast of how you would expect nursing leaders and managers to approach your selected issue meets all criteria for the assignment, and is provided in detail. The comparison and contrast of how you would expect nursing leaders and managers to approach your selected issue meets all criteria for the assignment, is provided in detail. Higher level thinking is demonstrated by incorporating prior learning or reflective thought.
40.0 %Identify the approach that best fits your personal and professional philosophy of nursing and explain why the approach is suited to your personal leadership style. The identification of the approach that best fits your personal and professional philosophy of nursing is not provided. The identification of the approach that best fits your personal and professional philosophy of nursing is provided; however, relevant information is missing, such as an explanation to why the approach is suited to your personal leadership style. The identification of the approach that best fits your personal and professional philosophy of nursing is provided and meets the basic criteria for the assignment. The identification of the approach that best fits your personal and professional philosophy of nursing, along with an explanation to why the approach is suited to your personal leadership style, is provided in detail. The identification of the approach that best fits your personal and professional philosophy of nursing meets all criteria for the assignment, and is provided in detail. Higher level thinking is demonstrated by incorporating prior learning or reflective thought.
15.0 %Organization and Effectiveness
5.0 %Thesis Development and Purpose Paper lacks any discernible overall purpose or organizing claim. Thesis and/or main claim are insufficiently developed and/or vague; purpose is not clear. Thesis and/or main claim are apparent and appropriate to purpose. Thesis and/or main claim are clear and forecast the development of the pap. It is descriptive and reflective of the arguments and appropriate to the purpose. Thesis and/or main claim are comprehensive; contained within the thesis is the essence of the paper. Thesis statement makes the purpose of the paper clear.
15.0 %Organization and Effectiveness
5.0 %Paragraph Development and Transitions Paragraphs and transitions consistently lack unity and coherence. No apparent connections between paragraphs are established. Transitions are inappropriate to purpose and scope. Organization is disjointed. Some paragraphs and transitions may lack logical progression of ideas, unity, coherence, and/or cohesiveness. Some degree of organization is evident. Paragraphs are generally competent, but ideas may show some inconsistency in organization and/or in their relationships to each other. A logical progression of ideas between paragraphs is apparent. Paragraphs exhibit a unity, coherence, and cohesiveness. Topic sentences and concluding remarks are appropriate to purpose. There is a sophisticated construction of paragraphs and transitions. Ideas progress and relate to each other. Paragraph and transition construction guide the reader. Paragraph structure is seamless.
15.0 %Organization and Effectiveness
5.0 %Mechanics of Writing (includes spelling, punctuation, grammar, language use) Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice and/or sentence construction are used. Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register); sentence structure, and/or word choice are present. Some mechanical errors or typos are present, but are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used. Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used. Writer is clearly in command of standard, written, academic English.
5.0 %Format
2.0 %Paper Format (use of appropriate style for the major and assignment) Template is not used appropriately or documentation format is rarely followed correctly. Template is used, but some elements are missing or mistaken; lack of control with formatting is apparent. Template is used, and formatting is correct, although some minor errors may be present. Template is fully used; There are virtually no errors in formatting style. All format elements are correct.
3.0 %Research Citations (In-text citations for paraphrasing and direct quotes, and reference page listing and formatting, as appropriate to assignment) No reference page is included. No citations are used. Reference page is present. Citations are inconsistently used. Reference page is included and lists sources used in the paper. Sources are appropriately documented, although some errors may be present. Reference page is present and fully inclusive of all cited sources. Documentation is appropriate and GCU style is usually correct. In-text citations and a reference page are complete. The documentation of cited sources is free of error.
100 %Total Weightage

. Managed Care Models

Managed Care Models

Managed care’s level of control and relationships with medical service providers has been described on a continuum of control from the least controlled managed care model to the most restrictive as:

Tighter elements of control over health care delivery
More direct interaction with providers
Increased overhead cost and complexity
Greater control of utilization
Increased control on quality

The continuum of managed care models helps to understand the level of control for access, quality, and costs for each model. It is also true that managed care models are influenced by the market they serve. The geographic region impacts the design of managed care models. On the basis of what you learned in your readings of this week and the information provided in this assignment, answer the following questions:

Examine the importance of the continuum in understanding the differences among managed care plans.
Identify an MCO functioning in both your area and in some other parts of the country (for example, BCBS of California and BCBS of Georgia). Compare the organizations relative to the type of managed care products each offers.
Compare and contrast your findings with what you learned in readings this week.
If you were an employer looking for a managed care product for your employees, which of these three: HMO, PPO, or CDHP would you choose and why?

After answering the above questions, read the following information:

There are several key elements required in a physician’s contract with an MCO. A typical contract between an MCO and a physician specifies the types of services offered, the number of members or lives covered in the plan, the standards and credentials needed to be maintained by the provider, and, of course, compensation. Utilize your readings and search the South University Online library or the Internet to answer the following questions:

Explain the key elements of the physician’s contract.
Examine the common clauses and provisions of the physician’s contract.
Explain the contract negotiation and credentialing process.
please cite all sources

Health
Buy Cheap Essays, Nursing health

Details:

In this assignment, you will be writing a 1,000-1,250-word essay describing the differing approaches of nursing leaders and managers to issues in practice. To complete this assignment, do the following:

Select an issue from the following list: nursing shortage and nurse turn-over, nurse staffing ratios, unit closures and restructuring, use of contract employees (i.e., registry and travel nurses), continuous quality improvement and patient satisfaction, and magnet designation.
Compare and contrast how you would expect nursing leaders and managers to approach your selected issue. Support your rationale by using the theories, principles, skills, and roles of the leader versus manager described in your readings.
Identify the approach that best fits your personal and professional philosophy of nursing and explain why the approach is suited to your personal leadership style.
Use at least two references other than your text and those provided in the course.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment.

You are required to submit this assignment to Turnitin. Refer to the directions in the Student Success Center. Only Word documents can be submitted to Turnitin.

RUBRIC

Benchmark – Effective Approaches in Leadership and Management
1
Unsatisfactory
0.00% 2
Less than Satisfactory
71.00% 3
Satisfactory
79.00% 4
Good
89.00% 5
Excellent
100.00%
80.0 %Content
40.0 %Compare and contrast how you would expect nursing leaders and managers to approach your selected issue. Support your rationale by using the theories, principles, skills, and roles of the leader versus manager described in your readings. The comparison and contrast of how you would expect nursing leaders and managers to approach your selected issue is not provided. The comparison and contrast of how you would expect nursing leaders and managers to approach your selected issue is provided; however, relevant information is missing, such as not providing support for your rationale by using the theories, principles, skills and roles of the leader versus manager described in your readings, or not providing at least two references beyond your text. The comparison and contrast of how you would expect nursing leaders and managers to approach your selected issue is provided and meets the basic criteria for the assignment as indicated by the assignment instructions. The comparison and contrast of how you would expect nursing leaders and managers to approach your selected issue meets all criteria for the assignment, and is provided in detail. The comparison and contrast of how you would expect nursing leaders and managers to approach your selected issue meets all criteria for the assignment, is provided in detail. Higher level thinking is demonstrated by incorporating prior learning or reflective thought.
40.0 %Identify the approach that best fits your personal and professional philosophy of nursing and explain why the approach is suited to your personal leadership style. The identification of the approach that best fits your personal and professional philosophy of nursing is not provided. The identification of the approach that best fits your personal and professional philosophy of nursing is provided; however, relevant information is missing, such as an explanation to why the approach is suited to your personal leadership style. The identification of the approach that best fits your personal and professional philosophy of nursing is provided and meets the basic criteria for the assignment. The identification of the approach that best fits your personal and professional philosophy of nursing, along with an explanation to why the approach is suited to your personal leadership style, is provided in detail. The identification of the approach that best fits your personal and professional philosophy of nursing meets all criteria for the assignment, and is provided in detail. Higher level thinking is demonstrated by incorporating prior learning or reflective thought.
15.0 %Organization and Effectiveness
5.0 %Thesis Development and Purpose Paper lacks any discernible overall purpose or organizing claim. Thesis and/or main claim are insufficiently developed and/or vague; purpose is not clear. Thesis and/or main claim are apparent and appropriate to purpose. Thesis and/or main claim are clear and forecast the development of the pap. It is descriptive and reflective of the arguments and appropriate to the purpose. Thesis and/or main claim are comprehensive; contained within the thesis is the essence of the paper. Thesis statement makes the purpose of the paper clear.
15.0 %Organization and Effectiveness
5.0 %Paragraph Development and Transitions Paragraphs and transitions consistently lack unity and coherence. No apparent connections between paragraphs are established. Transitions are inappropriate to purpose and scope. Organization is disjointed. Some paragraphs and transitions may lack logical progression of ideas, unity, coherence, and/or cohesiveness. Some degree of organization is evident. Paragraphs are generally competent, but ideas may show some inconsistency in organization and/or in their relationships to each other. A logical progression of ideas between paragraphs is apparent. Paragraphs exhibit a unity, coherence, and cohesiveness. Topic sentences and concluding remarks are appropriate to purpose. There is a sophisticated construction of paragraphs and transitions. Ideas progress and relate to each other. Paragraph and transition construction guide the reader. Paragraph structure is seamless.
15.0 %Organization and Effectiveness
5.0 %Mechanics of Writing (includes spelling, punctuation, grammar, language use) Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice and/or sentence construction are used. Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register); sentence structure, and/or word choice are present. Some mechanical errors or typos are present, but are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used. Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used. Writer is clearly in command of standard, written, academic English.
5.0 %Format
2.0 %Paper Format (use of appropriate style for the major and assignment) Template is not used appropriately or documentation format is rarely followed correctly. Template is used, but some elements are missing or mistaken; lack of control with formatting is apparent. Template is used, and formatting is correct, although some minor errors may be present. Template is fully used; There are virtually no errors in formatting style. All format elements are correct.
3.0 %Research Citations (In-text citations for paraphrasing and direct quotes, and reference page listing and formatting, as appropriate to assignment) No reference page is included. No citations are used. Reference page is present. Citations are inconsistently used. Reference page is included and lists sources used in the paper. Sources are appropriately documented, although some errors may be present. Reference page is present and fully inclusive of all cited sources. Documentation is appropriate and GCU style is usually correct. In-text citations and a reference page are complete. The documentation of cited sources is free of error.
100 %Total Weightage

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