Risk Management and Managed Care
Risk Management and Managed Care
Reflective Analysis: Risk Management and Managed Care
The purpose of this assignment is to analyze the role of managed care organizations within health care and risk management programs.
Reflect on and evaluate the role that the managed care organization (MCO) plays in today’s health care environment by developing a 250‐500-word response that addresses the following:
1. What is a health care organization’s administrative role in executing risk management policies and ensuring compliance with managed care organization (MCO) standards?
2. What value do the regulatory statutes of a typical MCO provide in Risk Management and Managed Care to a health care organization? Consider how strategies pertaining to policies such as conflict resolution and risk management affect patients as well as employees and employers.
3. 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?
In addition to your textbook, you are required to support your analysis with a minimum of two peer‐reviewed references.
Discussion: Risk Management and Managed Care
Health care organizations continually face challenges from various regulatory and government agencies while also being bound by a 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?
2 peer-reviewed sources 250 words Use the questions above in the answer.
Discussion 2: Risk Management and Managed Care
The Affordable Care Act (ACA) identifies requirements related to provider compliance with fraud, waste, and abuse laws that have been enacted to protect consumers. Research three of these requirements and describe the corresponding measures that your health care organization has initiated, or could initiate, to comply with the ACA. Support your analysis with a minimum of two peer-reviewed articles.
