3 pages/≈825 words
Health, Medicine, Nursing
Managed Care Organizations and Integrated Health Care Networks (Essay Sample)
Answer each problem in a short paragraph of 70- 80 words. Submit the assignment in a single Microsoft Word document. 1. Discuss risk management's role in managed care organizations (MCOs). 2. Explain the patients' conflict regarding an MCO and the family physician 3. Define MCO. 4. Discuss the types of MCOs. 5. Discuss the regulatory statutes regarding MCOs. 6. Explain the future resolution of conflict between MCOs and risk management. 7. What is an integrated health care network? 8. Define the four most common types of integrated health care networks. 9. What kind of cultural issues face risk management in the conversion to an integrated health care network? 10. What are the legal issues faced by risk management regarding health care networks? 11. What are some areas of liability in integrated health care networks? 12. Explain the duties of a risk manager. Please my instructor grade using turn it in and Plagerized paper would not be accepted. Please ensure you put the questions above the answer. Thank you! source..
Managed Care Organizations and Integrated Health Care NetworksName: Course: Instructor: Date: 1. Discuss risk management's role in managed care organizations (MCOs). The role of risk management is to identify risks inherent in managed care organizations, and hence limit financial losses and injuries, patients, visitors and employees. However, the healthcare sector is ever evolving, with laws, new regulatory frameworks, and regulations placing increased risks on risk managers in identifying and mitigating risks. Thus, the management has the obligation to provide quality health care as this would reduce costs, risk exposure of lawsuits, but will also increase patient satisfaction. Explain the patients' conflict regarding an MCO and the family physician MCOs and physicians need to be cost effective, but this may bring conflicts with patients because physicians may typically spend lest time with patients. In essence, physicians result to spend less time on evaluating patients’ in order to cut on costs. A conflict arises in the physical patient relationship as both have different perspectives on the appropriate visit length time. Health insurance policies may lead to conflicts physician patient conflicts as cost implications are at times a disincentive to physicians. Define MCO. A managed care organization is a network of health care providers for providing quality health care at a low cost. These organizations came into being after integration of business models in the health care to improve on efficiency. Through coordinated efforts, MCOs provide health care, but patients typically choose their physicians among those available in the network. An MCO goes beyond primary health care provision as patients may be referred to specialists within the network unlike traditional healthcare organizations. Discuss the types of MCOs. There are no clear guidelines on categorizing managed care organizations, but differences arise in care plans providers. Preferred provider organizations (PPO) refer to entities that cater for health insurances for employees among a pool of participating providers. Point of service (POS) are a mix of other plans where members can seek the servicers of providers outside the plan if necessary (Kongstvedt, 2007). Exclusive provider organizations (EPO) allow members to receive services solely from providers under these plans (Kongstvedt, 2007). Discuss the regulatory statutes regarding MCOs. Various States in America have different laws that govern managed care, but all aim to protect patients, with most of acts legislated in the years1992-2002. Consumer protections also extends to benefits under insurance policies including the selected benefit mandates under Alabama law Ala. Code § 27-1-10.1 (1997) of 1997 (ILRU, 2004). In Arizona, managed care organizations need to disclose material information pertaining to penalties or incentives from health care providers under Ariz. Rev. Stat. Ann. § 20-1076(A)(6) (West 1997) (I...
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