reflective analysis risk management and the role of managed care 5

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 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 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.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

Read “The Health Care Fraud and Abuse Control Program Protects Consumers and Taxpayers by Combating Health Care Fraud,” from the CMS Newsroom (2016), located on the U.S. Centers for Medicare and Medicaid Services (CMS) website.

https://www.cms.gov/newsroom/fact-sheets/health-care-fraud-and-abuse-control-program-protects-consumers-and-taxpayers-combating-health-care

Read “Assessing Changes to Medicaid Managed Care Regulations: Facilitating Integration of Physical and Behavioral Health Care,” by Edwards (2017), located on The Commonwealth Fund website.

https://www.commonwealthfund.org/publications/issue-briefs/2017/oct/assessing-changes-medicaid-managed-care-regulations-facilitating

View the presentation “EMTALA: A Shifting Landscape,” located on the American Bar Association (ABA) website.

https://www.americanbar.org/content/dam/aba/administrative/healthlaw/EMTALA_4_10_18.authcheckdam.pdf