MCO

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:

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?
2. 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.
3. 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?

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

 

 

 

Rubric:

 

	1 Unsatisfactory 0.00%	2 Less than Satisfactory 65.00%	3 Satisfactory 75.00%	4 Good 85.00%	5 Excellent 100.00%
70.0 %Content
20.0 %Explains the Administrative Role of a Health Care Organization Regarding Oversight of Risk Management Policies and Ensuring Compliance With Managed Care Organization (MCO) Standards	Not included.	An explanation of the administrative role of a health care organization regarding oversight of risk management policies and ensuring compliance with MCO standards is somewhat present, but the information provided is incomplete, inaccurate, or otherwise deficient.	An explanation of a health care organization’s administrative role regarding oversight of risk management policies and ensuring compliance with MCO standards is present, but minimal detail or support is provided for one or more components.	An explanation of a health care organization’s administrative role regarding oversight of risk management policies and ensuring compliance with MCO standards is present, and is incorporated in full. The submission encompasses essential details and provides appropriate support.	An explanation of a health care organization’s administrative role regarding oversight of risk management policies and ensuring compliance with MCO standards is present and comprehensive. The submission further incorporates analysis of supporting evidence insightfully and provides specific examples with relevance. Level of detail is appropriate.
20.0 %Discussion Regarding Assessment of the Value Provided to an Organization That Stems From the Following Aspects of a Typical MCO: Regulatory Statutes, Inclusive of Conflict Resolution and Risk Management Strategies From the Employer/Employee Perspective and Patient Conflict Circumstances	Not included.	A discussion regarding assessment of the value provided to an organization that stems from a typical MCO (regulatory statutes, inclusive of conflict resolution and risk management strategies from the employer/employee perspective and patient conflict circumstances) is somewhat present, but the information provided is incomplete, inaccurate, or otherwise deficient.	A discussion regarding assessment of the value provided to an organization that stems from a typical MCO (regulatory statutes, inclusive of conflict resolution and risk management strategies from the employer/employee perspective and patient conflict circumstances) is present, but minimal detail or support is provided for one or more components.	A discussion regarding assessment of the value provided to an organization that stems from a typical MCO (regulatory statutes, inclusive of conflict resolution and risk management strategies from the employer/employee perspective and patient conflict circumstances) is present and incorporated in full. The submission encompasses essential details and provides appropriate support.	A discussion regarding assessment of the value provided to an organization that stems from a typical MCO (regulatory statutes, inclusive of conflict resolution and risk management strategies from the employer/employee perspective and patient conflict circumstances) is present and comprehensive. The submission further incorporates analysis of supporting evidence insightfully and provides specific examples with relevance. Level of detail is appropriate.
20.0 %Describes MCO Responsibilities Pertaining to the Patient Protection and Affordable Care Act (PPACA) and Center for Medicare and Medicaid Services (CMS) Focus on Fraud, Waste, and Abuse Laws	Not included.	A description of MCO responsibilities pertaining to PPACA and CMS focus on fraud, waste, and abuse laws is somewhat present, but the information provided is incomplete, inaccurate, or otherwise deficient.	A description of MCO responsibilities pertaining to PPACA and CMS focus on fraud, waste, and abuse laws is present, but minimal detail or support is provided for one or more components.	A description of MCO responsibilities pertaining to PPACA and CMS focus on fraud, waste, and abuse laws is present and incorporated in full. The submission encompasses essential details and provides appropriate support.	A description of MCO responsibilities pertaining to PPACA and CMS focus on fraud, waste, and abuse laws is present and comprehensive. The submission further incorporates analysis of supporting evidence insightfully and provides specific examples with relevance. Level of detail is appropriate.