Mid-Term Examination: (20 Points)
Exam questions and instructions are found in CANVAS.
| Questions | Total Points | Points Lost |
| Based on Chapter 2: Types of Health Insurers, Managed Health Care Organizations and Integrated Healthcare Delivery Systems | ||
| Discuss the principle elements of control found in each type of managed care plan. In which plans do those elements appear? | 15 | |
| Discuss the primary strengths and advantages; and weaknesses and disadvantages of each type of managed care plan. | 10 | |
| Based on Chapter 4: The Provider Network | ||
| Describe a typical physician credentialing process, indicating which steps are required and why they are required. Discuss possible problems that may arise for any steps that are not completed. | 10 | |
| Based on Chapter 5: Provider Payment | ||
| Discuss the main forms of facility payment, differentiating inpatient and ambulatory, and the impact of outliers and carve-outs. | 10 | |
| Based on Chapter 7: Basic Utilization and Case Management | ||
| Discuss the key attributes of managing basic medical-surgical utilization in different types of managed care plans. | 10 | |
| Describe the differences between case management and UM. | 10 | |
| Based on Chapter 9: Physician Practice Behavior and Managed Health Care | ||
| Discuss the reasons for an increased interest in managing physician practice behavior. | 15 | |
| Based on Chapter 10: Data Analysis and Provider Profiling in Health Plans | ||
| Discuss the most common technical, clinical, and organizational problems medical directors face in using data to manage utilization, and what steps might be taken to deal with those problems. | 10 | |
| Based on Chapter 14: Quality Management in Managed Health Care | ||
| Describe the strategies an MCO can use to involve physicians in managed care processes. | 10 | |
| Total points lost | ||
| Grade based on 100 | ||
| Grade based on 20% | ||
