Students will submit a written review assignment about a health insurance and reimbursement topic from the text that will be discussed. After reading the assigned chapters for this week, the student will discuss one (1) of the identified discussion topics for this week found at the beginning of each chapter. Once completed, the weekly written assignment will be posted to the assignment link. These assignments are designed to promote the students ability to convey their thoughts and ideas in writing on the challenges inherent in providing health care coverage for individuals as well as providing reimbursement to those who provide care. Each written assignment will be limited to four (4) double spaced pages not including the title page or reference page. 6th Edition APA format required. Please use at least 3 references. For this assignment, please choose one of the below questions: CHAPTER 9 1. Describe the routine actions a payer should take to positively influence provider behavior. 2. What behavior on the part of a payer would likely engender negative provider behavior? 3. Develop policies and procedures for a physician sanction program to deal with unacceptable physician behavior. 4. Describe common physician perceptions, both negative and positive, of managed care. What steps might a health maintenance organization take in regard to those perceptions? 5. How might an organized provider system approach physician behavior change in contrast to a payer? CHAPTER 11 1. Discuss the market forces, trends, and changes in the drug benefit over the past 15 years. 2. Discuss the essential elements of a managed care pharmacy benefit management program. 3. Identify the components of pharmacy program costs and discuss the implications of each. 4. Discuss the advantages and disadvantages for a managed care plan in using a PBM to manage its pharmacy services. 5. Discuss the impact of prescription copayments, cost-sharing, and formulary tiering on pharmacy program costs, drug access, and utilization. The book used for this course: Essentials in Managed Health Care 6th Ed. By: Peter R. Kongstvedt
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