health care management MCO/HMO

Your health care organization has decided to undergo a major restructuring to better align with the new Patient Protection and Affordable Care Act (PPACA) of 2010. You have been tasked with developing a managed care organization (MCO) and health maintenance organization (HMO) that will have as its core mission the ethical treatment of patients in their health care needs. Discuss the following in a double-spaced paper of 3–4 pages:

  • Define and propose what structure your MCO/HMO will use to maximize the ethical delivery of health care to your patients.
  • Research the library and other resources detailing best practices in MCO/HMO structuring to defend your answer.

Expert Solution Preview

Introduction:
The Patient Protection and Affordable Care Act (PPACA) of 2010 has brought significant changes to the healthcare industry. The concept of managed care organizations (MCOs) and health maintenance organizations (HMOs) have emerged as popular alternatives to traditional fee-for-service healthcare delivery models. This paper aims to propose a structure for an MCO/HMO that maximizes the ethical delivery of healthcare to patients. The paper will utilize research from credible sources to justify this proposed structure.

Answer:

The structure of an MCO/HMO is critical for the ethical delivery of healthcare to patients. To maximize ethical considerations, a structure that emphasizes patient-centered care and promotes transparency and accountability within the organization should be adopted. This proposed structure should include the following core components:

1. Patient-Centered Care: A patient-centered approach ensures that medical decisions and treatment options are made based on the individual needs and preferences of each patient. This approach places patients at the center of healthcare delivery and encourages patient involvement in decision-making.

2. Proactive, Preventative Care: MCO/HMOs should focus on preventative care to promote the overall health and wellbeing of their patients. This includes regular health screenings, immunizations, and education on healthy lifestyle choices.

3. Provider Collaboration: Collaborative decision-making between healthcare providers promotes shared decision-making and leads to better patient outcomes. Providers should work in teams to coordinate patient care, share medical expertise, and ensure continuity of care.

4. Transparency and Accountability: The MCO/HMO should be transparent in its operations and accountable for the quality of care it delivers. Patients should have access to information about their treatment options, the performance of their healthcare provider, and any fees they may incur.

Research from credible sources supports the proposed structure of the MCO/HMO. A study by the National Academy of Medicine found that patient-centered care is associated with improved healthcare outcomes, including increased patient satisfaction, improved health status, and fewer hospitalizations. Another study published in the Journal of General Internal Medicine found that collaborative decision-making leads to higher patient satisfaction and improved quality of care.

In conclusion, the proposed structure of an MCO/HMO that maximizes the ethical delivery of healthcare to patients should emphasize patient-centered care, proactive preventative care, provider collaboration, and transparency and accountability. This structure is supported by research from credible sources and aligns with current best practices in healthcare delivery.

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