Managed Care Overview Assignment Example | Topics and Well Written Essays - 250 words

Managed Care Overview - Assignment Example The members can change the providers by filling the form and submitting it to the HMO. IPA, on the contrary, provides assistance to HMO by way to legally contracting with physicians to provide their services to its members. PPO provides a network of physicians that is accessible to the HMOs or IPAs to connect with and charge a fee for it. POS is an upgraded plan that has elements of each of HMO, IPA and PPO. However, it is flexible as the members are allowed to use the services or move to another choice of service. PFFS is a combination of managed care and health insurance. They include a large number of physicians and hospitals and they are all paid for their services. The member however, has to choose the plan they want depending upon their needs and budget. HMO is more traditional and has set rules as it is based on Health Maintenance Organization Act of 1973. IPA and PPO both work as network providers to HMO members. POS and PFFS both are flexible plans in terms of budget plans to its members. The managed indemnity plan also now includes managed care in the shape of certifications to the admissions in non-emergency situations as well as utilization reviews. The patient can take a second opinion in case of doubt by informing the provider and making a formal request for it if it is included in the grievance policy (‘USAMCO’, 2013). The insurance card requires particulars of the applicant, any licenses or previous attachment with any provider, health related certifications and identity proofs through mail. In case a provider wants to quit the service of providing access to managed care to the members, it can under the HMO Act, 1973 file the related form and request for closing the provision of service (‘FAQ’, 2013). In PFFS, the providers make payment to physicians once the service has been provided. A formal letter detailing the problem that provider is not accepting the guidelines or

Contract and Procurement Essay Example | Topics and Well Written Essays - 750 words

Contract and Procurement - Essay Example On a counter view of the project, the evidence stated should be indicated and given in the section as this would help in validating the information given. Moreover, for a project to be successful all the internal project documents should be well document and the information in those documents used otherwise the project will not be successful (Ramakrishna 2010). Amber color should have been used to indicate that there are significant issues which need the management’s attention despite a successful delivery. 2. Summary of report recommendations The recommendations given by the review time are worth while as they provide a clear explanation of the situation in the entity. The recommendation time frame could either be Recommended, Critical and Essential. The review uses the â€Å"Recommended† time frame. â€Å"Recommended† means that the recommendations given should be beneficial to the project and should be linked to the project milestones, and this should be befor e the contract is signed. On a critical point view, the recommendations given by should be based on the three time frames given the other two are based on the successful outcome of the project depending on how fast action is taken a situation which affects the project. 3. Background and business case The background of the project is clearly stated with the project name and the programme. The problems facing the stated projects are also indicated which explains why the stated project are in need of improvements. The cost estimates for the improvements, the procurement delivery status including the start and expiry date, current position in regard to the OGC Gateway Review and conduct of the OGC Gateway Review have been well stated in connection to the business case (Marks 2012). Enough has been provided about the background of the project, that is, the background is explicit. However, including the current position in regard to the OGC Gateway Review without sufficient information ab out the past reviews is absurd. The reviewer should have obtained all information from the previous four Gateway Reviews before embarking on writing his or her review. The previous review would help the reviewer to fully understand all the problems facing the project and the improvements which have been done on the projects. 4. Findings and recommendations The findings for the project have been given explicitly with all parameters well stated. All the strengths and weaknesses of the project including lack of proper documentation and sufficient commitment to staff training and knowledge of training delivery amongst the main project teams have been elaborated. Validity of the project in connection to the business case has also been elaborated. The reviewer has done excellent in the elaboration of the findings of the project. The reviewer has gone further ahead to give the plans for the ongoing improvements in performance and innovation which include the continuous improvement and plan ning and performance measures. The reviewer has also gone a head to provide the organizations learning and maturity targets and its readiness for the future or the plans for any service provision in the future. However, the