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The consulting company that your group formed last week has grown and become very popular. Your...

The consulting company that your group formed last week has grown and become very popular. Your company has become well-known for the educational workshops that you provide. A client (who has facilities nationwide) that uses your services frequency has asked your consulting company to provide a recorded educational workshop on Managed Care Organizations. They would like to see an explanation as to what a managed care organization is, how managed care works, how managed care affects reimbursement, and nationwide examples of managed care organizations (HINT: check out PACE).

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Answer #1

Ans 1=A MCO is a medical care provider / a group / establishment of medical service providers that offer managed care health proposals.

Ans 2=It is a health establishment that contracts with the insurers / with the self-insured firms & funds & dispenses medical care utilizing a particular provider network & specific products/ services

They give a broad variety of quality & managed care services to the enrolled employees keeping medical expenses low via preventative medication/ patient education etc

Ans 3=The reimbursement method has an influence on the kind, the volume & the quality of the services dispensed by the provider. The managed medical care reimbursement systems are planned to control expenses via lessening the reimbursement rate thru discounts ,putting the provider at risk / via giving financial incentives for lessened utilization & giving disincentives for excessive utilization.

Ans 4=Examples are United Health Group, Aetna, Molina Healthcare etc.

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