Managed Care Organization 2 – Reflect on and evaluate the role that the managed care organization (MCO) plays in today’s health care environment – Best Answer

Managed Care Organization 2 – Reflect on and evaluate the role that the managed care organization (MCO) plays in today’s health care environment

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:

1. What is a health care organization’s administrative role in executing risk management policies and ensuring compliance with managed care organization (MCO) standards?
2. 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.
3. 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.

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What is the purpose of managed care organizations

Managed care organizations (MCOs) are a type of healthcare organization that was first introduced in the United States in the early 1980s. They are now present in most developed countries.

An MCO is a type of healthcare organization that contracts with other healthcare providers, such as hospitals, to provide care for its patients. These other healthcare providers then bill the MCO for the services they provide to the patients. This system is different than traditional healthcare systems where the government pays hospitals and doctors to provide care for its citizens.

The main purpose of an MCO is to take on the responsibility for managing a patient’s health and providing them with access to quality care. This allows MCOs to focus on their core business: providing health insurance services to their members.

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Another purpose of MCOs is to drive down the cost of healthcare. By contracting with other providers, they are able to offer lower prices than traditional healthcare systems. This lowers the overall cost of healthcare for their members, who may then use this savings to purchase health insurance products from an MCO.

Lastly, MCOs can help improve patient satisfaction rates by providing them with access to a variety of providers and care options.

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Related FAQs

1. What is the role of a managed care organization?

A managed care organization is a single organization which manages the financing, insurance, delivery and payment to provide health care services. Financing – the MCO and employer negotiates a fixed premium per enrollee and the health services provided in the contract.

2. What is a health care organization’s administrative role in executing risk management policies?

A healthcare organization administrator manages risk by identifying and evaluating risk as a way of lessening harm to patients, visitors, and workers. The administration works proactively as well as reactively to avert incidence or lessen the damages caused by an event.

3. What is an example of a managed care organization?

A good example of a managed care plan is a Health Maintenance Organization (HMO). HMOs closely manage your care. Your cost is lowest with an HMO. You are limited to seeing providers in a small local network, which also helps keep costs low.

4. What is a managed care environment?

Managed care plans are a type of health insurance. They have contracts with health care providers and medical facilities to provide care for members at reduced costs. These providers make up the plan’s network. How much of your care the plan will pay for depends on the network’s rules.

5. What is the role and purpose of risk management in healthcare?

Risk management cuts across a health system’s entire ecosystem, impacting everything from patient safety and compliance to operations, HR, and operating margins. Risk managers in the healthcare industry are trained to identify, evaluate, and mitigate risks to patients, staff, and visitors

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