Managed Care Models Nursing Essay Managed Care Models Nursing Essay Health Buy Cheap Essays, Nursing health Details: In this assignment, you will be writing a 1,000-1,250-word essay describing the differing approaches of nursing leaders and managers to issues in practice. To complete this assignment, do the following: Select an issue from the following list: nursing shortage and nurse turn-over, nurse staffing ratios, unit closures and restructuring, use of contract employees (i.e., registry and travel nurses), continuous quality improvement and patient satisfaction, and magnet designation. Compare and contrast how you would expect nursing leaders and managers to approach your selected issue. Support your rationale by using the theories, principles, skills, and roles of the leader versus manager described in your readings. ORDER INSTRUCTIONS-COMPLIANT NURSING PAPERS Identify the approach that best fits your personal and professional philosophy of nursing and explain why the approach is suited to your personal leadership style. Use at least two references other than your text and those provided in the course. Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required. This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment. You are required to submit this assignment to Turnitin. Refer to the directions in the Student Success Center. Only Word documents can be submitted to Turnitin. RUBRIC Benchmark ? Effective Approaches in Leadership and Management 1 Unsatisfactory 0.00% 2 Less than Satisfactory 71.00% 3 Satisfactory 79.00% 4 Good 89.00% 5 Excellent 100.00% 80.0 %Content 40.0 %Compare and contrast how you would expect nursing leaders and managers to approach your selected issue. Support your rationale by using the theories, principles, skills, and roles of the leader versus manager described in your readings. The comparison and contrast of how you would expect nursing leaders and managers to approach your selected issue is not provided. The comparison and contrast of how you would expect nursing leaders and managers to approach your selected issue is provided; however, relevant information is missing, such as not providing support for your rationale by using the theories, principles, skills and roles of the leader versus manager described in your readings, or not providing at least two references beyond your text. The comparison and contrast of how you would expect nursing leaders and managers to approach your selected issue is provided and meets the basic criteria for the assignment as indicated by the assignment instructions. The comparison and contrast of how you would expect nursing leaders and managers to approach your selected issue meets all criteria for the assignment, and is provided in detail. The comparison and contrast of how you would expect nursing leaders and managers to approach your selected issue meets all criteria for the assignment, is provided in detail. Higher level thinking is demonstrated by incorporating prior learning or reflective thought. 40.0 %Identify the approach that best fits your personal and professional philosophy of nursing and explain why the approach is suited to your personal leadership style. Managed Care Models Nursing Essay The identification of the approach that best fits your personal and professional philosophy of nursing is not provided. The identification of the approach that best fits your personal and professional philosophy of nursing is provided; however, relevant information is missing, such as an explanation to why the approach is suited to your personal leadership style. The identification of the approach that best fits your personal and professional philosophy of nursing is provided and meets the basic criteria for the assignment. The identification of the approach that best fits your personal and professional philosophy of nursing, along with an explanation to why the approach is suited to your personal leadership style, is provided in detail. The identification of the approach that best fits your personal and professional philosophy of nursing meets all criteria for the assignment, and is provided in detail. Higher level thinking is demonstrated by incorporating prior learning or reflective thought. 15.0 %Organization and Effectiveness 5.0 %Thesis Development and Purpose Paper lacks any discernible overall purpose or organizing claim. Thesis and/or main claim are insufficiently developed and/or vague; purpose is not clear. Thesis and/or main claim are apparent and appropriate to purpose. Thesis and/or main claim are clear and forecast the development of the pap. It is descriptive and reflective of the arguments and appropriate to the purpose. Thesis and/or main claim are comprehensive; contained within the thesis is the essence of the paper. Thesis statement makes the purpose of the paper clear. 15.0 %Organization and Effectiveness 5.0 %Paragraph Development and Transitions Paragraphs and transitions consistently lack unity and coherence. No apparent connections between paragraphs are established. Transitions are inappropriate to purpose and scope. Organization is disjointed. Some paragraphs and transitions may lack logical progression of ideas, unity, coherence, and/or cohesiveness. Some degree of organization is evident. Paragraphs are generally competent, but ideas may show some inconsistency in organization and/or in their relationships to each other. A logical progression of ideas between paragraphs is apparent. Paragraphs exhibit a unity, coherence, and cohesiveness. Topic sentences and concluding remarks are appropriate to purpose. There is a sophisticated construction of paragraphs and transitions. Ideas progress and relate to each other. Paragraph and transition construction guide the reader. Paragraph structure is seamless. 15.0 %Organization and Effectiveness 5.0 %Mechanics of Writing (includes spelling, punctuation, grammar, language use) Surface errors are pervasive enough that they impede communication of meaning. Managed Care Models Nursing Essay Inappropriate word choice and/or sentence construction are used. Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register); sentence structure, and/or word choice are present. Some mechanical errors or typos are present, but are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used. Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used. Writer is clearly in command of standard, written, academic English. 5.0 %Format 2.0 %Paper Format (use of appropriate style for the major and assignment) Template is not used appropriately or documentation format is rarely followed correctly. Template is used, but some elements are missing or mistaken; lack of control with formatting is apparent. Template is used, and formatting is correct, although some minor errors may be present. Template is fully used; There are virtually no errors in formatting style. All format elements are correct. 3.0 % Research Citations (In-text citations for paraphrasing and direct quotes, and reference page listing and formatting, as appropriate to assignment) No reference page is included. No citations are used. Reference page is present. Citations are inconsistently used. Reference page is included and lists sources used in the paper. Sources are appropriately documented, although some errors may be present. Reference page is present and fully inclusive of all cited sources. Documentation is appropriate and GCU style is usually correct. In-text citations and a reference page are complete. The documentation of cited sources is free of error. 100 %Total Weightage]]> Managed Care Models Nursing Essay Order Now

ADDITONAL INFORMATION 

Managed Care Models

Introduction

There are two main types of managed care: fee-for-service and capitation. Fee-for-service plans pay doctors and hospitals based on the amount of time they spend with patients; capitation plans pay a fixed amount to providers for each member enrolled in their program.

Fee for Service

Fee for service is the most common form of healthcare in the United States, and it’s also what most people think about when they hear “managed care.” Fee for service means that patients pay their providers directly for services.

The patient pays the provider directly for services, and then bills insurance companies or other third parties—like Medicare—for any remaining balance due at the end of a visit. The insurance company determines if there’s enough money left over after covering expenses related to each visit (including deductibles) so that it can pay out some portion of your bill; otherwise, you’ll be responsible for paying all or part of your deductible before any treatment is covered by insurance coverage.

Capitation

Capitation is a form of health insurance in which the insurance company pays a set amount to the health care provider for each patient enrolled in the plan. The provider is then responsible for providing all services for that patient, which can include everything from medical care to mental health counseling.

Capitated plans are used mostly by large employers who want their employees’ healthcare costs covered by an outside entity rather than having them pay out of pocket or through an employee-funded benefit plan like HSA funds or Flexible Spending Accounts (FSAs). They may also be used by individuals who don’t qualify for Medicare but still need some form of coverage.

Defined Benefit Plan

A defined benefit plan is a health plan that pays a fixed amount for each medical service. The health plan will pay the same amount regardless of what treatment you receive or how much it costs to treat your illness. A defined benefit plan can be used by employers as well as individuals, but they are more common with large companies and unions because they provide more predictable costs and lower administrative expenses than self-funded plans do.

Defined benefit plans have been around since the 1920s when doctors first began designing them to compensate employees for covered injuries or illnesses while working at their jobs. However, these types of plans were not commonplace until after World War II when employer-sponsored insurance became popular among businesses across America due to high unemployment rates during those years—and many employers wanted something other than wage replacement when hiring new employees again after returning home from serving overseas during WW II (or even just staying stateside).

Defined Contribution Plan

A defined contribution plan (also known as an employer-sponsored health insurance or self-funded ERISA plan) is a type of managed care that allows individuals and employers to contribute money toward their health care costs. In this model, individuals pay premiums for coverage and the insurer pays for covered services. Generally speaking, insurers are responsible for paying a set amount per month or year; however, some plans may offer different levels of benefits depending on how much you pay annually.

Exclusive Provider Organization (EPO)

The Exclusive Provider Organization (EPO) is a form of managed care that contracts with physicians to provide their services. In this model, each member pays a higher premium than members of other health plans because they must use doctors and hospitals that are part of the EPO network.

Managed care is designed to provide health services to members who pay for some or all of the costs through a monthly premium.

Managed care is a system of health care delivery that provides care through a network of health care providers. It aims to provide access to quality, affordable services for all members at an equitable level.

Managed care models differ in terms of how they deliver services and who pays for them—they fall into one of three categories:

• Traditional fee-for-service (FFS) – FFS means that patients pay directly for each service provided by their doctors; this model is used in most Medicare Advantage plans and employer-sponsored retiree plans.

• Point-of-service (POS) – POS means that members pay an annual membership fee plus co-pays or deductibles on any covered medical expenses; this model is used by some employers and many managed Medicaid programs

Conclusion

Managed care is designed to provide health services to members who pay for some or all of the costs through a monthly premium.

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