In the past two decades, managed care organizations have been receiving widespread acceptance across states. Lipschutz, Callow, Pollitz, Musumeci, and Jacobson (2015), assert that the ability of the managed care to enhance service utilization within the American healthcare sector is responsible for its wide acknowledgment. More so, its integration in the Medicaid programs, in which it grants the states the power to control costs related to the project also, plays a crucial role in its acceptance. Therefore, it is evident that managed care organizations have played a key role in the adoption of value-based payment changes. This essay is an analysis of the managed care organizations' roles in the healthcare sector and risk management programs.
Managed care organizations adopt a caring approach that is highly different from the fee-for-service model. According to Kimuyu (2018), the managed care organization limits their services only to their enrollees depending on the States’ fixed costs. To meet these requirements in the risk management process the healthcare organization leadership and management ensure there is a clear reporting structure between their staff and senior leadership with open lines of communication in either direction (Kimuyu, 2018). More so, they ensure that their healthcare practitioners are highly qualified while offering continued education for their personnel handling the Medicaid enrollees to ensure they avail a satisfactory type of care.
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There are various programs in managed care organizations, differing mainly on the restrictive aspect. Lipschutz et al. (2015) highlight the PPO (Preferred Provider Organization), HMO (Health Maintenance Organizations), and the POS (Point-of-Service) programs. The PPO encompasses the care entities in which enrollees in a particular network receive healthcare services attained through an agreement between the employer's health benefit plan and the health insurance carrier (Kimuyu, 2018). PPO appears to be less strict compared to the HMO. However, the HMO is cheaper compared to POS and PPO that are less strict. Therefore, the governing guidelines in every program ensure there are fewer conflicts concerning the healthcare services between employees and employers.
The managed care organization's responsibility in controlling costs is important in ensuring transparency as well as equality. According to Lipschutz et al. (2015), cost control in managed care organizations helps to save money by reducing redundancy and waste while improving the care of their enrollees. More so, cost controls ensure people do not abuse laws by participating in any fraudster activities as they seek the various healthcare services, which accrue to them. Therefore, managed care organizations work towards availing quality healthcare services to all through appropriate care providers and in a trustworthy manner.
References
Kimuyu, P. (2018). The Role of Managed Care Organizations within the Healthcare Industry.
Lipschutz, D., Callow, A., Pollitz, K., Musumeci, M., & Jacobson, G., (2015) Comparison of Consumer Protections in Three Health Insurance Markets: Medicare Advantage, Qualified health plans, and Medicaid Managed Care Organizations. Report
