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HE210 Exam 2 Questions And 100% Correct Answers
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HE210 Exam 2 Questions And 100% CorrectAnswers
managed care
A way of delivering health care services to members who are enrolled (prepaid)
*Focused on: Efficient use of resources and Controlling utilization and costs of care
top 3 causes of death in Canada
1. Ischemic heart disease
2. lung cancer
3. stroke
HMO (Health Maintenance Organization)
- most restrictive but cheaper
- patients MUST have pcp
- all services provided within HMO
PPO (Preferred Provider Organization)
- contracts with certain providers which are the "preferred" ones
- more flexibility with choice, can go to provider out of network but will pay more, most
popular
vertical integration (expansion strategy)
offers care across diverse providers and geographic locations
, +Don’t have to move around as much- certain companies have different specialities
horizontal integration (expansion strategy)
expanding control over certain types of similar services within geographic region (ex:
chains of nursing homes)
capitation (sharing risk)
upfront fees paid to provider to care for enrolled members
discounted fees (sharing risk)
fee schedules and/or contracted arrangements
salaries (sharing risk)
for healthcare providers who are direct employees of the managed care company
- Physicians/primary care providers may receive bonuses if cost goals are met
- Financial risk is shared between the PCP and the MCO
Controlling Utilization and costs of managed care organizations
LTC settings
- home health
- adult day care
- seniors centers
who pays for LTC?
NOT insurance!
- Medicaid- "spend down" and get rid of assets
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