HLT 308V Week 5 Reflective Analysis: Risk Management and the Role of Managed Care
HLT 308V Week 5 Reflective Analysis: Risk Management and the Role of Managed Care
HLT 308V Week 5 Reflective Analysis: Risk Management and the Role of Managed Care
HLT 308V Week 5 Reflective Analysis: Throughout this course, you have identified, examined, and provided individual as well as collaborative analysis on multiple facets of risk management in the health care setting.
Addressing the knowledge you have gained, and building on that knowledge to add your evaluation of the role that the managed care organization (MCO) plays in today’s health care environment, develop a 250-500 word reflection to incorporate the following:
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What is a health care organization’s administrative role regarding oversight of risk management policies and ensuring compliance with managed care organization (MCOs) standards?
What is your assessment of the value provided to an organization that stems from the regulatory statutes of a typical MCO? Consider the establishment of conflict resolution and risk management strategies within the health care organization from the employer/employee perspective as well as in regards to patient conflict circumstances.
What MCO responsibilities pertain to the Patient Protection and Affordable Care Act (PPACA) and Center for Medicare and Medicaid Services (CMS) focus on fraud, waste, and abuse laws?
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Reflective Analysis 2
Thesis Managed Care Organizations(MCO’s) have a complex role with Risk Management, Quality and Compliance that can have direct legal and financial consequences. It is important for MCO’s be diligent in their evaluation of their legal risk. Reflective Analysis 3 Question 1 What is a health care organization’s administrative role regarding oversight of risk management policies and ensuring compliance with managed care organization (MCOs) standards? I think that the administrative role regarding oversight of risk management policies will largely stem from the ability to comply with legal hospital requirements such as EMTLA. For example, EMTLA allows the physician to decide if the patient truly needs emergency care. Sometimes opinion of the individual, or person bias, can interfere with the physician’s ability to make medical sound decisions. The homeless population is an example of this. It is not an uncommon experience to see a h,,,
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