Question

What is true about Managed Care Organizations (MCO’s) that are used by Medicaid state programs like AHCCCS
	[A]	Not a full risk capitation contract
	[B]	About 2/3 of all beneficiaries are in Managed Care
	[C]	Administration fee is $4/pppm
	[D]	Patient still sees fee for service provider

Answer 1

MANAGED HEALTH CARE ORGANIZATIONS(MCO'S)

MCO'S is a health care company which consists of doctors, hospitals and other health care providers they work together to meet the health care needs.MCO'S are formed to reduce the cost associted with health care expenditure.The other roles of MCO'S are utilization and quality of health care services to the beneficiaries.

A. Not a full risk capitation contract

Full risk capitation provides financial coverage to all participants at risk.MCO'S provide a fixed amount of money(monthly fixed fee) to its members to the health care provider. So MCO'S are not a full risk capitation contract.

B. About 2/3 of all beneficiaries are in managed care

Managed care plans are the health insurance plan which provides medical facilites at low cost for the members.About 75% of the beneficieries are covered with managed care plans.

C.Administrative fee is $4/pmpm.

Administrative cost  includes hospital or physician practice administration and BIR costs.As per 2019 data the administrative cost in US was about $496 billion.PMPM means the cost or the revenue which is privided for each enrolled member in the plan.

D. Patient still sees fee for service provider

MCO'S provide a fixed amount of money(monthly fixed fee) to its members to the health care provider.It may not cover the full cost of medical expenditure. So patient still sees fee for service provider.

The true facts about MCO'S are

-Not a full risk capitation contract

- About 2/3 of all beneficiaries are in managed care

- Patient still sees fee for service provider