HSA 4109 Nursing Managed Care Plan Essay

HSA 4109 Nursing Managed Care Plan Essay

Instructions/Descriptions

HSA 4109 Nursing Managed Care Plan Essay

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Using the Managed Care Answer Guide, pgs. 17-23, Analyze and Evaluate your managed care plan* either through your private/government insurance or from the health care exchange (Obamacare) using the nine criteria (pg.17).  Based upon your evaluation, does your health plan meets your needs? Why or why not?

Disease Management Discussion

I don’t understand this Writing question and need help to study.

1:

A definite trend in US managed care is the move to Disease Management (DM) for patients with chronic diseases and long-term conditions. What exactly is Disease Management? Provide some examples of diseases which may benefit well from a DM model of care.

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2:

What is the difference between production and operations?

What are the primary resources used in the production process?

HSA 4109 Evaluating Concepts of Cost sharing

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Read the Reed et al. (2009) article, High Deductible Health Insurance Plans: Efforts to Sharpen a Blunt Instrument.

https://www.healthaffairs.org/doi/full/10.1377/hlthaff.28.4.1145

Evaluate the concept of cost-sharing, and what is known and what is not known by consumers with a high-deductible health insurance plan. Does the knowledge of having a HDHP change consumer behavior responses to cost-sharing?

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Writing Dashboard Information in Communication with Organization Leaders Paper

In many healthcare organizations, an interactive tool is usually incorporated to provide information that is captured electronically. These dashboards provide real-time data that help clinical and non-clinical managers to make informed decisions about patient care. Prior to beginning this discussion, review the Dashboards for Your Board: Communicating Data Effectively and Efficiently, Two Keys to Deliver Better Care and Measure: Pod Implementation & Dashboards, Utilizing Big Data to Provide Better Health at Lower Cost, and Intelligent and Actionable Dashboards articles. Additionally, review the following Saint Martin’s Clinic (Links to an external site.) sample dash board and research a few more financial healthcare dashboards.

As a healthcare manager, you are required to evaluate length of stay, volume or census, and payer mix, etc. to assess how well you are meeting the department goals. The dashboard examples provide snapshots of those components for managers to use for daily decision-making purposes. Explain to the Vice President of Operations via email two challenges to, as well as two opportunities to meet, the department’s goals based on one of the scenarios you select below.

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You are an inpatient service line director and your dashboard consists of Average Length of Stay (ALOS), re-admission rates, accounts receivable, timely submission of claims, pending charges waiting for the provider to hit the submit button, and credentialing updates on providers and managed care companies. Your goal is to keep length of stay low, decrease re-admissions, ensure claims are paid timely and providers understand the relevance of timely submittal of charges.

You are the practice administrator of a multi-specialty practice and your dashboard consists of patient cancellation appointments, no-show appointments, patients that arrived for appointments, pending referrals, completed referrals, daily claims submittal, and denial report. Your goal is to ensure patients are consistently coming in to be seen, reminding them of their appointments, verifying patient’s referrals are being used, and decrease claims being denied for payment.

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You are a hospice director and your dashboard consists of visit status (documentation of patients seen daily), claims on hold, intake list, discharged checklist, productivity, task list (what is due-recertification to continue visits, supervisor visits, and document tracking (orders missing). Your goal is to ensure patients are being seen daily by clinical staff, evaluate why claims are on hold, ensure more patients are being added than discharged weekly, and delegate assignments equally to staff.

HSA 4109 Nursing Managed Care Plan Essay

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