1. What do case managers do?
2. Is it advantageous to combine preadmission and concurrent review with case management services?
3. Describe the case management process.
4. When does discharge planning begin?
5. What do structural measures of health care quality focus on? Give examples.
6. What do process measures of health care quality focus on? Give examples.
7. What do outcomes measures of health care quality focus on? Give examples.
8. Assess the relevance of Donabedian’s criteria of assessing quality of care.
9. What are some traditional outcome measures of quality of care?
10. What do patient satisfaction surveys show?
11. What are appropriateness criteria used for?
12. What is upcoding?
13. Why did Congress establish “safe harbors”?
14. Can MCOs face liability for not choosing a particular physician to participate in their network?
15. What does ERISA do to the regulation of health plans?
16. What agencies are responsible for investigating violations of anti-trust?
17. What does HIPAA do and who does it apply to?
18. Have labor unions been supportive of HMOs?
19. Who regulates managed care?
20. What does demand management “manage”? Give some examples.