Assignment: MCOs

In this module you have learned about Managed Care Organizations.

For this assignment, include MCOs and detail the expectations of the MCOs' compliance programs. Relate MCOs to one of the seven elements in the process.

You should reference at least one new research source (Wikipedia, your textbook, and a source you used previously are not acceptable research sources) in your paper, and you must include appropriate citations for those sources.

For your compliance assignment , you are expected to discuss details of the MCO compliance program (research is key!) Be sure to also relate the MCO compliance program back to one of the 7 compliance elements.

Requirements

Details the expectations of the MCOs' compliance programs.
Relates MCOs to one of the seven elements in the process.
Provides appropriate citations for at least 1 research source.

Benefits and Services of MCOs

Managed Care

Results of Managed Care

From a patient's perspective, managed care can be considered an industry best practice. Patients benefit from a single point of entry into the health care system and have the continuity of a relationship with a primary care professional to direct their plan of care. Emphasizing primary care and preventive services is recognized as producing:

• Fewer hospitalizations
• Improved health outcomes
• Lower health care costs

Services of Managed Care Organizations (MCOs)

Managed Care Organizations, or MCOs, provide services in different settings. The type of services depends on the course of treatment for the patient's condition(s). Such services include:

• Medical homes
• Prenatal care
• Emergency services
• Diagnostic and laboratory services
• Certain home health services
• Physician services (inpatient and outpatient)
• Inpatient care
• Preventative care and wellness

Integrated Delivery Systems

What is an Integrated Health System?

Integrated Health Systems provide a coordinated system of care to a defined population and are willing to be held accountable for the cost, quality, and outcomes of care for the population served. There may not be a single point of ownership for services performed but a collaboration of entities involved to share accountability for the outcomes.

Here is more information on Integrated Health Systems:

Shortell, S., & McCurdy, R. (2010). Integrated health systems. Information Knowledge Systems Management, 8(1-4), 369-382. doi:10.3233/IKS-2009-0147.

Integrated health systems

Tensions and Conflicts

In IHS there are several entities involved, which can cause tension and conflict if lines of communication are not open and appropriate processes in place to ensure quality patient care. Sources of the tension and conflict may be:

• Hospital-to-hospital
• Physician-to-physician
• Physician-to-other health care professionals
• Physician-to-integrated health system

There is no formula for successful integration. The integration processes is to focus on process and not structure.