Health Insurance Case Assignment

Health Insurance Case Assignment

An MCO is a type of health care system that links health insurance with care delivery for a defined population. An MCO delivers health care through a network of providers, determines the prices for services, coordinates care, and manages appropriate use of health care services. According to the National Accountable Care Organization Summit (n.d.), ACOs are provider collaborations that support the integration of groups of physicians, hospitals, and other providers in different ways around the opportunity to receive additional payments by achieving continually advancing patient-focused quality targets and demonstrating real reductions in overall spending growth for their defined patient population. According to Shortell, Casalino, and Fisher (2010), there are at least five different types of practice arrangements that could serve as ACOs: the integrated or organized delivery system, multispecialty group practices, physician-hospital organizations, independent practice associations, and “virtual” physician organizations. The Accountable Care Model (ACO), the health care providers develop and drive the models’ respective agendas (McWilliams et al., 2016).

Given the similarities seen between MCOs and ACOs it is clear that MCOs have a more monopoly set up on their delivery method of care; while ACOs allows for free movement outside or within their integrated networks. Centers for Medicare and Medicaid Services (2015) states that participation in ACO is voluntary. This implies that the patient consumers have the freedom to select the Primary Care Physician of their choice, the hospitals they want and their favorable specialist. Given the current healthcare environment over time MCOs and ACOs can evolve into more organized networks of practices that will actively engage in practice redesign, quality improvement initiatives, and implementation of much more innovate technologies moving forward, for example one of their noteworthy success has been the implementation of electronic health records. The Electronic Health Records (EHRs) are now giving doctors and physicians real time secure access to patients records to better assist them across both MCO and ACO networks alike, saving time, money and creating more vital time providing much needed focused patient care.

Reference

Centers for Medicare and Medicaid Services. (2015). Accountable care organizations (ACO). (n.d.). Retrieved from http://www. cms. gov/Medicare/Medicare-Fee-for-Service-Payment/ACO/index. html.

National Accountable Care Organization Summit. (n.d.). What is an ACO? Retrieved from http://www.acosummit.com/past2011/overview.html

Shortell, S. M., Casalino, L. P. & Fisher. E. S. (2010). How the Center for Medicare and Medicaid Innovation Should Test Accountable Care Organizations. Health Affairs, 29 (7), 1293-1298.