HLT 308V GCU Evaluation of Managed Care Organization & Today Healths Role Discussion

HLT 308V GCU Evaluation of Managed Care Organization & Today Healths Role Discussion

HLT 308V GCU Evaluation of Managed Care Organization & Today Healths Role Discussion

DQ 1 – WATCH VIDEO

Health care organizations continually face challenges from various regulatory and government agencies while also being bound by Managed Care Organization (MCO) standards. View the video located in the study materials entitled “College of Nursing and Health Care Professions: “Do We Know What Our Future Holds?” for more information on the challenges of health-care reform. Based on the video, describe two key reform factors that you believe future health care workers or leaders will need to address and explain why. (Note: You can download the slides from this video to help you develop your forum response.) What role does adherence to MCO standards play in your long-term health care vision? (Response of 250 words plus x1 peer-reviewed source to back up response)

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Video link:

Watch the video “College of Nursing and Health Care Professionals: Do We Know What Our Future Is?”

URL:

http://lc.gcumedia.com/zwebassets/courseMaterialPages/nur508_healthcare-reform-video-series-v1.1.php

DQ2- Research with x2 sources- peer reviewed articles

The Affordable Care Act (ACA) identifies requirements related to provider compliance with fraud, waste, and abuse laws that have been enacted to protect consumers. (250 words response) Research three of these requirements and describe the corresponding measures that your health care organization has initiated, or could initiate, to comply with the ACA. Support your analysis with a minimum of two peer-reviewed articles.

PART B -Assignments Due by Fr

Assignment #1 – Paper

Title: Reflective Analysis- Risk Management & The Role of Managed Care

The purpose of this assignment is to analyze the role of managed care organizations within health care and risk management programs.

Reflect on and evaluate the role that the managed care organization (MCO) plays in today’s health care environment by developing a 250‐500-word response that addresses the following:

1.What is a health care organization’s administrative role in executing risk management policies and ensuring compliance with managed care organization (MCO) standards?

2.What value do the regulatory statutes of a typical MCO provide to a health care organization? Consider how strategies pertaining to policies such as conflict resolution and risk management affect patients as well as employees and employers.

3.What MCO responsibilities relevant to the Patient Protection and Affordable Care Act (ACA) and Center for Medicare and Medicaid Services (CMS) focus on fraud, waste, and abuse laws?

Required sources from: textbook (Read Chapters 18, 19, and 26 in Legal and Ethical Essentials of Health Care Administration.And you are required to support your analysis with a minimum of two peer‐reviewed references.

Prepare this assignment according to the guidelines found in the APA Style. An abstract is not required.

This assignment uses a rubric (see attached doc titled Assignment Paper Rubrics). Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

Assignment #2 – PowerPoint presentation

The purpose of this assignment is to create an educational risk management presentation.

SEE ATTACHED DOCUMENT WITH PART 1 OUTLINE AND INSTRUCTOR FEEDBACK AT THE BOTTOM OF THAT OUTLINE COLORED IN BLUE.

USE POWERPOINT TEMPLATE SENT AS SEPARATE ATTACHMENT

Building upon the outline for an educational session you created in the Educational Program on Risk Management Part One: Outline of Topic 2 assignment, develop a 12-15 slide PowerPoint presentation that expands in greater detail on how and why your organization should implement your proposed risk management strategy. Incorporate any instructor feedback from the Topic 2 assignment into this presentation and include talking points in the speaker notes section of each slide.

Keep in mind that the PowerPoint is meant to serve as a visual aide to bolster your presentation and is intended to highlight main ideas and key points. Do not use dense blocks of text or more than 7 bullet points of text per slide. However, you may include supplementary images, graphs, and data where relevant.

To successfully complete this assignment, include the following sections as per your outline from Topic 2, though you may include any additional sections as needed:

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1.Introduction

2.Rationale

3.Support

4.Implementation

5.Challenges

6.Evaluation

7.Opportunities

You are required to support your statements with a minimum of six citations from appropriate credible sources.(same as outline in part 1)

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting

This assignment uses a rubric (see attached doc titled-“PowerPoint Rubic”) for Rubics. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

POWERPOINT RUBRICS

1. Introduction (10 points)
Introduction slides are informative and thorough in explaining why increased attention to the proposed risk management strategy is needed. Specific examples are provided where appropriate.

2. Rationale (10 points)
Rationale slides are informative and thorough in explaining why the proposed risk management strategy is lacking in the selected plan. Specific examples are provided as to how its implementation will better meet compliance standards.

3. Support (10 points)
Support data slides are informative and thorough in showing how the data indicate a need for the proposed risk management initiative. Specific examples are provided where appropriate.

4. Implementation (10 points)
Implementation slides are informative and thorough in explaining the specific actionable steps by which the selected health care organization can implement the proposed risk management initiative.

5. Challenges (10 points )
Challenges slides are informative and thorough in explaining potential obstacles to the risk management implementation. Slides also provide specific examples of solutions for navigating or preempting predicted obstacles.

6. Evaluation (10 points )
Evaluation strategy slides are informative and thorough in providing specific examples of how the evaluation plan will assess alignment with the short-term, long-term, and end goals of the risk management program.

7. Opportunities (10 points)
Opportunities slides are informative and thorough in providing additional risk management improvements along with detailed support for the recommended changes.

8. Incorporation of Instructor Feedback From Previous Assignment (5 points)
Incorporation of instructor feedback from previous assignment is comprehensive.

9. Presentation of Content (5 points)
The content is written clearly and concisely. Ideas universally progress and relate to each other. The project includes motivating questions and advanced organizers. The project gives the audience a clear sense of the main idea.

 

10. Layout (5 points)
The layout is visually pleasing and contributes to the overall message with appropriate use of headings, subheadings, and white space. Text is appropriate in length for the target audience and to the point. The background and colors enhance the readability of the text.

11. Language Use and Audience Awareness (includes sentence construction, word choice, etc.) (5 points)
The writer uses a variety of sentence constructions, figures of speech, and word choice in distinctive and creative ways that are appropriate to purpose, discipline, and scope.

12. Mechanics of Writing (includes spelling, punctuation, grammar, language use) (5 points)
Writer is clearly in control of standard, written, academic English.

13. Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style) (5 points)
Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error. Research and citations are supportive of the rationale presented. Sources are distinctive and addresses all of the issues stated in the assignment criteria.

ASSIGNMENT PAPER RUBRICS

1. Administrative Role of a Health Care Organization in Ensuring Compliance With Managed Care Organization (MCO) Risk Management Standards (25points)
An assessment of the administrative role of a health care organization in ensuring compliance with MCO risk management standards is comprehensive. The submission further incorporates analysis of supporting evidence insightfully and provides specific examples with relevance. Level of detail is appropriate.

2. Value of MCO Regulatory Statutes to a Health Care Organization (25 points)
An explanation of the value MCO regulatory statutes provide to a health care organization is present and comprehensive. The submission further incorporates analysis of supporting evidence insightfully and provides specific examples with relevance. Level of detail is appropriate.

3. MCO Responsibilities Relative to ACA and CMS Focus on Fraud, Waste, and Abuse Laws (25 points)
A description of the MCO responsibilities relative to the ACA and CMS focus on fraud, waste, and abuse laws is comprehensive. The submission further incorporates analysis of supporting evidence insightfully and provides specific examples with relevance. Level of detail is appropriate.

4. Thesis Development and Purpose (5 points)
Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.

5. Argument Logic and Construction (5 points)
Clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.

6. Mechanics of Writing (includes spelling, punctuation, grammar, language use) (5 points)
Writer is clearly in command of standard, written, academic English.

7. Paper Format APA STYLE (use of appropriate style for the major and assignment) (5 points)
APA style format elements are correct.

8. Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)(5 points)
Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.

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