The purpose of this assignment is to analyze the role of managed care organizations within health care and risk management programs. Reflect on and evaluate the role that the managed care organization (MCO) plays in today’s health care environment by developing a 250‐500-word response that addresses the following: What is a health care organization’s administrative role in executing risk management policies and ensuring compliance with managed care organization (MCO) standards?

 

1. What value do the regulatory statutes of a typical MCO provide to a health care organization? Consider how strategies pertaining to policies such as conflict resolution and risk management affect patients as well as employees and employers.
2. What MCO responsibilities relevant to the Patient Protection and Affordable Care Act (ACA) and Center for Medicare and Medicaid Services (CMS) focus on fraud, waste, and abuse laws?

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A health care organization’s role in executing risk management policies and ensuring compliance with managed care organization (MCO) standards

The execution of risk management policies is mainly carried out by healthcare organizations and they always focus on complying with the standards and protocols that are provided. The administrative manager of a healthcare organization helps in the process of management of risk by identifying and evaluating to ensure that there is a reduction of any harm on the patients, any visitors in the healthcare organization, and the staff working in the healthcare organization. Their role as well helps in the aversion of the various risks that may be experienced and ensure that the damages that are experienced are effectively managed (Ratna, 2019). The process of identification of risks includes the need for consciousness among the healthcare staff on the risks. The process of carrying out a risk analysis is vital in that allows for the development of a comprehensive process of management of risk and ensures that the impact of the risks is avoided. …

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