Question

1. What is a managed care organization (MCO)?

2. Identify three types of managed care organizations that reflect the extent of integration between third-party payers and healthcare providers?

Answer 1

Ans 1=A MCO, by definition, is an establishment which puts into practise managed care principles. Its a health plan / health firm which functions to give quality medical care at a cost-effectual pricing. Healthcare establishments include providers like hospices , physicians and other medical professionals who operate together on behalf of the patients.

Ans 2=MCOs fall into 3 chief groupings. 'Health Maintenance establishments' need patients to have a family physician who must give referrals to other medical experts in the same provider network. 'Preferred Provider establishments' are the most usual MCOs & they permit patients to avail care external to the network for a marginally higher cost. 'Point of Service schemes' need patients to have a primary care physician to oversee care & give referrals, though out-of-network care is obtainable at a marginally increased cost.