HSA3109 2022 December Complete Course Latest (Full)

HSA3109 Foundations of Managed Care

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Module 1 Discussion

Healthcare Choices

Today’s healthcare consumer has more insurance coverage options available than ever before. Managed care organizations have made it so that individuals, on their own (through Medicare or Medicaid) or through their employers, can select healthcare coverage plans that best align to their needs. Everyone’s family dynamic, income, and needs are different, and making choices regarding healthcare coverage allows people to make decisions based on those differences. Some people would prefer to pay more up front so that they don’t have to pay as much on the back end. Others think about addressing health conditions that may be existing. Health insurance is not a one-size-fits-all. What are some of the things that should be considered when making decisions about what health insurance is best for you? Explain.


HSA3109 Foundations of Managed Care

Module 2 Discussion

Continuity of Care

When we think about continuity of care, which involves multiple healthcare providers working together over time to best manage a patient’s health, we should think about the provider (physical therapist, physician) and the healthcare institution (hospital, ambulatory surgery center). The goal is to render the patient high quality, accessible, and cost-effective care. Explain a possible concern that a patient may have with a provider or facility responsible for their care and who, as part of a managed care plan, they would address those concerns with.


HSA3109 Foundations of Managed Care

Module 3 Discussion

Preventative Care

In recent years, there has been an increasing focus on preventative care from all levels—federal, local, state, private insurance, and managed care. By having patients receive regular checkups from their healthcare providers, the patients are more likely to remain healthy because their healthcare providers have more opportunities to detect, treat, and/or prevent potential healthcare concerns. From a managed care perspective, early detection and potential prevention is more cost-effective than if concerns went unnoticed and could potentially evolve into costly conditions.

For your initial discussion board posting, conduct research that helps you to explain how early detection and prevention of a specific illness or disease, such as diabetes, can help both the patient and the managed care organization. Think about what it would mean for someone to find out that they are pre-diabetic, as opposed to finding out later when the condition has had time to manifest. Discuss the impact it could have on both patient and managed care organizations if not detected early.




HSA3109 Foundations of Managed Care

Module 4 Discussion

Patient Outcomes

From the perspective of patients, it often seems as though they have been sent home early from being hospitalized even though they still feel ill. With changes in healthcare reimbursement models, this may be changing. Many insurance companies are now reimbursing healthcare providers based on patient outcomes.

Do hospitals benefit from discharging patients early before they are fully recovered? Can you share an example of when you or someone you know was treated or hospitalized by a healthcare provider but somehow felt the care you received was not adequate? How should reimbursement to healthcare providers work in those situations?


HSA3109 Foundations of Managed Care

Module 5 Discussion

Uninsured and Underinsured

Although there have been more individuals and families insured as a result of the implementation of the Affordable Care Act (ACA), there are still many that are uninsured and underinsured. Share your thoughts on the difference between being uninsured and underinsured, then describe one way that we can help bridge the disparity in healthcare?


HSA3109 Foundations of Managed Care

Module 6 Discussion

Healthcare Coverage Models

In a traditional fee-for-service model of healthcare coverage, healthcare providers are reimbursed based on each service rendered. In a fee-for-service model, patients are not restricted or limited to receiving care from a specific healthcare network and instead are free to move from provider to provider, as long as the provider accepts their health coverage plan. In a managed care model, providers are reimbursed based on an agreed upon amount (capitated) that is received periodically (usually monthly). In this model, patients are part of an affiliated network of providers and facilities that work together to address patient’s needs. Based on your readings and/or experience, which of these models do you think is best for patients and why? Share a brief example of a healthcare encounter, in either model, (patient financial responsibility and outcome) and how it supports your decision.







HSA3109 Foundations of Managed Care

Module 1 Assignment  

Managed Care Models

There are multiple managed care models across the country. There are private models, such as Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Exclusive Provider Organization (EPO), and Point of Service (POS). There are also models associated with government plans, such as Medicare Advantage. Compare two of the models of managed care and share what you believe are advantages and disadvantages of each model.

Write a 2–3-page paper that includes the following:

Identify each of the managed care models.

Describe key characteristics of each managed care model.

Explain how the plans differ and who would be better suited for each model.

Discuss the financial burden that each model places on the individual consumer.

Explain a recommendation for which model you are personally better suited for and why.

Use a minimum of 2 scholarly resources, with at least 1 from the Rasmussen library.

Include at least 2 in-text citations.

Use proper APA format.


HSA3109 Foundations of Managed Care

Module 2 Assignment  

Managed Care Reimbursement Methods

The healthcare industry continues to look for ways to improve patient outcomes. Shifting to a process that makes providers more accountable has been the direction it’s headed of late. There are many methods of reimbursement to healthcare providers, not all are based on the quality of care rendered.

Conduct research of the different managed care reimbursement methods and address the following:

Write a 2–3-page paper that examines one managed care reimbursement method. Select the method that you believe best aligns to the value-based reimbursement approach.

Explain how the reimbursement method works.

Discuss how quality is at the forefront of the reimbursement method, as opposed to quantity.

Describe how both the patient and the provider benefit in a value-based reimbursement process.

Explain your thoughts on value-based reimbursement. Can it be improved? Is it the best approach?

Use a minimum of 2 scholarly resources, with at least 1 from the Rasmussen library.

Include at least 2 in-text citations.Use proper APA format.

HSA3109 Foundations of Managed Care

Module 3 Assignment  

Managed Care Concept

Write a 2–3-page paper that identifies a managed care concept (capitation, utilization management, preventative care, primary care physician, referral, etc.) and share the purpose and benefits associated with that concept. Be sure to include:

Identify the managed care concept that you’ve researched and describe how it works.

Discuss 2 benefits associated with the concept.

Explain whether a similar concept exists outside of managed care and if so, how it differs.

Recommend an improvement that can be implemented for the concept.

Use a minimum of 2 scholarly resources, with at least 1 from the Rasmussen library.

Include at least 2 in-text citations.

Use proper APA format.


HSA3109 Foundations of Managed Care

Module 4 Assignment  

Prevention of Fraud, Abuse, and Waste

The healthcare industry, which accounted for 19.7% of gross domestic product in the United States, spent roughly $4.1 trillion in 2020 (cms.gov). According to the National Health Care Anti-Fraud Association (NHCAA), health insurance carriers suffer losses between 3% and 10% annually due to a number of reasons, including the overutilization of services, incorrect billing, and a lack of coordination of care (nhcaa.org). Care coordination works to prevent duplicate services and unnecessary services. Health insurance carriers, including managed care organizations and government sponsored-healthcare coverage plans, are continuously searching for ways to control healthcare costs and minimize losses.

Conduct research and write a 4-5-page paper on different strategies being used in healthcare today that assist in the prevention of fraud, abuse, and waste that also help control unnecessary spending. In your paper, be sure to address the following:

Describe different reimbursement options and how they work towards controlling cost.

Explain the concept of pay-for-performance.

Discuss how fraud, abuse, and waste impact the cost of healthcare.

Describe how the quality of the service rendered by healthcare providers impact their reimbursement.

Discuss why healthcare accounted for almost 20% of the U.S. gross domestic product in 2020.

Explain a recommendation for how you, as a healthcare consumer, can assist in the prevention of fraud, waste, and abuse.

Describe how managed care organizations incentivize healthcare providers.

Use a minimum of 3 scholarly resources, with at least 2 from the Rasmussen library.

Include at least 3 in-text citations.

Use proper APA format.


HSA3109 Foundations of Managed Care

Module 5 Assignment  

Government and Managed Care Organizations

The government plays a major role in the healthcare arena. Through its own government-sponsored healthcare coverage, the government ensures that those who are most vulnerable, such as the elderly, children, and those in low-income populations, have access to healthcare services. The government has partnered with managed care organizations as well as created mandates and enacted laws to better serve healthcare consumers and to manage healthcare expenditures.

For this assignment, write a 4-5-page paper that addresses the following:

Explain how the government has included managed care in its coverage plans.

Describe at least one provision in the Affordable Care Act that you believe impacts the quality of care that healthcare providers render.

Explain the purpose of value-based reimbursement and who it impacts.

Discuss one example of how the government and managed care organizations work to control healthcare costs.

Explain whether you believe the government’s role in healthcare should increase, decrease, or remain as is.

Discuss whether you believe the type of healthcare coverage someone has (Medicaid, United Healthcare, Blue Cross, etc.) dictates the type of care that person receives.

Explain one thing, approach, or concept you believe is missing from healthcare delivery as it stands today.

Use a minimum of 3 scholarly resources, with at least 2 from the Rasmussen library.

Include at least 3 in-text citations.

Use proper APA format.


HSA3109 Foundations of Managed Care

Module 6 Assignment  

The Role of the Physician

Managed care has had an impact on the healthcare industry since its inception. It introduced different managed care models as well as different payment systems. More directly, managed care has changed patient and provider behavior in terms of what they can and can’t do. Healthcare providers have been directly impacted in the way they are reimbursed and the factors that lead to maximum reimbursement.

Conduct research on how the role of the physician has changed with the advent of managed care. Write a 4-5-page paper that addresses the following:

Explain how managed care has changed the healthcare landscape.

Discuss how managed care impacts provider reimbursement.

Describe how the relationship between physician and patient has changed through managed care.

Explain whether, in your opinion, the new focus on healthcare outcomes is better or worse.

Discuss who benefits from the new reimbursement approach.

Describe the relationship between first, second, and third-party in a managed care plan.

Use a minimum of 3 scholarly resources, with at least 2 from the Rasmussen library.

Include at least 3 in-text citations.

Use proper APA format.




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