Cost-Control Measures of Managed Care Organizations {MEGS}
Cost-Control Measures of Managed Care Organizations {MEGS} a. Name and briefly describe the 2 primary measures MCfls manage costs b. Focusing on utilization reviev’.r i. What is it? ii. In your own words, describe each type of utilization review and provide an example 2. Insurance and Reimbursement Three types of reimbursement: retrospective reimbursement, prospective reimbursement, and prospective payment system. a. Explain each type i. Include which major type of insurance {indemnity or managed care} it supports ii. 1|Which type of reimbursement focuses on revenue generation? Cost saving? Briefly explain b. Chronologically, how did these reimbursement types evolve [which came first, second, and third) i. What is the significance of DRGs {diagnostic-related groups) in this evolution? c. Name and briefly describe 2 other ‘group’ types that followed the DRG model 3. Epidemiology and the lil Essential Public Health Activities a. Using the epidemiological triangle, explain how CDVID 19 was transmitted through the population b. Describe how CDVID 19 was managed in the US. using the II] essential public health activities cited in the text. 4. Managed Care a. In your own words, describe the 4 models of managed care discussed b. State how providers are compensated for each model
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