Reflective Analysis: Risk Management and the Role of Managed Care
Develop a 250-500 word reflection to incorporate the following:
1.What is a health care organization's administrative role regarding oversight of risk management policies and ensuring compliance with managed care organization (MCOs) standards?
2.What is your assessment of the value provided to an organization that stems from the regulatory statutes of a typical MCO? Consider the establishment of conflict resolution and risk management strategies within the health care organization from the employer/employee perspective as well as in regards to patient conflict circumstances.
3.What MCO responsibilities pertain to the Patient Protection and Affordable Care Act (PPACA) and Center for Medicare and Medicaid Services (CMS) focus on fraud, waste, and abuse laws?
Please include introduction and conclusion
Reflective Analysis
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Reflective Analysis
Health care provision has been a major headache in the United States. To provide a cheaper option, managed care delivery system was established. The system is aimed towards managing cost, quality, and utilization (Paul et al., 2014). Managed care organizations are tasked with delivering “Medicaid health care programs”. These organizations have a complex risk management role. Moreover, they have to ensure quality while complying with all the set regulations. MCO’s must therefore be diligent on how they manage risks.
Health care organizations have an important administrative role to play in overseeing risk management policies and ensuring compliance with standards that have been set for the MCOs. The most important role is to ensure that there is sufficient staffing. Moreover, they need to ensure that they have sufficient clinics for the provision of Medicaid healthcare services (Kongstvedt, 2012). It is also the administrative role of the health care organizations to ensure that they provide quality care to the Medicaid beneficiaries.
Any organization that stems from the regulatory statutes of a typical MCO can gain important values especially in conflict ...
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