Title: Health Records and Managed Care
Course: HIM 2012 Health Law > Section: Module 3 - Health Records and Managed Care

Introduction

The healthcare environment is constantly changing.  Managed  care brings a variety of medical practice arrangements  and numerous health care specialties that need to understand healthcare law.  Due to the rise of malpractice suits, physicians are protecting themselves  by ordering multiple testing procedures- some that may not be necessary.  In addition, patients want newer tests that are more expensive.

Managed care is a method of restructuring the healthcare system.  Managed care provides incentives to keep the cost of healthcare down by  administratively managing an enrolled population of patients.  The goal of managed care is to offer medical care at lower costs by decreasing the amount of unnecessary medical procedures.  Three common models of managed care organizations are health maintenance organization (HMO), preferred provider organization (PPO) and the exclusive provider organization(EPO).

Objectives

Upon completion of this module, the student will be able to
- Discuss the role of managed care
- Describe health maintenance organizations (HMO)
- Discuss joint ventures and preferred provider organizations (PPOs)

Readings & Resources

Required reading:  Brodnik, Melanie.  Fundamentals of Law for Health Informatics and Information Management.  AHIMA Press.  Current edition. (Chapter 6)

Optional reading:  Pozgar, George.  Legal Aspects of Health Care Administration.  Jones and Bartlett Learning.  Current edition.  (Chapter 23)
American Society of Law, Medicine and Ethics
American Health Information Management Association
Agency for Healthcare Research and Quality
Healthcare Information and Management Systems Society
American Medical Informatics Association
Kaiser Health News

Assignments and Activities

- Read Chp. 6 in the Brodnik text

- Take the Module 3 Quiz
- Post on the Module 3 Discussion Board
- Post the Module 3 Internet Activity
- Continue working on the Health Law Electronic Portfolio (due in Module 10)