Describe the basic components of quality and utilization management, including structure, process, and outcome. Identify and describe the basic structure of governance and management in payer organizations.

HE380 Managed Healthcare.

Part I

For each of the lessons you were presented with two required readings. Choose one required reading article from each lesson and summarize the article and explain its importance to understanding managed care. Each summary should be a minimum of 250 words. Combine all summaries into one Word document.

Part II

Explain why the following course objectives are important to understanding managed care:

5. Describe the basic components of quality and utilization management, including structure, process, and outcome.

6. Identify and describe the basic structure of governance and management in payer organizations.

7. Understand the basic issues involved with Medicare Advantage and managed Medicaid plans.

8. Describe the basic structure of state and federal oversight of managed care organizations (MCOs).

Include at least 3 scholarly articles as a part of your response as well as a minimum word count of 750 words. Overall response will be formatted according to APA style and the total assignment of Part II should be between 3-6 pages, not including title page and reference page.