Managed & Accountable Care Organizations Assignment Help
Discuss the differences and similarities between Managed Care Organizations (MCOs) vs. Accountable Care Organizations (ACOs). Given the current health care environment, provide a solid speculation to how MCOs and ACOs may transform to meet the needs of its consumers. Be sure to support your thoughts and analysis with scholarly sources.
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The cost of health care and majority of the spending in this field is responsible for the formulation of different types of payment systems and the enrollees of health care insurance can thus obtain care from both managed care organizations or MCOs or the Accountable care organizations or the ACOs.
MCOs comprise of a set of people who work together to meet cost of healthcare by working with various health care providers. The plans of MCOs are however not as flexible as that of ACOs though both of them provide incentives to the various associated physicians. MCOs include health maintenance organization (HMO), preferred provider organization (PPO), exclusive provider organization (EPO) and also the point of service plan (POS). The HMOs make payment only within their own network and incase specialist advice is required, referral needs to be arranged. PPOs cover both within and outside the network; however the rates are costly for out of network providers. The PPOs and HMOs both provide Medicare option (Goodrick and Reay ., 2016).
ACOs on the other hand consist of a series of health care providers and healthcare settings who work together to improve the overall health care quality. They include pharmacists, clinicians, nurses and the different healthcare staff along with rehabilitation workers. They cooperate and coordinate to ensure maximum care for the patient. Bartels et al (2015), described the characteristics of ACO as "joint accountability, accountability in terms of both quality of care and spending of healthcare and overall care of people of the population".
ACOs provide freedom to patients so that they can choose the type of care they would like and also reward the health care providers for maintaining the healthcare quality and eliminating unwanted spending. MCOs focus on profit while ACOs do not.
In the current environemtn, it is essential that they provide flexibility and quality care at affordable costs so that people are sound and healthy.
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