Managed care and health insurance

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Reference no: EM13739137

Managed Care and Health Insurance:

What are the most critical components of state regulation for managed care organizations? And which federal regulations also bring specific requirements for the operation of such entities? Discuss state and federal regulation of MCOs.

What will be the primary impacts of PPACA on managed care organizations. Consider both positive and negative impacts in your answer.

Project Management:

Case Study 1.

Answer the three questions at the end of the case. Your answers must be supported by the facts of the case. You will be graded on the content of your answers as well as your feedback to other responses.

1.Applying Goldratt's ideas of critical resources, what is the system constraint within the Special Projects Division that is causing bottlenecks and delaying the projects?
2.How is multitasking contributing to systemic delays in project development at Ramstein?
3.How could the drum buffer concepts from Critical Chain Portfolio Management be applied to this problem?

Case Study 2.

Questions

1.What termination method does it appear the company is using with the Regency Project?
2.What are the problems with motivation when project team members perceive that a project is earmarked for termination?
3.Why would you suspect Harry Shapiro has a role in keeping the project alive?

Case Study 1.

Judy's Hunt for Authenticity

Judy Thomas barely had time to celebrate her appointment to head her old department at Optimal Logistics before she became embroiled in an ongoing problem with the project management personnel. As part of her new duties, Judy was responsible for heading all new projects at OL, a job that required her to oversee anywhere from 20 to 35 projects at any time. Judy believed in holding detailed project review meetings every two weeks with her immediate subordinates, the six-person senior systems group, to assess the status of ongoing projects, develop resource assignments for new projects, and generally troubleshoot the project development process. One of the senior programmers' responsibilities was to develop a Work Breakdown Structure for new projects and, after consulting with the junior and lead programmers, give a preliminary estimate of the time frame needed to complete the assignment.

Judy soon noticed that her senior programmers had a much more pessimistic assessment of the time needed to complete projects than her own view. In particular, all project assignments seemed to her to be grossly overestimated. As a former programmer herself, with more than 10 years' experience, Judy had a hard time understanding how the programmers and the senior systems managers were coming up with such lengthy estimates.

The problem came to a head one afternoon when she received an assessment for a routine reprogramming job that was estimated to take more than 120 hours of work. Holding the assessment in her hand, she determined to find out how this figure had been derived. Judy first approached the lead programmer, Sid, as he sat at his desk.

"Sid, this estimate from you shows that you requested 32 hours to upgrade an online system that only needs minor tweaks. What gives?"

Sid reacted with a start. "I never put down 32 hours. Randy asked me for my estimate and I told him I thought it would take about 24 hours of work."

Judy pursed her lips. "Well, I need to talk about that with Randy. Even allowing for the fact that you requested 24 hours instead of 32, Sid, you and I both know that the work we are estimating should not take anywhere near that much time to finish."

Sid's response did not improve Judy's confidence. "Um, well, Judy, the thing is ... I mean, you have to understand that there are a lot of other projects I am working on right now and ..."

Judy interrupted, "I'm not concerned with your other assignments right now, Sid. I am trying to get a handle on this estimate. How did you get 24 hours?"

Sid squirmed in his seat. Finally, he cleared his throat and looked Judy in the eye. "Judy, the fact is that I have seven projects going on right now. If you pulled me off the other six, I could get that routine finished in about six hours, but I don't have six uninterrupted hours. Plus, you know how Randy works. If I give him an honest estimate and miss it, even if it isn't my fault, he never lets me forget it. Put yourself in my position for a moment: How would you handle this job?"

Judy walked back to her desk in a thoughtful mood. "Maybe the problem around here isn't our ability to develop accurate estimates," she thought. "Maybe it's the culture that is pushing us to avoid being authentic with each other."

Case Study 2.

The Project That Wouldn't Die

Ben walked into his boss's office Tuesday morning in a foul mood. Without wasting any time on pleasantries, he confronted Alice. "How on earth did I get roped into working on the Regency Project?" he asked, holding the memo that announced his immediate transfer. Alice had been expecting such a reaction and sat back a moment to collect her thoughts on how to proceed.

The Regency Project was a minor legend around the office. Begun as an internal audit of business practices 20 months earlier, the project never seemed to get anything accomplished, was not taken seriously within the company, and had yet to make one concrete proposal for improving working practices. In fact, as far as Ben and many other members of the company were concerned, it appeared to be a complete waste of time. And now here Ben was, assigned to join the project!

Ben continued, "Alice, you know this assignment is misusing my abilities. Nothing has come from Regency; in fact, I'd love to know how top management, who are usually so cost conscious, have allowed this project to continue. I mean, the thing just won't die!"

Alice laughed. "Ben, the answer to your question can be easily found. Have you bothered taking a look at any of the early work coming out of Regency during its first three months?" When Ben shook his head, she continued, "The early Statement of Work and other scope development was overseen by Harry Shapiro. He was the original project manager for Regency."

All of a sudden, light dawned on Ben. "Harry Shapiro? You mean Vice President Harry Shapiro?"

"That's right. Harry was promoted to the VP job just over a year ago. Prior to that, he was responsible for getting Regency off the ground. Think about it-do you really expect Harry to kill his brainchild? Useless or not, Regency will be around longer than any of us."

Ben groaned, "Great, so I'm getting roped into serving on Harry's pet project! What am I supposed to do?"

Alice offered him a sympathetic look. "Look, my best advice is to go into it with good intentions and try to do your best. I've seen the budget for Regency, and top management has been trimming their support for it. That means they must recognize the project isn't going well. They just don't want to kill it outright."

"Remember," Alice continued, "the project may not die because Harry's so committed to it, but that also means it has high visibility for him. Do a good job and you may get noticed. Then your next assignment is bound to be better." Alice laughed. "Heck, it can't be much worse!"

Reference no: EM13739137

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