Managed care organizations and integrated health care networks

  Topic 5 DQ 1

Although Managed Care Organization (MCO) standards create challenges for health care organizations, they are vital to improving quality care for_ patients that require long term and_ who have complicated health conditions. The goal of Managed Care Organization (MCO) primary goal is to manage health costs and quality care (Grand Canyon University, 2019).

Two factors that need to be addressed are Value-based purchasing (VBP) and the uninsured population. Value-based purchasing (VBP) is another measure that is tied in performance to reimbursement. VBP encourages hospitals to improve the quality efficiency, patient experience and safety of care” (Hong et al., 2020). It is an essential program because it enhances the quality of care for the patients, and patients have a better experience during their hospital stay. These scores are tracked and made public by CMS.

The second factor is the number of uninsured people in the United States. Everyone should be able to receive healthcare when they need it. They should receive the appropriate health care treatment in an emergency without penalizing the health care providers that assisted with such cases. Although, they should also emphasize the social determinants of healthcare, such as patients should fully comprehend the meaning of actual emergencies. MCO can sometimes rule out that treatment received in an emergency department as verified emergency cases and deny payment for the procedures and services; which puts the hospitals and physicians to be responsible for the nonpayment risks (Dickman, Himmelstein, & Woolhandler, 2017)

Managed care assist in better patient outcomes and fights to balance quality of care with the

cost-efficiency, and it continues to evolve to meet the needs of private and government plan sponsors

as well as patient members. MCO’s provides cost savings for patients while delivering an integrated

financing system that includes preventative care and coordinated care for patients with chronic

conditions.

 Health care organizations continually face challenges from various regulatory and government agencies while also being bound by Managed Care Organization (MCO) standards. View the video located in the study materials entitled “College of Nursing and Health Care Professions: Do We Know What Our Future Is?” for insight into the challenges of health care reform. Based on the video, describe two key reform factors that you believe will need to be addressed by future health care workers or leaders and explain why. (Note: You can download slides from this video for ease of review in developing your forum response). Additionally, what role does adherence to MCO standards play in your future health care vision? 

  

Using 200-300 words APA format with at least two references. Sources must be published within the last 5 years. There should be a mix between research and your reflections. Add critical thinking in the posts along with research. Apply the material in a substantial way.

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