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Essay / Research Paper Abstract
A 14 page research paper in which the writer answers four specific questions about managed care. Topics covered include the uses of provider profiling by MCOs and the difference between case management and disease management. Bibliography lists 13 sources.
Page Count:
14 pages (~225 words per page)
File: D0_khmgcar4.rtf
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Unformatted sample text from the term paper:
aspects of profiling that the MCO must keep in mind? Would provider profiling influence provider behavior change? According to Kongstvedt, Goldfield and Plocher (2003), the employment of data
and information for the purposes of medical management, and specifically for provider profiling, is becoming increasing important. The capacity of managers to understand and use data in order to better
manage health care delivery systems provides a key factor in "distinguishing those plans that truly excel from those plans that are, at best, adequate performers" (Kongstvedt, Goldfield and Plocher, 2003,
p. 380). Provider profiling, as a term, refers to the "identification, collection, collation and analysis of data to develop provider-specific characterization of their performance" (Kongstvedt, Goldfield and Plocher, 2003, p.
380). As this suggests, health delivery systems, as with all other aspects of modern society, are becoming increasing driven by the efficient flow of information. Provider or practice profiles are
put to a variety of uses by MCOs. For example, they are used to produce feedback reports that help providers modify their own behavior, as well as provide devices for
recruiting providers into a network or determining which providers are not suitable for a network (Kongstvedt, Goldfield and Plocher, 2003). Physician profiling provides one source for generating information concerning
the processes of care and generally utilizes claims data in order to discern rates of service delivery that are, in turn, linked to enrollment and eligibility data (Walsh, et al,
2002). For instance, claims might be used to evaluate mammography rates overall, as well as by subgroups according to age, race or ethnicity (Walsh, et al, 2002). Claims are readily
available for systematically accessing patterns of care, as they can "support analysis of treatment patterns for an entire enrolled population, and are much less costly than medical record reviews" (Walsh,
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