This is the book and the questions are attached as well Kongstvedt, Essentials of Managed Care, Sixth Edition ISBN: 978-1-4496-5331-6 Based on Chapter 2: Types of Health Insurers, Managed Health

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%