Rasmussen College Importance of Case Mix to Managed Reimbursement Methods Paper

To help you to better understand why case mix is important to managed care and reimbursement methods; here are some fictional heart attack mortality rates for three different hospitals. Consider the national average for heart attack death rates to be 16%.

Hospital

Mortality Rate

National Mortality Rate

Hospital A

16.1%

16%

Hospital B

18.6%

Hospital C

15.7%

Part I

Write a 3-4 page report in which you answer the following questions: Explain case mix and why it is important in evaluating different health care providers. Refer to the table of heart attack mortality rates for Hospitals A, B, and C. From your reading this week, what variables might be impacting the rates in the table? Please explain and discuss the use of data analysis for evaluating this kind of information.

Part II

You are a staff member at Hospital B, which has the worst mortality rate from heart attacks as seen in the table. Imagine that the administrator for Hospital B has asked you to appear at a Press Conference to share your knowledge about case mix.

Hospital

Mortality Rate

National Mortality Rate

Hospital A

16.1%

16%

Hospital B

18.6%

Hospital C

15.7%

After participating in the Press Conference, write a 2-page summary to explain the use of date for decision-making purposes, and how the technology department performs critical core business processes essential to the managed care organization.

DISCUSSION

Employers are making an effort to involve employees more in their health care. This is evidenced by the increase in consumer-directed health plans being offered by employers today. Employers feel that the more informed and engaged an employee is, the lower their health care costs will be. Employee engagement is a way for employers to battle rising health care costs and outlook on managed care plans.

What managed care trends do you think affect employers today and which do you think has the greatest impact on employers? Explain your perspective with examples. Do these trends impact small and large employers the same or not?

 

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