LEARNING OBJECTIVES
WHAT IS MANAGED CARE?
Participants in the Managed Care System and Their Roles
Concept of Managed Care
Traditional Provider Approach or Fee-for-Service (FFS)
Appoach
Versus Managed Care Approach
Types of Managed Care Organizations (MCOs)
HMO Models
MCO Program Elements
Implementation of Managed Care for Medicare Patients
CAPITATION MODEL
Capitation - Definition
Capitation - Features
General Points
Basic Capitation Model
MANAGING RISK
FINANCIAL MANAGEMENT
Actuarial Data
Member Months
MPM - Per Member Per Month
Utilization Rate
MEDICAL MANAGEMENT
Patient Process Utilization Mode
QUALITY MANAGEMENT
Quality Improvement vs. Quality Assurance
NCQA
HEDIS 3.0
HEDIS 3.0 Reporting and Testing Set Measures
HEDIS 3.0 1998 Measures Required for Reporting by
Medicare
Health Plans in 1998
RESOURCES
GLOSSARY OF HEALTH CARE TERMS
SELF ASSESSMENT