Managed Healthcare Key Concepts

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Managed Healthcare Key Concepts

(Managed Healthcare Key Concepts)

Managed healthcare

My class is managed healthcare.

I have presentation about this.

1- Accountable Care Organizations (ACOs)

2- Deductible.

3- Pre – Certification / Pre – Authorization / Pre – Notification.

It’s about 10-15 minutes.

-> And you have to do Summare /Define.

-> How does it impact

– Pitants.

– Poviders.

– Payers.

Managed Healthcare Key Concepts

Slide 1: Title Slide

  • Title: Managed Healthcare
  • Subtitle: Exploring Key Concepts and Their Impact
  • Include your name, class, and presentation date.

Slide 2: Introduction to Managed Healthcare

  • Definition: A system that integrates the delivery and financing of healthcare to improve quality and control costs.
  • Purpose: Introduce the three main topics and their relevance in managed healthcare.

Slide 3: Accountable Care Organizations (ACOs)

  • Definition: Groups of doctors, hospitals, and other healthcare providers who voluntarily come together to provide coordinated care to patients.
    Goal: Avoid unnecessary duplication of services and prevent medical errors.
  • Impact:
    • Patients: Better care coordination, improved health outcomes, potential for lower out-of-pocket costs.
    • Providers: Incentives for high-quality care, shared savings programs, increased collaboration.
    • Payers: Cost savings through efficient care delivery, reduced hospital readmissions.

Slide 4: Deductible

  • Definition: The amount a patient must pay out-of-pocket before insurance coverage begins to pay for services.
  • Impact:
    • Patients: Financial burden if deductible is high; encourages cost-conscious healthcare choices.
    • Providers: May face delays in payments if patients struggle to meet deductibles.
    • Payers: Helps manage risk by ensuring patients share in initial healthcare costs.

Slide 5: Pre-Certification/Pre-Authorization/Pre-Notification

  • Definition:
    • Pre-Certification: Approval required before certain services are provided to ensure medical necessity.
    • Pre-Authorization: A broader process where insurers approve procedures, tests, or treatments in advance.
    • Pre-Notification: Informing the insurer of planned services (often required for non-emergency procedures).
  • Impact:
    • Patients: Potential delays in accessing care but helps ensure coverage and avoids unexpected costs.
    • Providers: Administrative burden to obtain approvals but ensures payment for services rendered.
    • Payers: Controls costs by ensuring only medically necessary services are covered.

Slide 6: Comparison Table

  • Use a table to summarize the impacts on patients, providers, and payers for all three topics.

Slide 7: Challenges and Opportunities

  • Challenges: Complexity for patients, administrative burden for providers, potential delays in care.
  • Opportunities: Improved care quality, cost management, and streamlined processes.

Slide 8: Conclusion

  • Recap the key points about ACOs, deductibles, and pre-certification.
  • Emphasize how these components align with the goals of managed healthcare.

Slide 9: Q&A Slide

  • Open the floor for questions from your audience.
 
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