Reflective Analysis: Risk Management and the Role of Managed Care

The purpose of this assignment is to analyze the role of managed care organizations within health care and risk management programs.

Reflect on and evaluate the role that the managed care organization (MCO) plays in today’s health care environment by developing a 250‐500-word response that addresses the following:

What is a health care organization’s administrative role in executing risk management policies and ensuring compliance with managed care organization (MCO) standards?

What value do the regulatory statutes of a typical MCO provide to a health care organization? Consider how strategies pertaining to policies such as conflict resolution and risk management affect patients as well as employees and employers.

What MCO responsibilities relevant to the Patient Protection and Affordable Care Act (ACA) and Center for Medicare and Medicaid Services (CMS) focus on fraud, waste, and abuse laws?

In addition to your textbook, you are required to support your analysis with a minimum of two peer‐reviewed references.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required

Shawna, a new staff member, has been working from 7 a.m. to 3 p.m. on an infectious disease floor since obtaining her RN license 4 months ago. Most of the staff members with whom she works with have been there since the unit opened 5 years ago. On a typical day, the staffing consists of a nurse manager, two RNs, an LPN, and one technician for approximately 40 patients. Most patients are HIV-positive with multisystem failure. Many are severely debilitated and need help with their activities of daily living. Although the staff members encourage family members and loved ones to help, most of them are unavailable because they work during the day. Several days a week, the nursing students from Shawna’s community college program are assigned to the floor.

Tina, the nurse manager, does not participate in any direct patient care, saying that she is “too busy at the desk.” Laverne, the other RN, says the unit depresses her and that she has requested a transfer to pediatrics. Lynn, the LPN, wants to “give meds” because she is “sick of the patients’ constant whining,” and Sheila, the technician, is “just plain exhausted.” Lately, Shawna has noticed that the other staff members seem to avoid the nursing students and reply to their questions with annoyed, short answers. Shawna is feeling alone and overwhelmed and goes home at night worrying about the patients, who need more care and attention. She is afraid to ask Tina for more help because she does not want to be considered incompetent or a complainer. When she confided in Lynn about her concerns, Lynn replied, “Get real-no one here cares about the patients or us. All they care about is the bottom line! Why did a smart girl like you choose nursing in the first place?”

Respond to each question in 150 to 200 words per question and include 4 reference in APA 7th format. 

1. Identify at least 5 problems in the case study. 

2. Explain why these are problems and what types of dilemma they present *

3. Determine the additional information needed to develop a solution for the problems. *

4. Include bias that each person in the scenario might have which could affect the problems and solutions. *

5. List and explain at least 4 solutions to the problems. *

6. Discuss both positive and negative outcomes for each solution solutions.

7. Determine the best possible FINAL solution. [stated clearly] *

You (the LPN) are working in an urgent care center on a team with an RN, Physician, and NP. You receive a client (54 year-old-male) who is complaining of acute lower back pain that began four hours ago. The client has no previous history of back pain and denies any recent injury. The client has a history of hypertension and Marfan Syndrome. You perform data collection, and the client’s vital signs are: 174/90, 112, 24, 98.0 PO. You note that the client’s skin is cool and clammy. The RN performs an assessment and notes a pulsatile mass in the client’s abdomen. His lungs are clear, and his pulse is regular. The physician orders two large bore IV’s to be inserted but no IV fluids and nitroglycerine to lower his blood pressure.

Answer the following questions:

Question # 1: What is the significance of the client’s history of Marfan Syndrome? (5-10 sentences)

Question # 2: What vital sign(s) should the LPN immediately report? Why? (5-10 sentences)

Question # 3: What is the significance of the “pulsatile mass” (5-10 sentences)

Question # 4: Why did the physician order IV’s but no IV fluids? (3 sentences)

Question # 5: Why does the client need to have his blood pressure lowered? (3 sentences)

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

The growth, development, and learned behaviors that occur during the first year of infancy have a direct effect on the individual throughout a lifetime. For this assignment, research an environmental factor that poses a threat to the health or safety of infants and develop a health promotion that can be presented to caregivers.

Create a 10-12 slide PowerPoint health promotion, with speaker notes, that outlines a teaching plan. For the presentation of your PowerPoint, use Loom to create a voice over or a video. Include an additional slide for the Loom link at the beginning, and an additional slide for references at the end.

In developing your PowerPoint, take into consideration the health care literacy level of your target audience, as well as the demographic of the caregiver/patient (socioeconomic level, language, culture, and any other relevant characteristic of the caregiver) for which the presentation is tailored.

Include the following in your presentation:

1. Describe the selected environmental factor. Explain how the environmental factor you selected can potentially affect the health or safety of infants.
2. Create a health promotion plan that can be presented to caregivers to address the environmental factor and improve the overall health and well-being of infants.
3. Offer recommendations on accident prevention and safety promotion as they relate to the selected environmental factor and the health or safety of infants.
4. Offer examples, interventions, and suggestions from evidence-based research. At least three scholarly resources are required. Two of the three resources must be peer-reviewed and no more than 6 years old.
5. Provide readers with two community resources, a national resource, and a Web-based resource. Include a brief description and contact information for each resource.

Refer to the resource, “Creating Effective PowerPoint Presentations,” located in the Student Success Center, for additional guidance on completing this assignment in the appropriate style.

Refer to the resource, “Loom,” located in the Student Success Center, for additional guidance on recording your presentation.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

Assignment Content

1. Resource: Annotated Bibliography Template

   Finalize your sustainability initiative by combining parts 1 through 5 of the sustainability initiative assignments:

   • Sustainability initiative proposal
   • Analysis of the costs and benefits associated with your initiative
   • Evaluation of how your initiative will improve patient care and outcomes
   • Evaluation of how your initiative will reduce waste
   • Suggestions for community partnerships and education programs
   • Petition to the leadership for resources to enact the initiative
   • Compile a 6- to 8-page paper of your sustainability initiative. Include diagrams, flowcharts, and other visuals that support your initiative.

     Create an annotated bibliography that contains each article you identified in the Weeks Two through Five Article Search assignments and include it in your paper.

     Cite 3 reputable references to support your assignment (e.g., trade or industry publications, government or agency websites, scholarly works, or other sources of similar quality).

     Format your assignment according to APA guidelines.