You are the new CFO, of UMUC Medical Center, a 120 multi-skilled level three (3) healthcare facility. You have summoned a team of healthcare and business experts to assist with the process of contract negotiating. Based on the federal mandate of the Affordable Care Act (ACA), prepare a proposal summarizing the team’s final recommendations in preparation for an upcoming meeting. 

Devise a proposal that addresses the following:

• Present a four to five (4-5) page proposal recommending the team’s final decision based on the review of National Committee on Quality Assurance (NCQA), 2016-2017 health insurance plans rating that can be located directly at http://healthinsuranceratings.ncqa.org/2016/Default.aspx. The proposal must identify the following:
  • Conduct a one (1) page analysis of the ACA and its future implications on managed care organizations (in particularly in reference to reimbursement)
  • Create a one (1) page checklist that will be utilized as a tool to review managed care contracts presented to the organization.
  • A one year (1) financial analysis as a predictive measure/tool projecting the financial performance based on the adoption of the selected health plan and reimbursement model [based on fictitious data and figures]
  • Identify at minimum three (3) involved parties the team recommends as a contributing player in the review of all managed care contracts under consideration. Briefly, support your reasoning for each recommended person to participate in the review.
•  Submit one (1) single Microsoft Word document  

Resources:

Successfully Negotiating Managed Care Contracts: http:// Care Answer Guide: http:// Care Contracts – Key Provisions for Providers  https://corporate.findlaw.com/law-library/managed-care-contracts-key-provisions-for-providers.html

National Council on Disability (2013).  Chapter 1. An Overview of Medicaid Managed Care.  https:// R. (1998, September/October).  Negotiating or renegotiating managed care contracts.. Medical Group Management Journal. pp. 66-71.  (In Week 4 Learning Resources)

Managed Care Contracting Toolkit: https:// Managed Care Contract Template: https://

I need help filling in this case study with information I don’t even know where to begin. Hopefully there is a person who has nursing experience that can help me fill this in.

There are bacteria adapted to survive in every kind of habitat. There are marine bacteria and freshwater bacteria –and even some that thrive only in brackish waters, which are part marine and part fresh. Lately, bacteria that live in brackish waters have been causing serious wound infections, and even some deaths,in humans.                               

In 2006, a mortgage broker in his 30s fell into a harbor in Hawaii 6 days after a sewage pipe failure had allowed 48 million gallons of sewage to flow into the harbor water. The man was admitted to the hospital, and within days he died from massive organ failure caused by septicemia with Vibrio Vulnific

You may be familiar with Vibrio cholerae, the diarrhea agent. Its relative, V. vulnificus, tends to invade breaks in the skin and then proliferate in the bloodstream, often causing massive infections necessitating amputation, and sometimes even leading to death.

Case Study Title:

Step 1: (Find Relevant Material in Case Study)

Purpose:

Your Notes:

Situation

Reason for visit, signs, symptoms, & age.

Background

Medical history, lab results, and allergies.

Assessment

What do you think the problem is?

Recommendation

Treatment.

Step 2:       

Your Answers:

Signs:

Symptoms:

Test & Results from Test

(Required for Diagnosis):

Organism:

Disease:

Treatment:

Epidemiology:

Answers to Case Study:

1.Once the man was admitted to the hospital, what steps would you take to determine what

was making him ill?

2. If you were a public official in charge of Hawaii’s recreational waters, how would you determine when the waters were safe again?

This is the template that I have to use to put the information into.

References: