Managed Care Organizations and Integrated Health Care Networks - Assignment Example

Management care Managed care The Role of Management in the Managed Care Organization (MCO) The management is concerned withreduction of care costs through providing economical incentives meant for the patients and physicians and advice on the less costly care forms. In addition, it has to come up with programmes that help to review the need for the medical services. The management controls the admission of patients and the duration they stay in the hospital. It also cuts on the costs that are required incases of major surgeries. Finally, the management solves cases, which need a lot of capital for their resolution. The roles of risk managers increase due to lack or insufficient certified standards and presence of state laws that is conflicting. Furthermore, there is no standard federal law that risk managers seek guidance from the state on legal matters. The managers have to improvise methods of dealing with the fast growth in size of management. 2. The Problems Associated with Conflict with MCO and the Family Physician According to Kavaler & Spiegel the physicians have a duty to keep all the information from the patients as confidential as possible (2003). The physicians should deal with information without interfering with the code of ethics and adhere to all the legal procedures. There are cases when the physician should not disclose the patient’s confidentiality unless required by the federal law. This can occur when a patient threatens to cause body harm to himself or the other partner. Therefore, the ethical requirements are not a set of rules but acts as a legal procedure. 3. What does MCO mean? MCO refers to an organization that incorporates care delivery, administration, and provision of health insurance. 4. Types of MCOs. According to Kavaler & Spiegel, there are three major types of MCOs: (2003). a). Health Maintenance Organization (HMOs) This organization assumes fully the risk with the employer, insurer, and oneself. In this type, payments are done on each individual employee or member in a given population in a specific month. The staff model for this type of organization comprises the employees in HMO. Furthermore, they are supposed to be physicians from HMO and can only become specialists after approval. Either a doctor or a nurse administers the cancer drugs and it may require that before some drugs be administered before reapprove. b). Preferred Provider Organization (PPO) They assume their risks by taking partial risks and pay the fee depending on the service that is delivered at every discount. The members are supposed to be either part of the group or self-employed. c). Point Of Service (POS) These are also partial risk takers and they pay their fee at a given schedule of delivering at required discounts. The members may either be self-employed or group members. This organization may prefer a relatively higher pay as compared to the others. In administering of cancer to the patients then the members are not supposed to be reapproved to a ruler. 5). Regulatory status regarding the MCOs. The physicians have a duty to be confidential with the information after diagnosis. The physician should not disclose any information that the patient has given out. Thus, to execute any nursing information, we have to follow the judicial legal procedures and adhere to the codes of ethics. However, there are cases that codes of ethics may have some abnormal requirements. For instance, the physician may be allowed to disclose information if required by the state to disclose (Kavaler & Spiegel, 2003). This can only be possible if the patient threatens to harm him or the others. 6). Future resolution of conflict between MCOs and risk management. The management has to advice the organizations to come up with reforms to join self-help groups. Thus there is need to provide education to the consumers. The management can also collaborate the consumers and the organization. On the other hand, the consumers can participate in provision of services and training ad planning of the health reform. In addition, the consumers must be able to accept any money in case of providing services for the MCO. 7). Integrated health network An integrated health network provides all the services that are required to support the consumers involved in the process for instance, the physician office and the patients and the teams that are concerned in managing to curb the spread of chronic diseases. In this perspective the patients have a customized network and address the care needs for the patients. 8). The major types of integrated health care networks. The major trends in the network: The key role of care systems is to avail all health insurance services and provide both the outpatient and inpatient services to cater for the long term health practices. The second trend is to integrate the administration with the consumer. In addition, the administration has to integrate the clinical care and the information technology and help in financing of the health care program. The step that is very vital in integrating the healthcare system to show the most regarded values that have an advantage that surpasses their competitors. 9). Cultural issues facing managers in integrating health care network Many global contexts arise such as the exact composition of health care and the workforce. The size of the work force and the training given to the workers majorly determine the type of management affect the kind of health care given to the consumers (Kavaler & Spiegel, 2003). The most vital concern in management is the issue of development of economy in a given country. 10). Legal issues faced by risk management in regard to health care network In dealing with management, the health care should monitor national reforms and their initiatives. The management has the mandate to focus on the issues that ensures that the management documents are kept safely. The most probable disputes that may arise and how to control the dispute is part of the management legal issue. Another critical issue is that the management should curb on the problem of denying the consumers care (Kavaler & Spiegel, 2003). The management has to make sure that the main goal of good management is to provide a global and a balanced method of dealing with legal issues. 11). Liabilities in integrated health care network. The most striking liabilities include system liability due to its relationship with the provider selection plus other vital services that it provides. In addition, legal issues that demand close attention are vital liabilities in health network. Furthermore, the health network has set up an organization called ERISA group. The group operates under the federal law regulation in handling disputes in health care. In this regard, the patients are considered in administering medical information and their information is considered confidential (Kavaler & Spiegel 2003). The federal law demands that the records of patients be kept and no one should access unless under critical situations. The management is also concerned with dealing with insurance structure and the related program. 12). Duties of a risk manager Health care has outlined the various roles of a risk a manager and include, finding out the functions and outlining the risks the network can incur. Furthermore, the manager has to determine the likelihood that the health care network is associated with in financial process. The manager shows his ability to assess risks by making budgets because budgets assess the operations and processes that can easily cause troubles in the financial sector of the network. The risk managers have the potential to expand their responsibilities. 13) Conclusion In conclusion, a well-managed care has the objective to reduce the costs that consumers incur in health care. Consumers enjoy only when the costs of dealing with health care down. Through this, the future of the health care reforms is considered and should be contained in the network for heath. As a growing discipline, it has developed numerous policies to govern its operation. The management has to operate in line with the MCO and other regulatory groups such as the code of ethics. To develop a standard agency, there has to be understanding between the federal law and the MCO union. References Kavaler, F., & Spiegel, A. (2003). Risk management in health care institutions: A strategic approach. Boston: Jones & Bartlett Publishers. Read More