Identify ONE organizational structure used in health care. What are the central characteristics of each? To what extent is bureaucracy necessary in healthcare organizations? Explain.

Determine the effectiveness of implementing a chronic pain visit template and pain flowsheet within the electronic record to reduce opioid abuse in psychiatric care.

One of the biggest challenges for new healthcare managers/directors to understand is the payer source of the revenue side of their budgets. Where does this money come from? How is the plan, no matter the type administered? Who is the “gatekeeper” of care for the beneficiary? What are the types of insurer programs- underneath the alphabet soup of payers? (PPO, HMO, POS, etc.)

In an essay:

1. Describe the primary strengths and advantages, and weaknesses and disadvantages, of each type of managed care plan.

2. Describe the impact of PPACA-Obama Care on the managed care process. This will require a little research, make sure you consider how this will impact Medicare and Medicaid, along with Commercial insurance carriers.

Quantitative methods in nursing practice

Discuss why the quantitative method is the best method based on your project questions and data. Choose three potential designs that you could use for your project. Based on the three potential designs, determine potential analyses methods and why?

Clinical/PICOT Questions:
Do elderly patients in long-term care (P) that have a urinary Foley catheter that is placed on a Prevention Strategy Urinary Catheter Protocol (I) experience reduced chances of acquiring catheter-associated urinary infections (O) compared to those without (C) within 4 weeks of implementation?

The quality improvement will be based on a perspective that will be carried out on elderly patients in medical/surgical/telemetry. The setting for the study is West Covina, CA 76-bed hospital. The hospital provides care for patients in West Covina and the surrounding communities. The quality improvement project will also be supported by the hospital’s management at all levels. The quality improvement will involve of patients 65 years and older.

Utilization Management

The principal objective of utilization management is the reduction of practice variations by establishing parameters for the cost-effective use of healthcare resources. There are four main techniques or tools used in utilization management: demand management, utilization review, case management, and disease management. Utilization management helps MCOs control costs and improve quality.

Refer to the readings of this week and the Internet on the above information, and answer the following questions:

What are the challenges faced by MCOs regarding practice variations? What do you think can be done to meet these challenges?
Differentiate between the three main processes of institutional utilization management.
Determine the main purposes of each process of institutional utilization management. Which process do you think is the most important, and why?
Research the role of the utilization management nurse.
Explain the functions of the utilization management nurse, and compare and contrast the information from that organization.
Explain your understanding of disease management and case management. What is your opinion are one major similarity and one major difference between the two types of management?
Now, access information on disease and case management by searching the Internet by using the following keywords:

Care Continuum Alliance
Commission of Case Manager Certification
Based on your research, answer the following questions:

What is the purpose or mission of these professional organizations?
What standards do these organizations set for certification or membership?
How do these organizations define disease or case management and do they differ from the text definitions?