Answer two of the following (500 words) What are some of the key differences be
Answer two of the following (500 words) What are some of the key differences between traditional indemnity insurance and managed care? What are the three main payment mechanisms used in managed care? With each mechanism, who bears the risk? Explain how the fee-for-service practice of medicine led to uncontrolled utilization. How do MCOs achieve cost-efficiencies by integrating the quad functions, risk sharing with providers, and care coordination? What are some of the inefficiencies created by managed care? Discuss the concept of utilization monitoring and control. How does case management achieve efficiencies in the delivery of health care? How does case management differ from disease management? Explain how MCOs engage in pharmaceutical management. How does utilization review apply to drug management? Describe the three utilization review methods, giving appropriate examples. Discuss the benefits of each type of utilization review. What is an HMO? How does it differ from a PPO? Briefly explain the four main models for organizing an HMO. Discuss the advantages and disadvantages of each model. What is a point-of-service plan? Why did it initially grow in popularity? What caused its subsequent decline? To what extent has managed care been successful in containing health care costs? Has the quality of health care declined as a result of managed care? Explain. What is organizational integration? What is its ultimate aim? Why did health care organizations integrate? What is the difference between a merger and an acquisition? What is the purpose of these organizational consolidations? Give examples. What is an accountable care organization (ACO)? Describe its current status in U.S. health care delivery. Answer two of the following (500 words) Long-term care services must be individualized, integrated, and coordinated. Elaborate on this statement, pointing out why these elements are essential in the delivery of LTC. What are some of the challenges in the delivery of mental health services for the elderly? What are the main goals of ­community-based and institution-based LTC services? What is respite care? Why is it needed? Briefly discuss the brokerage model of case management and the PACE program. What is meant by the continuum of institutional long-term care? Discuss the clinical services delivered by residential/personal care facilities, assisted living facilities, and skilled nursing facilities. What is the difference between licensure and certification? What are the two types of certifications? What purpose does each serve from (a) a clinical standpoint and (b) a financial standpoint? Discuss the main issues with private long-term care insurance. Briefly explain the Long-Term Care Insurance Partnership Program..

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