Network Development In The Managed Care Organization

1375 Words3 Pages

Network Development in the Managed Care Organization To guarantee that its members receive appropriate, high level quality care in a cost-effective manner, each managed care organization (MCO) tailors its networks according to the characteristics of the providers, consumers, and competitors in a specific market. Other considerations for creating the network are the managed care organization's own goals for quality, accessibility, cost savings, and member satisfaction. Strategic planning for networks is a continuing process. In addition to an initial evaluation of its markets and goals, the managed care organization must periodically reevaluate its target markets and objectives. After reviewing the markets, then the organization must modify its network strategies accordingly to remain competitive in the rapidly changing healthcare industry. Coventry Health Care, Inc and its affiliated companies recognize the importance of developing and managing an adequate network of qualified providers to serve the need of customers and enrolled members (Coventry Health Care Intranet, Creasy and Spath, http://cvtynet/ ). "A central goal of managed care is containing the costs of delivering care, but the wide variety of organizations typically lumped together under the umbrella of managed care pursue this goal using combination of numerous strategies that vary from market to market and from organization to organization" (Baker , 2000, p.2).

Show More
Related

  • Bestcare Health Maintenance Organization Net Working Capital

    579 Words  | 2 Pages

    Balance sheet lists assets, liabilities and owner’s equity. The assets listed on the balance sheet are acquired either by debt (liabilities) or equity. “Companies that use more debt than equity to finance assets have a high leverage ratio and an aggressive capital structure. A company that pays for assets with more equity than debt has a low leverage ratio and a conservative capital structure. That said, a high leverage ratio and/or an aggressive capital structure can also lead

    Read More

  • Managed Care Quaternion Or Iron Triangle?

    785 Words  | 2 Pages

    This group is more focused on satisfaction, access and quality of care. Providers, or practitioners, are also key stakeholders within an organization. The term provider can encompasses not only physicians and surgeons, but also nurses, physical and occupational therapists, technicians, and other members of a clinical staff. Providers fall into two categories, primary, which includes hospitals and health departments and secondary, which includes educational institutions and pharmaceutical companies. Providers are focused on the best treatments for patients and are involved in delivering health services and products. The final element of the MCQ model is the employer who by far is the largest paying and purchasing stakeholder of an organization. The employers focus is primarily on their return on investment within an organization. Cost and quality is a focus for employers when choosing health benefits but are mindful that access is just as important. Within the Patient Healthcare model, MCQ explains the interactions between the four elements of employer, patient, provider and payer while the Iron Triangle focuses on the factors of cost, quality, and access. The Patient Healthcare model charges healthcare leaders with the task of balancing satisfaction with the stakeholder (employer, patient, provider, and payer) in relation to cost, quality and access. This may be very difficult since stakeholders may have competing priorities. Changes and variations made in how healthcare organizations operate may have profound effects on how stakeholders perceive the quality, access and cost. For instance, a patient may consider cost to be a top priority when seeking healthcare and at the same time the healthcare organization may consider raising costs and therefore devaluing access and quality. Patients who begin to incur high out-of-pocket costs may begin to perceive a financial

    Read More

  • Medtronic Case Analysis

    2105 Words  | 5 Pages

    The current health care landscape has been characterized by large scale consolidation and vertical integration of payers and providers. This has led to a handful of dominate players with substantial influence, and an increasing overlap in responsibilities between payers and providers. Although payers and providers have traditionally been on opposing sides, battling each other about quality of care versus cost-effective care, they are shifting to working together to achieve better value.

    Read More

  • Kaiser Permanente Case Study

    957 Words  | 2 Pages

    Integrated Managed Care Organization- The organization is properly aligned for the primary driver being cost cutting services. Since all entities within the organization are responsible and affected by any expenses endured on any entity being unfavorable or favorable, the foundation serves as a primary motivator to reduce costs at all levels. This alignment eliminates any financial gains from driving high utilization of services or higher intensity services within the organization. Ultimately, this system allows the physician medical group to drive patient care, being responsible for the clinical care decisions as opposed to health plan making those decisions as designed in other organizations. This is the preferable model for Medicaid

    Read More

  • Vertical Integration In Health Care Case Study

    951 Words  | 2 Pages

    If Canada wishes to improve upon the quality of health care and tackle down generic issues in health care, one should consider integrating services. Integrated health services are considered part of the solution for the recurrent problem, one example being the continuous problem of chronic disease in Canada’s health care system. Integrated services come in many formats; horizontal, vertical, clinical, and physician.

    Read More

  • Managed Care: An Overview and Its Uncertain Future

    1114 Words  | 3 Pages

    It is enthralling to note that in spite of the advances in healthcare systems, such as our hospital’s ability to provide patients with lower cost, managed One being the Health Maintenance Organizations (HMO), which was first proposed in the 1960s by Dr. Paul Elwood in the "Health Maintenance Strategy”. The HMO concept was created to decrease increasing health care costs and was set in law as the Health Maintenance Organization Act of 1973, after promotion from the Nixon Administration. HMO would, in exchange for a fee, allow members access to employed physicians and facilities. In return, the HMO received market access and could earn federal development funds.

    Read More

  • Managed Health Care Issues

    3218 Words  | 7 Pages

    When one examines managed health care and the hospitals that provide the care, a degree of variation is found in the treatment and care of their patients. This variation can be between hospitals or even between physicians within a health care network. For managed care companies the variation may be beneficial. This may provide them with opportunities to save money when it comes to paying for their policy holder’s care, however this large variation may also be detrimental to the insurance company. This would fall into the category of management of utilization, if hospitals and managed care organizations can control treatment utilization, they can control premium costs for both themselves and their customers (Rodwin 1996). If health care organizations can implement prevention as a way to warrant good health with their consumers, insurance companies can also illuminate unnecessary health care. These are just a few examples of how the health care industry can help benefit their patients, but that does not mean every issue involving physician over utilization or quality of care is erased because there is a management mechanism set in place.

    Read More

  • HMO Regulation

    1302 Words  | 3 Pages

    Health Maintenance Organizations, or HMO’s, are a very important part of the American health care system. Also referred to as managed care programs, HMO's are combinations of doctors and insurance companies that are formed into one organization. This organization provides treatment to its members at fixed costs and decides on what treatment, if any, will be given based on the patient's or doctor's current health plan. Sometimes, no treatment is given at all. HMO's main concerns are to control costs and supposedly provide the best possible treatment to their patients. But it seems to the naked eye that instead their main goal is to get more people enrolled so that they can maintain or raise current premiums paid by consumers using their service. For HMO's, profit comes first- not patients' lives.

    Read More

  • Most Significant Issues Facing Health Care Organizations

    1334 Words  | 3 Pages

    Formed in 1998, the Managed Care Executive Group (MCEG) is a national organization of U.S. senior health executives who provide an open exchange of shared resources by discussing issues which are currently faced by health care organizations. In the fall of 2011, 61 organizations, which represented 90 responders, ranked the top ten strategic issues for 2012. Although the issues were ranked according to their priority, this report discusses the top three issues which I believe to be the most significant due to the need for competitive and inter-related products, quality care and cost containment.

    Read More

  • The Mayo Clinic: A Performance Management Assessment

    2102 Words  | 5 Pages

    Competitive advantage matters greatly to those responsible for the management of healthcare institutions. Together with rapidly escalating healthcare costs, increasingly complex medical technologies, and growing regulatory and legal pressures, healthcare organizations face a critical need to improve the quality of care at reduced costs (Cu...

    Read More

  • Managed Care

    928 Words  | 2 Pages

    Managed care dominates health care in the United States. It is any health care delivery system that combines the functions of health insurance and the actual delivery of care, where costs and utilization of services are controlled by methods such as gatekeeping, case management, and utilization review. Different types of managed care plans came into development by three major factors. These factors include choice of providers, different ways of arranging the delivery of services, and payment and risk sharing. Types of managed care organizations include Health Maintenance Organizations (HMOs) which consist of five common models that differ according to how the HMO is related to the participating physicians, Preferred Provider Organizations (PPOs), Exclusive Provider Organizations (EPO), and Point of Service Plans (POS). `The information management system in a managed care organization is determined by the structure of the organization' (Peden,1998, p.90). The goal of a managed care system is to provide subscribers and dependants with needed health care services at the lowest possible cost. Certain managed care plans also focus on prevention by trying to keep members healthy.

    Read More

  • Criticisms Of Managed Care

    1003 Words  | 3 Pages

    Managed care plans present as forms of health insurance covers. These plans have contracts with medical facilities and health care providers to offer care for clients at decreased costs (Dixon, Greene & Hibbard, 2008). This paper will discuss the criticisms that have been addressed regarding managed care, and the different features that are included in a CDHP. Additionally, it will discuss the existing differences between the choice of providers, cost sharing, and covered benefits of HMOs and CDHPs. This will help in drawing conclusions regarding the latest information that surrounds managed care.

    Read More

  • Health Care Marketing Plan for Primary Care

    2855 Words  | 6 Pages

    When promoting primary health care services, there are many factors that must be considered when developing an effective marketing plan. Primary care providers are the gatekeepers of health care in the United States; many patients have to visit them before being referred to specialist providers (Bodenheimer, 2003). They are also being tasked with ensuring patients are receiving preventative services and managing more complex chronic diseases (Akinci & Healey, 2004). Recruitment of primary care physicians is challenging because they are expected to do more and are not being reimbursed proportionally for the added workload (Bodenheimer, 2003). In this paper, a group of primary care physicians in Washington D.C. is looking to research their consumer population base in order to provide them better services and recruit new primary care physicians to their practice (Colorado State University-Global Campus, 2013). A successful primary care marketing plan will recruit quality health care providers while improving consumer accessibility to their services, customer satisfaction rates, and patients’ continuity of care with their health care provider.

    Read More

  • The 5 P 's Of Healthcare Marketing

    936 Words  | 2 Pages

    Healthcare organizations are designed to meet the healthcare needs of individuals and promote a healthy community. The three healthcare organizations that interest me are: The Heart Hospital Baylor of Plano, Texas Health Center for Diagnostics & Surgery Plan, and Parkland Health and Hospital System. Due to the evolving healthcare industry, focusing on just patients and physicians is no longer a marketing strategy. According to Mycek (2015), “Marketing teams need to expand their consideration set and focus on the new 5 P’s of Healthcare Marketing” (p. 1).

    Read More

  • Professional Nursing Organization Analysis

    1001 Words  | 3 Pages

    There are many benefits to joining a professional organization and individuals become a member for a variety of reasons, but it is typically to advance or advocate for their career (Sullivan, 2001). Professional nursing organizations advocate for their members and nurses in general by providing a powerful influence and the support needed to meet changes in the world of healthcare (Matthews, 2012). According to Haley-Andrews, belonging to a professional nursing organization is important for nurses of all proficiencies. Membership can enhance the career of veteran nurses or play a critical part in creating a successful beginning for new graduate nurses (Haley-Andrews, 2001).

    Read More

More about Network Development In The Managed Care Organization

Open Document