Managed Care Flashcards
what businesses are exempt from ERISA?
those with less than 25 employees
What did HIPAA do to ERISA?
Amended ERISA to prohibit employers form discriminations against employees on the basis of health status and sets rules regarding preexisting conditions
and to improve continuity of health insurance coverage for employees who terminate employment with a company
What is managed care?
A system that integrates the financing and delivery of health services
Three principles of managed care
Limited access to providers (panels open/closed, credentialing, physician as gatekeeper)
Payment mechs that reward efficiency (discounted fee schedule, bundling, capitation)
Quality control (utilization reviews, benchmarking, case management)
what are some managed care products?
managed indemnity- pre-approval
ppo (preferred provider org)
pos (point of service- hmo ppo hybrid)
What are some concerns of managed care for pt/ot?
fewer visits, less reibursement, less autonomy as a provider, pats moved to quickly through the system, less choice for consumers, ethical issues related to payment structures
what are some of the benefits of managed care for pt/ot?
pats take more responsibility (hep), use of evidence based medicine, emphasis on preventive care, outcome research, improved care from preset protocols, more consultation and supervisory roles
What is the patient bill of rights? who wrote it?
Informs pats what they can expect from their health care providers. includes right to privacy, confidentiality, safety, refuse, information
written by the AHA
t/f: a hsa can only be used in conjunction with a high deductible plan
true
What led to the rise of managed care?
Rising health costs, overulitization of services
Health Maintenance Organization act 1973
monthly premiums and limited providers
