Learn to speak the Managed Care Language (101)

Everyone should be able to walk out of this session feeling empowered by having learned the basic flow of funds (starting at the payer).

About this Event

Healthcare flow of funds explained. Managed Care 101 for healthcare entrepreneurs seeking to do business in the California market. Session led by Alex Yarijanian, CEO Carenodes. The aim: providing healthcare entrepreneurs with a framework within which they will find their place in the business value chain.

Topics covered in this session are as follows:

1. Managed Care Mind

  • Managed care: ‘utilization management’
  • Payment: Volume shift to value
  • Quality (‘value’) measured
  • Patient experience
  • Clinical outcomes

2. Lines of Business aka ‘LOB’ (funding source)

  • Medicare (Traditional Medicare and Medicare Advantage, Parts ABCD)
  • Medicaid (managed Medicaid, state / federal, Medi-Cal)
  • Duals (Medicare and Medicaid beneficiaries)
  • Commercial (on exchange, off exchange)

3. Products (benefit designs)

  • The spectrum of products: HMO, PPO, POS, EPO, FFS
  • Business ramifications

4. Difference between ‘LOB’ vs ‘product’

  • Difference between ‘LOB‘ (Medicare, commercial, etc) vs ‘product‘ (HMO, PPO, etc.)

The video and article link below is of an expanded version of this training https://www.carenodes.com/healthcare-flow-of-funds-explained-healthcare-entrepreneur-bootcamp/

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