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HSM 320 Areas and Issues That MCOs Try to Control Discussions 1 Week 2
Managed care can be considered any system of delivering health services in which care is delivered by a specified network of doctors, hospitals, and clinics that all agree to comply with the care regimes established by a care-management process. Providers may receive a capitated payment for providing all medically necessary care to enrollees or may be paid on a fee-for-service basis. Managed care often involves a defined delivery system of providers with some form of contractual arrangement with a health plan.  What are some of the areas and issues that MCOs try to control? How effective do you feel the MCOs in your own area have been in these efforts?