Mar 29, 2023  
2012-2013 Saint Joseph’s College Online 
2012-2013 Saint Joseph’s College Online [Archived Catalog]

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HA 695 - Managed Care and Reimbursement

Examines critical concepts of managed care and health care reimbursement from the perspective of the payer and the provider. Topics include the history of managed health care, types of managed care plans and integrated health care delivery systems as well as Medicare and Medicaid. The course will examine the implications of managed care plans for major provider sectors and review the mechanics of third party reimbursement with a goal of developing a basic understanding of managed care and the reimbursement process.

Assignment Overview
Assignments: 5 Units

Interactivity: Discussion Board

Final Assessment: Final Research Paper

Course Learning Objectives
Upon completion of this course, you should be able to do the following: 

  • Explain the history of managed care and trace its evolution to the present. 
  • Describe the various types of Managed Care Organizations (MCOs), their goals, and the methods used to achieve them. 
  • Explain various approaches to reimbursement of primary, specialty, hospital, and ancillary providers and discuss the difference between them, and advantages and disadvantages of each. 
  • Identify general approaches to utilization and care management and explain their benefits to patients, payers, and providers. 
  • Discuss the origins, goals, and structure of Medicare and Medicaid managed care programs and differentiate them from traditional fee-for-service approaches. 
  • Form a well-reasoned and researched viewpoint on the degree to which managed care programs have resulted in improvements in the overall cost and quality of health care in America, and take an informed position on the future of managed care in an era of escalating costs and health care consumerism.

Credits: 3

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