Managed Care Reimbursement

Compensation and reimbursement models are another method of controlling access, cost, and quality in a managed care environment. An MCO doesn’t have direct control over physicians or hospitals but through contractual agreements that set incentives for meeting agreed-upon standards, it can exert influence.

This week, you are required to write an essay on the following topics:

• Managed care hospital reimbursement
• Managed care provider reimbursement

Using South University Online library (e.g. CINAHL) or the Internet, review at least two articles for each topic and write a review for each source of information. Use the following guidelines for developing your essay:

• Write a summary for each topic tying together the information learned about that topic.
• Analyze the market forces that would favor using one reimbursement method over another.
• Evaluate the key differences between different types of payment methodologies from the provider and hospital point of view.
• Evaluate the advantages and disadvantages of the payment methodologies reviewed from the provider and hospital point of view.
• Evaluate new payment methodologies resulting from the Patient Protection and Affordable Care Act (PPACA) and discuss future changes in reimbursement methodologies.
• Compare and contrast each article to the information discussed in the course textbook.

Based on your understanding, create a 3- to 4-page Microsoft Word document that includes the answers to the questions for the above topics.

Support your responses with examples.

Cite any sources in APA form.