Question

In your own words, provide a 100-word discussion of each of the following eight topics. Each mini-essay earns from zero to three points. Points earned are based on a writing skills rubric. The maximum points available for this assignment is 24 points.

Topic #1: Compare and contrast managed care and case management.

Topic #2: Discuss four milestones in the history and evolution of case management systems.

Topic #3: Compare and contrast acute care case management vs. palliative care case management.

Topic #4: Discuss the role of the case manager in the areas of management and leadership.

Topic #5: Discuss the role of the case manager in the areas of provision of case management services and outcomes evaluation.

Topic #6: Discuss the case manager's utilization of negotiating skills. Provide an example of such a negotiation.

Topic #7: Discuss the history of Medicare and compare and contrast Medicare Part A vs. Medicare Part B.

Topic #8: Discuss the history of Medicaid and describe the categories of Medicaid eligibility. What is the primary function of Medicaid?

Answer 1

1.Managed care is any method of organizing health care providers to achieve the dual goals of controlling health care costs and managing quality of care.Under managed care, states sign contracts with "managed care organizations," or MCOs, that provide medical services through their own networks of doctors and hospitals. The state pays the MCO a fixed annual fee for each Medicaid patient. And the MCO takes responsibility for overseeing each person's care

Case management focuses on rehabilitation and recovery as a whole, bringing all the aspects together to create one successful journey.It is a process by which a patient's condition is assessed and options are discussed with the appropriate doctors and nurses to ensure the most timely, safe, and cost-effective care. A case managerenables not only patient satisfaction, but also reductions in patient length of stay and healthcarecosts.

2.case management mile stones

1. 20s & 30s - Polio treatment centers, first coordinated systems of care
2. 30s & 40s - Antibiotics developed
3. Post WWII, 1946 - physiatry was born & rehabilitation nurses functioned as case managers
4. 54 - Rehabilitation act of 54, established funds for universities to train VR (Virtual Reality)

3.In acute care case management, one of the most important factors in improving patient outcomes is what happens after the acute care setting. Specifically, the quality of post-acute care transitions can either increase the chances of a successful recovery, or make readmission and longer length of stay (LOS) more likely.

Case management in palliative care should aim at maintaining continuity of care to ensure that patients and those close to them experience palliative care as personalised, coherent and consistent. There is a high level of agreement about the underlying dimensions of continuity of care

4& 5)Providing care team management, leadership and coordination
- Coordinating patient care within or throughout continuums of care
- Providing assessments of patients, including clinical and psychosocial
- Works with the entire health care team to achieve the goals and expected outcomes for patients
- Oversees the patients' plans of care while the patient is receiving care
- Provides frequent reassessments and evaluations of patient care received
- Collaborates and facilitates needed changes to the overall plan of care

Educates members of the health care team on issues related to costs and cost containments, as well as the benefits plans for patients
- Participates in studies and research related to patient outcomes as well as studies that support evidence based practices in health care
- Oversees that unnecessary health care costs and over utilization are avoided
- Contributes to the ongoing evolution of the role as the external health care environment transforms
- Ensures the ethical and legal issues related to patient care delivery are addressed and that care is provided appropriately
- Works closely with or within managed care organizations

Assists and advises the organization in the development of policies and procedures that will guide safe and effective quality of care outcomes
- Coordinates the movement of patients from one continuum of care to another
- Participates in discharge planning for patients
- Participates on quality of care reviews within the organization and with outside agencies
- Coordinates the patients ongoing care in conjunction with outside agencies as needed
- Participates on quality of care committees and is an active participant in the development of quality care initiatives

6.Negotiation is a method by which people settle differences. It is a process by which compromise or agreement is reached while avoiding argument and dispute. Case Managers use Negotiation To:

• Work with patients and care providers to develop a realistic plan of care
• Obtain approval for needed services
• Control cost
• Obtain benefits outside of the benefit contract
• Determine length of stay

Good interpersonal skills are essential for effective negotiations, both in formal situations and in less formal or one-to-one negotiations.For example;Effective verbal comm

7.History of Medicare:On July 30, 1965, President Lyndon B. Johnson signed into law legislation that established the Medicare and Medicaid programs. For 50 years, these programs have been protecting the health and well-being of millions of American families, saving lives, and improving the economic security of our nation

Medicare Part A is hospital insurance. Part A generally covers inpatient hospital stays, skilled nursing care, hospice care, and limited home health-care services. You typically pay a deductible and coinsurance and/or copayments.

Medicare Part B is medical insurance. It generally covers services and items such as:

• Doctor office visits
• Preventive services, such as certain tests and screenings
• Flu shots
• Pneumococcal shots
• Mental health care (outpatient)
• Alcohol use counseling
• Chemotherapy
• Physical therapy
• Diabetes screenings, supplies, and self-management therapy
• Durable medical equipment, such as wheelchairs

8.Authorized by Title XIX of the Social Security Act, Medicaid was signed into law in 1965 alongside Medicare. All states, the District of Columbia, and the U.S. territories have Medicaid programs designed to provide health coverage for low-income people.

Medicaid beneficiaries generally must be residents of the state in which they are receiving Medicaid. They must be either citizens of the United States or certain qualified non-citizens, such as lawful permanent residents. In addition, some eligibility groups are limited by age, or by pregnancy or parenting status.Medicaid covers three main groups of low-income Americans: parents and children, the elderly, and the disabled.

Medicaid provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults and people with disabilities. Medicaid is administered by states, according to federal requirements. The program is funded jointly by states and the federal government.