MANAGED CARE ORGANIZATIONS Managed Care Organizations

Managed Care Organizations

1.Discuss risk management's role in managed care organizations (MCOs)

Risk management role in MCOs is to provide health care in a broad framework. The area defined should be fixed. The managed care organizations are meant to deliver services at a fixed price. Many strategies are also used by them to control costs.

2.Explain the patient's conflict regarding MCO and the family physician

Many physicians have a conflict with MOCs and family physicians which arise as a result of which physicians are undermined.

3.Define MCO

A managed care organization (MCO) is a health insurance plan with a group of doctors and other providers working together to provide medical services to members. In managed care, you are a member of a managed care organization (MCO) or program in the state (Margaret, 1992).

4.Discuss the types of MCOs

There are various types of MCOs, which are described, as follows:

1.Staff-model HMO

2.Group-model HMO

3.Network-model HMO

4.Independent-Practice Association model

5.Direct-contract-model HMOs

6.Point of Service (POS) HMO

7.Preferred Provider Organization

8.Exclusive Provider Organization

9.Physician-Hospital Organizations (PHOs)

5.Discuss the regulatory statutes regarding MCOs

Majority of Americans receives health benefits through proper managed care settings. Apart from these services 20% of them are directly provided to the health management organization. Apart from these others are served through Preferred provider organizations. Furthermore, 30% are provided by point of service plan. The Health Tracking Service summarizes the change of state regulatory agencies. . The HMO laws are practiced and remain in place since the year 2000 (Peter, 2001).

6.Explain the future resolution of conflict between MCOs and risk management.

The risk reduction strategy is to control the decision making from MCOs to doctors. The care has always been managed. The old system of care was doctor managed while the new system is corporate managed care. This care is welcomed by many patients as it maintains a sense of equality of the relationship. The focus of care is to help the person through self managed care.

7.What is an integrated health care network?

It is a type of health care system which provides support to the participating patients, physicians and practice teams in order to manage chronic diseases. These networks are customized for the patients and help in accessing the patient's needs directly. The patient is considered as the main key partner in this health care system.

8.Define the four most common types of integrated health care networks.

The common types of integrated health care networks are:

Functional: It deals with the functioning of support functions and Activities. They deal with the overall value of the system.

Physician: It is the system which deals with the extent to which the delivery system are organized and associated with the aims and objectives which are to be achieved through mutual share.

Clinical: It deals to the extent which the care services are coordinated with people and functions and activities associated with them. Virtual: It is associated with the arms length relationships which are made through joint alliances and mutual ventures (Cox, 2010).

9.What kind of cultural issues faces risk management in the conversion to an integrated health care network?

There are ...