Managed Healthcare Key Concepts
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.
