Discussion Question

MHA 540 TUI Utilization Management Utilization Review and Case Management Essentials Paper
Assignment Overview With the consistently rising costs of health care services, utilization management and utilization rev …

MHA 540 TUI Utilization Management Utilization Review and Case Management Essentials Paper
Assignment Overview With the consistently rising costs of health care services, utilization management and utilization review are routinely used in the vast majority of current health care settings. How are they evolving over time, and what is involved in these processes? What do health care managers need to be aware of as the processes play out? In the absence of sweeping policy change (or the complete restructuring of the United States health care system), utilization management and utilization review are much more moderate processes to attempt to preserve the quality of care provided while controlling overall health care expenditures. Let’s learn a bit about each of these processes, and how they are implemented in our current health care environment. Case Assignment Using the information in the required readings as well as some additional research in peerreviewed sources, complete your Case Assignment by answering the following: Compare and contrast utilization review and utilization management in health care. What are the similarities and the differences between each type of assessment? (Hint: One is generally a prospective process, and the other is generally a retrospective process). Explain the specific role of each method in providing value-based health care. Who benefits from the method—the health care system, the insurance company, and/or the patient? Articulate how individual case management is critical to a hospital’s long-term survival. In what way does this practice protect your patients while keeping your doors open for business? What are the ethical pitfalls to be aware of in performing these types of quality reviews? What must health care managers be aware of in terms of ethical pitfalls and also potential unintended negative consequences? Assignment Expectations Conduct additional research to gather sufficient information to support your analysis. Provide a response of 3-5 pages, not including title page and references. As we have multiple required items to be addressed herein, please use subheadings to show where you’re responding to each required item and to ensure that none are omitted. Support your paper with peer-reviewed articles and reliable sources. Use at least three references, and a minimum of two of these from peer-reviewed sources. For additional information on how to recognize peer-reviewed journals, see:Angelo State University Library. (n.d.). Library Guides: How to recognize peer-reviewed (refereed) journals. Retrieved from https://www.angelo.edu/services/library/handouts/peerrev.php and for evaluating internet sources:Georgetown University Library. (n.d.). Evaluating internet resources. Retrieved from https://www.library.georgetown.edu/tutorials/research-guides/evaluating-internet-content You may use the following source to assist in your formatting your assignment:Purdue Online Writing Lab. (n.d.). General APA guidelines. Retrieved from https://owl.english.purdue.edu/owl/resource/560/01/. Paraphrase all source information into your own words carefully, and use in-text citations.Module 2 – BackgroundUtilization Management, Utilization Review, and Case Management EssentialsRequired Reading/ViewingView: Baker, J. (2018). Improving quality of care through utilization management [Video file]. Retrieved from https://youtu.be/g-T-YeP53nY Carasso, S. (2017). Is that test necessary? The key to laboratory utilization management.The Journal of Medical Practice Management: MPM, 33(3), 160-164. Retrieved from theTrident Online Library.Desai, S., Gruber, P. F., Eiting, E., Seabury, S. A., Mack, W. J., Voyageur, C., . . . Terp, S. (2017). The effect of utilization review on emergency department operations. Annals of Emergency Medicine, 70(5), 623-631.e1. Retrieved from the Trident Online Library.El-Othmani, M. M., Sayeed, Z., Ramsey, J. A., Abaab, L., Little, B. E., & Saleh, K. J. (2019).The joint utilization management program: Implementation of a bundle payment model and comparison between year 1 and 2 results. The Journal of Arthroplasty, 34(11), 2532-2537.Retrieved from the Trident Online Library.Parast, M. M., & Golmohammadi, D. (2019). Quality management in healthcareorganizations: Empirical evidence from the Baldrige data. International Journal of ProductionEconomics, 216, 133-144. Retrieved from the Trident Online Library.Suklar, S. (2018). Quality assurance system at primary level of healthcare. Izzivi Prihodnosti, 3(1), 21-53. Retrieved from the Trident Online Library.Wakefield, E., Keller, H., Mianzo, H., Nagaraj, C. B., Tawde, S., & Ulm, E. (2018). Reductionof health care costs and improved appropriateness of incoming test orders: The impact ofgenetic counselor review in an academic genetic testing laboratory. Journal of GeneticCounseling, 27(5), 1067-1073. Retrieved from the Trident Online Library.Optional ReadingInstitute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Available at https://www.ncbi.nlm.nih.gov/books/NBK222274/ (Use this link for free full text .pdf download).

MSNFP6026 Capella Biopsychosocial Population Health Policy Proposal
Develop a 2–4-page proposal for a policy that should help to improve health care and outcomes for your target population …

MSNFP6026 Capella Biopsychosocial Population Health Policy Proposal
Develop a 2–4-page proposal for a policy that should help to improve health care and outcomes for your target population.Note: Each assessment in this course builds on the work you completed in the previous assessment. Therefore, you must complete the assessments in this course in the order in which they are presented.Cost and access to care continue to be main concerns for patients and providers. As technology improves our ability to care for and improve outcomes in patients with chronic and complex illnesses, questions of cost and access become increasingly important. As a master’s-prepared nurse, you must be able to develop policies that will ensure the delivery of care that is effective and can be provided in an ethical and equitable manner.Assessment InstructionsScenarioThe analysis of position papers that your interprofessional team presented to the committee has convinced them that it would be worth the time and effort to develop a new policy to address your specific issue in the target population. To that end, your interprofessional team has been asked to submit a policy proposal that outlines a specific approach to improving the outcomes for your target population. This proposal should be supported by evidence and best practices that illustrate why the specific approaches are likely to be successful. Additionally, you have been asked to address the ways in which applying your policy to interprofessional teams could lead to efficiency or effectiveness gains.InstructionsFor this assessment you will develop a policy proposal that seeks to improve the outcomes for the health care issue and target population you addressed in Assessment 1. If for some reason you wish to change your specific issue and/or target population, contact your FlexPath faculty.The bullet points below correspond to the grading criteria in the scoring guide. Be sure that your submission addresses all of them. You may also want to read the Biopsychosocial Population Health Policy Proposal Scoring Guide and Guiding Questions: Biopsychosocial Population Health Policy Proposal to better understand how each grading criterion will be assessed.Propose a policy and guidelines that will lead to improved outcomes and quality of care for a specific issue in a target population.Advocate the need for a proposed policy in the context of current outcomes and quality of care for a specific issue in a target population.Analyze the potential for an interprofessional approach to implementing a proposed policy to increase the efficiency or effectiveness of the care setting to achieve high-quality outcomes.Communicate proposal in a professional and persuasive manner, writing content clearly and logically with correct use of grammar, punctuation, and spelling.Integrate relevant sources to support assertions, correctly formatting citations and references using APA style.Example Assessment: You may use the assessment example, linked in the Assessment Example section of the Resources, to give you an idea of what a Proficient or higher rating on the scoring guide would look like.Additional RequirementsLength of proposal: 2–4 double-spaced, typed pages, not including title page or reference list. Your proposal should be succinct yet substantive.Number of references: Cite a minimum of 3–5 sources of scholarly or professional evidence that supports the relevance of or need for your policy, as well as interprofessional considerations. Resources should be no more than five years old.APA formatting: Use the APA Style Paper Template linked in the Resources. An APA Style Paper Tutorial is also provided to help you in writing and formatting your analysis.ResourcesAssessment ExampleAssessment 2 Example [PDF].Suggested ResourcesThe resources provided here are optional. You may use other resources of your choice to prepare for this assessment; however, you will need to ensure that they are appropriate, credible, and valid. The MSN-FP6026 – Biopsychosocial Concepts for Advanced Nursing Practice II Library Guide can help direct your research, and the Supplemental Resources and Research Resources, both linked from the left navigation menu in your courseroom, provide additional resources to help support you.Access to CareBrooks, E., Dailey, N. K., Bair, B. D., & Shore, J. H. (2016) Listening to the patient: Women veterans’ insights about health care needs, access, and quality in rural areas. Military Medicine, 181(9), 976–981.Caldwell, J. T., Ford, C. L., Wallace, S. P., Wang, M. C., & Takahashi, L. M. (2016). Intersection of living in a rural versus urban area and race/ethnicity in explaining access to health care in the United States. American Journal of Public Health, 106(8), 1463–1469.Linder, J. A. & Levine, D. M. (2016). Health care communication technology and improved access, continuity, and relationships: The revolution will be Uberized. JAMA Internal Medicine, 176(5), 643–644.

Saudi Electronic University Public Health Infrastructure Discussion
Public Health Infrastructure (CRITICAL THINKING ) Identify any public health concern that contributes to health risk …

Saudi Electronic University Public Health Infrastructure Discussion
Public Health Infrastructure (CRITICAL THINKING ) Identify any public health concern that contributes to health risk or disease. Identity at least three agencies that are involved in addressing this health concern. Why is it important for those agencies to collaborate? Please address the topic below: Background facts about the public health concern including incidence and prevalence The role that the three agencies play in public health including their mission and sphere of influence How these agencies collaborate and any challenges to collaboration Your recommendations to facilitate collaboration and effective public health response Provide support for your statements with in-text citations from a minimum of four scholarly articles. Two of these sources may be from the class readings, textbook, or lectures, but the other two must be external. The Saudi Digital Library is a good place to find these references

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