Fundamentals and Core Competencies of Disease Mana

Fundamentals and Core Competencies of Disease Management

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Networks and Contracting Chapter 4: The Provider Network

Chapter 5: Provider Payment

Chapter 6: Legal Issues in Provider Contracting Course Project Topic

Graded Discussion Topics Week 3 TCOs 3 and 4

Utilization and Case Management Chapter 7: Basic Utilization and Case Management

Chapter 8: Fundamentals and Core Competencies of Disease Management

Chapter 9: Physician Practice Behavior and Managed Health Care

Chapter 10: Data Analysis and Provider Profiling in Health Plans Graded Discussion Topics Week 4 TCOs 1, 2, and 4

Specialized Aspects of Managed Care Chapter 11: Prescription Drug Benefits in Managed Care

Chapter 12: Introduction to Managed Behavioral Healthcare Organizations

Chapter 13: Disease Prevention in Managed Health Care Plans

Chapter 14: Quality Management in Managed Health Care Midterm

Graded Discussion Topics Week 5 TCOs 3, 4, 5, and 6

MCO Marketing Chapter 15: Accreditation and Performance Measurement Programs in Managed Health Care

Chapter 16: Marketing and Sales

Chapter 17: Enrollment and Billing

Chapter 18: Claims and Benefits Administration Course Project Outline

Graded Discussion Topics Week 6 TCOs 5, 6, and 7

Underwriting and Rating / Fraud and Abuse Chapter 19: Health Care Fraud and Abuse

Chapter 20: Member Services

Chapter 21: Operational Finance and Budgeting

Chapter 22: Underwriting and Rating

Chapter 23: Information Systems and Electronic Data Interchange in Managed Health Care Graded Discussion Topics Week 7 TCO 7

Legal and Regulatory Aspects Chapter 28: State Regulation of Managed Health Care

Chapter 29: Federal Regulation of Health Insurance and Managed Health Care

Chapter 30: The Patient Protection and Affordable Care Act Final Course Project

Graded Discussion Topics Week 8 All TCOs Course Project Review

• Your Course Project should be 7–10 pages in length, with 10-point font, and double-spaced. Include a cover page, table of contents, introduction, body of the report, summary/conclusion, and works cited. • Even though this is not a scientific writing assignment, and is mostly creative in nature, references are still very important. At least six authoritative outside references are required. These should be listed on the last page, titled Works Cited. • Appropriate citations are required. • All DeVry University policies are in effect, including the plagiarism policy. • Papers are due during Week 7 of this course. • Any questions about this paper may be discussed in the weekly Q & A Discussion topic. • This Course Project is worth 320 total points and will be graded on quality of research topic, quality of paper information, use of citations, grammar, and sentence structure. Possible Course Project Topics Back to Top • Pros and Cons of Managed Care in America

• Challenges in Managing Health Maintenance Organizations (HMOs)

• Challenges in Managing Preferred Provider Organizations (PPOs)

• Problems in Network Contracting for Managed Care

• Legal Issues Associated With Managed Care Contracting

• Challenges in Utilization and Case Management in Managed Care

• Approaches to Disease Management in Managed Care

• Managing Quality Improvement in Managed Care

• Achieving Effective Marketing and Sales in Managed Care

• Achieving and Maintaining Accreditation in Managed Care

• Preventing Fraud and Abuse in Managed Care

• Complying With State and Federal Regulation of Managed Care

• Problems in Medicare Managed Care

• Problems in Medicaid Managed Care

• Effective Information Systems in Managed Care

• Challenges in Patient Relations for Managed Care

• Challenges in Provider Relations for Managed Care NOTE: Other topics related to course content and TCOs are acceptable, but only as approved in advance by your professor. Milestones Back to Top The Course Project is worth 370 points (50 for the Course Project topic, 100 for the Course Project outline, 170 for the final Course Project, and 50 for the Peer Review).

Topic (Week 2): 50 points It is expected that you will provide a focused topic, including a statement of the key challenges or problems currently associated with the topic in America.

Outline (Week 5): 100 points

It is expected that the outline be submitted in a formal outline format as demonstrated below. Your outline should show enough detail to demonstrate that you have begun thinking about the organization of your paper and the research required into the topic. After your outline, please submit a listing of the sources you have already identified for your paper. I. Each Roman numeral should be a main section of the paper. A. Subpoint 1. Details of Subpoint a. Details Related to the Subpoint B. Subpoint Final Course Project (Week 7): 170 points

It is expected that the final version of your Course Project will be 7–10 pages in length, with 6–8 sources identified.

APA in-text citation is required in addition to listing all of your sources on a works cited page at the end of the document. Your grade will be affected if you do not cite or identify your sources correctly.

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