ESSENTIALS OF MANAGED HEALTH CARE - PART 3B: MEDICAL MANAGEMENT

Course overview

OUTLINE Section 1: Managed Behavioral Health Care and Chemical Dependency Services A. HISTORICAL PERSPECTIVE B. KEY TREATMENT PRINCIPLES C. BENEFIT PLAN DESIGN D. UTILIZATION MANAGEMENT E. CHANNELING MECHANISMS F. PROVIDER STRUCTURES FOR INTEGRATED DELIVERY SYSTEMS TO MEET MANAGED CARE OBJECTIVES G. QUALITY ASSURANCE H. BH INFORMATION SYSTEMS I. PUBLIC / PRIVATE SYSTEMS INTEGRATION J. EMERGING ISSUES Section 2: Quality Management in Managed Care A. TRADITIONAL QUALITY ASSURANCE B. COMPONENTS OF A QUALITY MANAGEMENT PROGRAM C. A PROCESS MODEL FOR A MODERN QUALITY MANAGEMENT PROGRAM Section 3: Using Data and Provider Profiling in Medical Management A. USE OF DATA AND INFORMATION IN MEDICAL MANAGEMENT B. PATIENT DATA CONFIDENTIALITY C. DATA ELEMENTS AND THE APPLICATION OF REPORTS D. GENERAL TYPES OF REPORTS E. PROVIDER PROFILING F. DESIRED CHARACTERISTICS OF PROVIDER PROFILES G. THE NEED TO ADJUST FOR SEVERITY OF ILLNESS H. SELECTION OF A PROFILING VENDOR I. THE FUTURE OF DATA USE Section 4: Physician Behavior Change in Managed Health Care A. GENERAL ASPECTS OF PHYSICIAN PRACTICE BEHAVIOR B. GENERAL APPROACHES TO CHANGING BEHAVIOR C. PROGRAMMATIC APPROACHES TO CHANGIN PHYSICIAN BEHAVIOR D. ADDRESSING NONCOMPLIANCE BY INDIVIDUAL PHYSICIANS