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Managed Care

Managed care has had a profound impact on the way healthcare is delivered and paid for in the U.S. Healing Hands Hospital is significantly impacted by managed care. The operation decisions that Healing Hands Hospital makes must take the managed care reimbursement issues into consideration. Mr. Woods has asked you to help provide some training to the members of the PR committee to help them understand key managed care terms so they can include them in their campaign of community education.

Identify eight managed care contracting terms and write a brief definition of each term. Remember to site all sources and be sure to write each definition using your own words. I need references. Thank you.

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1. Identify eight managed care contracting terms and write a brief definition of each term. Remember to site all sources and be sure to write each definition using your own words.

I located an excellent glossary of managed care contracting terms from a-z (click http://www.pohly.com/terms.html for other terms to consider). The following terms and descriptions are from this website. Because the scenario mentioned reimbursement issues, I choose concepts that reflected methods and systems of reimbursements, or clauses referring to charges and reimbursement limitations. However, the glossary is comprehensive, so perhaps you want to include others as well.

Let's take a closer look.

1. All-Payer System is a system where prices for health services and payment methods are the same, regardless of who is paying. For example, in an all-payer system, federal or state government, a private insurer, a self-insured employer plan, an individual, or any other payer could pay the same rates. Thus, the uniform fee bars health care providers from shifting costs from one payer to another.

2. Fee-For-Service (FFS) is a traditional method of payment for health care services where specific payment is made for specific services rendered. Usually people speak of this in contrast to capitation, DRG or per diem discounted rates, none of which are similar to the traditional fee for service method of reimbursement. Under a fee-for-service payment system, expenditures increase if the fees themselves increase, if more units of service are provided, or if more expensive services are substituted for less expensive ones. This system contrasts with salary, per capita, ...

Solution Summary

This solution identifies ten managed care contracting terms and writes a brief definition of each term.

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