INTRODUCTION TO MANAGED CARE/HEALTH INS & HMO: PART 1: OVERVIEW PART 2: THE ADVANTAGES OF MANAGED CARE

Course overview

PART 1: OVERVIEW OBJECTIVES SECTION 1: Intro to Managed Care The case manager will be able to: 1. To understand the definition of managed care 2. To understand who, what and how HMOs are regulated. 3. To understand the basis for establishing premiums. 4. How do Medicare and HMO coverage relate SECTION 2: Health Insurance & HMO The case manager will be able to: 1. Describe the different health insurance products on the market 2. Describe the different types of HMOs 3. Understand the different payment methodologies 4. Identify optional riders and supplemental coverage. PART 2: THE ADVANTAGES OF MANAGED CARE OBJECTIVES Case Manager will be able to: 1. Identify 5 (five) advantageous programs of managed care. 2. Explain 4 (four) ways that managed care improves the quality of care and health outcomes for patients. a. Disease Management b. Utilization Management c. Case Management d. Quality Management 3. Describe the increase in benefit plans for members. 4. List 2 (two) ways managed care reduces fraud and abuse.