Week 2 There are several key elements required in a health care provider's contract with a managed ...
Week 2 There are several key elements required in a health care provider's contract with a managed care organization (MCO). A typical contract between an MCO and a physician contains definitions, terms, obligations, and other features of payer-provider agreements. Terms and clauses are not expected to be changed, while payment terms that can be renegotiated should be placed in appendices. For this assignment, you are taking on the role of a provider relations manager at Allianta insurance company. You have an appointment with the practice administrator and physician leader at Ashford Medical Group (AMG), which is a multispecialty practice with 10 health care providers. Currently, AMG is not a participating provider at Allianta. The goal of this appointment is to recruit AMG to be an in-the-network provider at Allianta. For this assignment, you must prepare a thorough PowerPoint presentation and record a screencast video of your PowerPoint presentation. You must use the Provider contracts presentation powerpoint template. Compose a transcript for your presentation in the Speaker Notes area Part 1: PowerPoint Presentation The PowerPoint presentation must include the following: Identify the justifications for health care providers to contract with Allianta. Note: Reference Table 3.1 - Payer and Provider Reasons for Contracting in your textbook for information regarding the benefits of being an in-the-network provider. Discuss the credentialing process. Examine two important common clauses in the contract: no balance billing and nondiscrimination. Analyze the importance of provider contracts in maintaining a provider network. Explain network adequacy and its significance to health plan members. The Provider Contracts Presentation video must be five to seven minutes in length and share your 10- to 12-slide PowerPoint presentation. The PowerPoint presentation must include a separate title slide with the following in title case: title of project in bold font Space should appear between the title and the rest of the information on the title page. student’s name name of institution (The University of Arizona Global Campus) course name and number instructor’s name due date must include introduction and conclusion slides. must use at least three scholarly, peer-reviewed, or credible sources published in the last 5 years must include a separate references slide that is formatted according to APA Style Week 3 This assignment is designed to get you started on your research and development of the final paper. Go to Week 6, and review the requirements for your Managed Health Care Delivery Models final paper. For the final paper, you are to choose a managed health care delivery model, an accountable care organization, or a patient-centered medical home. For this assignment, you will write a two-page detailed outline that addresses the first three requirements of your final paper. For your Final Paper Prep, develop an outline that addresses the following: Discuss the origin and structure of your selected managed health care delivery model. Describe how your selected model strives to contain the costs or improve the quality of care. Summarize health care providers’ contracts and payment methods in your selected model. The Final Paper Prep must be two to three double-spaced pages in length (not including title and references page and formatted according to APA style. must include a separate title page with the following in title case: title of paper in bold font Space should appear between the title and the rest of the information on the title page. student’s name name of institution (The University of Arizona Global Campus) course name and number instructor’s name due date must use at least three scholarly sources published in the last 5 years in addition to the course text. must include a separate references page that is formatted according to APA Style as outlined in the Writing Center. Week 5 The Patient Protection and Affordable Care Act (PPACA) was signed into law by President Obama in 2010. The law is expected to significantly increase access to Medicaid for uninsured, low-income families and individuals. Medicaid managed care plans have been implemented by most states, mainly because of rising costs, plan quality, access to providers, and the decrease in state revenues. For your Medicaid Managed Care Plans assignment, you must complete a two- to four-page paper. In your paper, Describe the role of Medicaid managed care plans in the health care delivery system. Analyze the challenges Medicaid managed care plans face in terms of access to care, quality of care, and cost of care. Formulate at least one recommendation to overcome the challenge(s) that you identified. The Medicaid Managed Care Plans paper must be two to four double-spaced pages in length (not including title and references page) and formatted according to APA style. must include a separate title page with the following in title case: title of paper in bold font Space should appear between the title and the rest of the information on the title page. student’s name name of institution (The University of Arizona Global Campus) course name and number instructor’s name due date must utilize academic voice. must include an introduction and conclusion paragraph. Your introduction paragraph needs to end with a clear thesis statement that indicates the purpose of your paper. must use at least two scholarly or peer-reviewed sources published in the last 5 years in addition to the course text. must include a separate references page that is formatted according to APA Style as outlined in the Writing Center. Week 6 The Patient Protection and Affordable Care Act (PPACA) of 2010 brought many changes to the types of provider organizations available. Accountable care organizations (ACOs) and patient-centered medical homes (PCMHs) are two organizations formed under the PPACA. Both ACOs and PCMHs are models that are established to promote coordinated high-quality care at lower costs and improve patient outcomes. You must select either ACOs or PCMHs for this final paper. For your Managed Health Care Delivery Models final paper, you must complete an eight- to 12-page paper. In your paper, Discuss the origin and structure of your selected managed health care delivery model. Describe how your selected model has striven to contain the costs or improve the quality of care. Summarize health care providers’ contracts and payment methods in your selected model. Assess the impacts of your selected model on either Medicare or Medicaid. Examine one specific public policy or regulation (e.g., PPACA) in relation to your selected model. Evaluate the challenges or opportunities facing payers and providers in your selected model. Create a plan of action to overcome identified challenges or take advantage of identified opportunities in the context of access, quality, and cost. The Managed Health Care Delivery Models final paper, must be eight to 12 double-spaced pages in length (not including title and references pages and formatted according to APA Style. must include a separate title page with the following in title case: title of paper in bold font Space should appear between the title and the rest of the information on the title page. student’s name name of institution (The University of Arizona Global Campus) course name and number instructor’s name due date must utilize academic voice. must include an introduction and conclusion paragraph. Your introduction paragraph needs to end with a clear thesis statement that indicates the purpose of your paper. must use at least two scholarly or peer-reviewed sources published in the last 5 years in addition to the course text. must include a separate references page that is formatted according to APA Style as outlined in the Writing Center.
