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Discuss healthcare fraud in relation to managed healthcare and provide examples.
Introduction This Course Project gives you the opportunity to select a managed healthcare organization or an integrated delivery system that currently exists in our healthcare system and analyze the positive and negative aspects of the integrated delivery system or managed healthcare organization. The paper should critically analyze the issues related to the topic and identify key strategies for improvement. In order to meet the project requirements, it is important to identify an issue or problem within the integrated delivery system or managed healthcare organization. Please analyze and review the grading rubric to understand why this is important. Peer-reviewed references are required for this paper. Example Course Project Topics Describe a managed care organization or integrated delivery system, and discuss the positive and negative aspects related to healthcare quality, costs, and access to healthcare. Choose a closed- or open-panel health maintenance organization and discuss a specific model, such as a direct contact model, group model, or staff model. Evaluate healthcare quality and cost related to health maintenance organizations. Choose an integrated healthcare delivery system, such as a physician group practice, and discuss the benefits and legal structure for group practices. Evaluate physician hospital organizations and how the organizations contract with insurance companies. Discuss healthcare fraud in relationship to managed healthcare and provide examples. Evaluate quality management of healthcare in managed healthcare, utilization, and cost management and provide examples. Discuss the federal and state regulations for managed care and integrated delivery systems and explain how trends have changed in the past 2 years. Evaluate challenges to provide healthcare services to the newly insured population through marketplace.gov health insurance exchanges. Grading Rubric Introduce the issue. Define the problem. Search the literature. Analyze the problem. Offer possible solutions. Develop an implementation plan. Justify why and how your solution will solve the identified problem.
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