Question

Why is it in the providers' interest to sign up with MCOs, for the Class?

How do providers select the MCO which best suits their interests?

By establishing a provider network, it will help contract cost for care or services, the quality of it (that is being provided), and it also creates drug formulary (pharmaceutical) or tiering cost of the drug for the patients. This network of provider sort of acts as a bundle where all services that are being given or requested falls under this group. Manage Care Organizations (MCOs) also contract with health plan insurance to create some type of program where they can help manage the patient's medication, a service where they have someone reviewing and answering any question the patient may have about their medication and making sure that they are using it correctly and effectively. Prior to any treatment or services that are about to receive, the patient can request a second opinion, to see if that treatment or services is appropriate, before going forward with it. It is about managing cost for the patient and provider, the patient will be receiving adequate care at a reduced cost, and the provider is generating profit from it because the client base is assured

Answer 1

MCO means managed care organization, which is a healthcare system that provides cost effective care to patients where quality is not compromised. it includes a group of healthcare professionals including doctors who work together to give complete health cover for patients. The main types are HPO(Health Maintenance Organization), PPO(Preferred Provider Organization).

Managed care organizations help the provider to earn more profit as it reduces the cost of care thereby decreasing the national health expenditure by ensuring quality care for the clients. it works on the client's interests.

The health providers should see whether the MCO is helping to reduce the cost for health care services without compromising the quality of care. It should also provide required explanation to clients who are seeking additional informations on their medications sothat the patient can have a second opinion regarding their treatments.