Question

1. Discuss the role of managed care organizations and third-party payers and their impact within your health care organization.

Answer 1

Managed care organizations, also called Health Maintenance Organizations or HMOs, combines healthcare providers with insurance companies to keep costs down.

Third-party payers are those insurance carriers including public, private, managed care and preferred provider networks that reimburse fully or partially the cost of healthcare provider services. The healthcare providers are hospitals, physicians, dieticians, pharmacists, nurse practitioners and all those caring for the patient.

The role of HMOs and Third-party payers:

i. Both can ensure better availability of healthcare services by streamlining their operations, by full disclosure of information to the health beneficiaries, government and the healthcare system.

ii. Both can ensure better service by easing terms of condition of healthcare services and health insurance.

iii. Share non-confidential and public information of patients to the NGOs for better health coverage and to encourage research activities.

iv. The insurance claim and process of reeimbursement shall be easy and paperless to the patients, both parties have role to play in this.