As employers look to control health care costs, MCOs have implemented utilizatio
ID: 409983 • Letter: A
Question
As employers look to control health care costs, MCOs have implemented utilization review protocols to ensure the right care is provided to patients at the right time. At the same time, employers, regulatory agencies, and accreditation organizations have increased their expectations that the quality of care increases for patients receiving care through the MCO.
1.Define the key elements of utilization review and quality management.
2.Compare and contrast these two functions and how they have changed over time.
3.What role does each of these play in managed care?
4.Do these functions add value to managed care?
Explanation / Answer
1.Key elements of utilization review and quality management:
The MCO are "managed health care" a term used in the united nations to describe activities conducted as a group to make better the health care activities provided.It is providing healtha care since 1980s through variety of mechanisms such as providibg patoents with the information of better quality and low cost service and better preivilages for physicians ,in patentient waiting queue alcualtion etc.
The key elemts of utilisation and quality management generally involves a network called integrated delivery netwoks that involves:
a)Standards for providing service
b)Foral utilization review and quality check
c)Selection of doctors and arrangement of required facilities
d)Preventive measures and finacial incentives.
3) Role of MCOs in health care
MCOs are acting in respose to changing need of the society and they priovide health programs according to changinglife style.They provide safety to patients
4) yes the activities add value to managed care.but their is also an argument against MCOs
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