HLT-308V. Reflective Analysis: Risk Management and the Role of Managed Care

Risk Management Reflective Analysis
HLT-308V
Reflective Analysis
The United States continues to face serious challenges in fixing its healthcare system. The establishment of managed care organizations (MCOs) was one of the efforts to manage quality, cost, and utilization of care through disease prevention, surveillance, treatment, and research strategies. Healthcare organizations play an important administrative role in overseeing risk management policies and ensuring quality care delivery to enrolled populations in line with MCOs standards. Over the past decades, MCOs have made progress in managing risks in controlling infectious diseases (Chorba, Scholes & BlueSpruce, 2004). However, potential challenges such as containing cost of reimbursement for care services, the move to the management infectious diseases by non-specialists, and a change from inpatient to outpatient care have all raised challenges in reporting, controlling and preventing infectious diseases (Davis, 2000). In addition, managed care practices may further complicate investigation of infectious disease outbreak and the public health response.
The regulatory statutes of MCOs ensure the establishment of conflict resolution and risk management strategies within a healthcare organization. From the perspective of an employer, this ensures that the use of services by the employee/patient is controlled by restricting settlement for services. Employers purchase healthcare services from MCOs, which in turn select care providers for the beneficiaries. Patients can then choose or get assigned to a qualified and competent provider trained in managed care on issues pertaining vicarious liability, malpractice, negligence prevention, and litigation. Employers will enter contracts with MCOs because of benefits packages, quality of service, and cost containment and this adds incentive to healthcare org...