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Health, Medicine, Nursing
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Risk Management and Role of Managed Care (Essay Sample)


Throughout this course, you have identified, examined, and provided individual as well as collaborative analysis on multiple facets of risk management in the health care setting.
Addressing the knowledge you have gained, and building on that knowledge to add your evaluation of the role that the managed care organization (MCO) plays in today's health care environment, 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?
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.


Reflective Analysis: Risk Management and Role of Managed Care


Institution Affiliation
Reflective Analysis: Risk Management and Role of Managed Care

Question 1

Healthcare organizations have policies that govern their daily operations. The administration is pivotal in relation to risk management policies, by coming up with guidelines and programs that comply with Managed Care Organization (MCO) standards. First, the organization develops policies such as infection control and discharge policies that guide practitioners in their daily tasks (Willeumier & Juman, 2015). Development and maintenance of such policies establish a culture of compliance with MCO standards, alleviates risk, and aids the organization in achieving its goals (Willeumier & Juman, 2015). Secondly, the administration creates an effective contract program in appointing practitioners. Health organizations are required to monitor doctors’ compliance and quality delivery before hiring them. However, failure to comply with the canons calls for contract termination (Willeumier & Juman, 2015). Lastly, the organization ensures the policies and programs are effectively implemented through audit and periodic reviews, which provide data for effective policy management (Willeumier & Juman, 2015).

Question 2

Majority of errors in the health organization result from communication problems, which arise from conflicts amongst practitioners (Hetzler, Messina, & Smith, 2011). Healthcare organizations require effective teamwork and

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