UTILIZATION MANAGEMENT: OLD AND NEW APPROACHES TOWARD MANAGING THE DELIVERY OF HEALTH CARE GOODS AND SERVICES
HSA 312 ONLINE SPRING 2021
MANAGED HEALTH CARE
FOR EACH QUESTION, FIND THE PERTINENT ANSWERS TO THE QUESTIONS IN THE INDICATED READINGS.
PLEASE COMPLETE AND SUBMIT VIA BLACKBOARD ASSIGNMENTS BY MONDAY, MAY 17, 11:59 PM.
MAKE SURE YOUR ANSWERS DIRECTLY ADDRESS THE QUESTION – THE ANSWERS SHOULD BE BRIEF BUT MUST ANSWER THE QUESTION.
QUESTIONS TO BE ANSWERED ARE IN GREEN.
· QUESTIONS HAVE MULTIPLE PARTS – BRIEFLY ANSWER EACH PART.
· ANSWERS SHOULD BE SHORT – 3-6 SENTENCES PER QUESTION PART.
· SINGLE SPACED.
· 12 POINT ARIAL FRONT.
· DOWNLOAD THE QUESTIONS FOR THE FINAL, WRITE ANSWERS UNDER THE QUESTIONS (IN BOLD), AND SUBMIT THE FINAL DOCUMENT VIA THE ASSIGNMENTS PROCESS.
QUESTION 1: UTILIZATION MANAGEMENT – WHAT IT IS, AND WHAT IT ATTEMPTS TO DO.
USING ATTACHED OVERVIEW 9, PAGES 1 – 5. ALSO, AS NEEDED, READING 4.G. ON INTEGRATED DELIVERY SYSTEMS.
ANSWER THE FOLLOWING:
PART A: What are TWO (2) of the main goals of Utilization Management?
PART B : Whose behavior do most Utilization Management approaches try to influence?
( For Example: Through Utilization Review, Reducing Hospital Acquired Complications, Improving Care Coordination).
PART C : Which TWO types of health care organizations implement Utilization Management programs since 2000?
QUESTION 1.C.: THE ANSWER IS SOMEWHERE IN PAGES 4-5 OF OVERVIEW 9. FOR FURTHER HELP, SEE READING 4.G.
QUESTION 2: IDENTIFYING HIGH UTILIZERS OF HEALTH SERVICES AND CHANGING THEIR BEHAVIOR.
READING 4; READING 5; READING 6.
PART A: Briefly describe what “Hot Spotting” programs are designed to do. READING 4
PART B: Are “Hot Spotting” programs equally focused on the provision of appropriate medical services AND the provision social support services to the high utilizers whom they identify? YES OR NO? READING 4. (Also, READING 6 may help you.)
PART C: What kinds of high utilizers does the Blue Cross program described in Reading 5 identify? READING 5.
QUESTION 3: IMPROVING CARE BY FOCUSING ON SOCIAL DETERMINANTS OF HEALTH.
USING ATTACHED READING 6.
PART A: Give TWO (2) examples of Social Determinants of Health.
PART B: Give ONE (1) example of how addressing Social Determinants of Health , in addition to providing the right Medical Treatment, is CRITICAL for ensuring that patients get better, and do not have to keep coming back to the hospital for additional health care goods and services.
QUESTION 4: DISEASE MANAGEMENT AND COORDINATION OF CARE.
USING OVERVIEW 10, PAGES 8-9. ; AND READINGS 7.A., 7.B., AND 7.C. ANSWER THE FOLLOWING:
PART A: Disease Management targets people with which kinds of clinical conditions?
READINGS 7.A. AND 7.C.
PART B: Does Disease Management use a data – based Population Health approach to identify the Insurance Plan Enrollees who may need Disease Management services? YES OR NO?
PART C: Briefly describe the Collaborative Model of Care Delivery which is the basis for the services which Disease Management offers to the individuals and families which it identifies.
READINGS 7.A. AND 7.C.
PART D: How does Disease Management DIFFER from Large Case Management in terms of a focus on?
· Single patients, or a whole population of persons with particular clinical conditions?
· People with acute catastrophic conditions, or people with targeted chronic conditions?
· People with seriously acute, or with moderately acute clinical conditions?
QUESTION 5: DEMAND MANAGEMENT AS A UTILIZATION MANAGEMENT STRATEGY.
USING ATTACHED READING 8
USE READING 9 TO GIVE YOURSELF A BETTER UNDERSTANDING OF THE SPECIFICS OF PATIENT DECISION – SHARING.
PART A: Give TWO (2) examples of the focus of health insurance plan Demand Management prior to 2000.
PART B: What is the purpose of Patient Decision Sharing , which has emerged as an additional form of Demand Management since 2000?
PART C: What kinds of medical treatments are the appropriate objects of Patient Decision Sharing.