Reflective Analysis: Risk Management and the Role of Managed Care (Healthcare Assignment)

Risk management helps to reduce the cost of accessing health care. Application of proper risk management policies will see a person or an individual getting the best medical care, even when they do not earn much. On the other hand, Managed Care Organizations offer health plans to both individuals and groups. Their aim is to keep medical costs down through patient education and giving preventive medicine. It is hard for low-income earners to access proper medical care when they get sick. Even the higher income earners sometimes find it hard to obtain an appropriate medication, especially when suffering from complicated illnesses or suffering from serious injuries. As a result, most people prefer to take the necessary measures so that they can access proper medication when they fall sick. Managed Care Organizations help most people to plan, and hence it will be easy to get medical attention needed when they fall ill. This essay will explore the role of the Managed Care Organization in healthcare (Healthcare Assignment).

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What is a health care organization’s administrative role in executing risk management policies and ensuring compliance with managed care organization (MCO) standards?

Healthcare organizations should ensure that their employees have taken good medical covers that can cater to their bills in case of any illnesses. Also, Medical institutions should ensure that they educate their patients on the importance of having medical covers. They should give the patients some examples of these cover and explain to them how they work. By taking these steps, it will be easier for the patients to pay for their bills, hence the medical institutions will not have to suffer from bad debts (Shi, 2006). On the other hand, medical institution employees should be enrolled in medical insurance policies. The insurance money can be deducted from their salaries at the end of the month before the employee gets their share. According to Pozgar, one of the MCO standards is to ensure that medical care providers can manage their patients’ and employees’ medical expenses (2014).  To make it easier for the employee, especially those who do not earn a lot, the medical institutions can choose to pay some part of the cost.

What value do the regulatory statutes of a typical MCO provide to a healthcare organization? Consider how strategies pertaining to policies such as conflict resolution and risk management affect patients as well as employees and employers

All healthcare providers who adhere to the set rules and regulations of MCO have a competitive advantage. Since MCO help the medical institutions to cut the cost of medical services, the institutions are always on the frontline in terms of affordability and quality of services (Jones, 2016). Such risk management strategies like cost-sharing and partnership reduce the cost of medical services to patients.

What MCO responsibilities relevant to the Patient Protection and Affordable Care Act (ACA) and the Center for Medicare and Medicaid Services (CMS) focus on fraud, waste, and abuse laws?

One of the values that the MCO provides is ensuring that proper guidelines are followed. Such guidelines include adequate screening and thorough background checks. The measures are included in the ACA laws, which include that healthcare institutions should not engage in fraud or abuse (ASHRM, 2009). Besides, MCO ensures that all healthcare institutions provide proper medical services. The services should not be exaggerated, and patients should be treated well regardless of their status.

In conclusion, risk management services help both the medical institution as well as the patient. MCO help healthcare providers to utilize the set strategies. Asa result, better, efficient, as well as reliable services, are given to the patients.

References

(ASHRM), A. S. (2009). Risk Management Handbook for Health Care Organizations, Student Edition (J-B Public Health Health Services Text). New York.

Jones, C. P. (2016). A comprehensive survey of managed care organization (MCO) medication adherence intervention programs. Research in Social and Administrative Pharmacy, 6.

Pozgar, G. D. (2014). Legal and ethical essentials of health care administration. Burlington, Mass: Jones & Bartlett Learning.

Shi, L. (2006). Managing Human Resources in Health Care Organizations. New York: Jones & Bartlett Pub.