Discuss the similarities and differences between six medical management committees of an MCO.

Managed care is a complex system involved in the financing and delivery of health care.  The main goals of this system are to control access, quality, and cost of health care.  MCOs have complex relationships or contracts with buyers (employers or individuals), providers (health care facilities and physicians), and consumers (patients).  to this end, there is a need for complex management structures to organize and oversee these relationships.

 

There are six different medical management committees typically formed within an MCO.  Some serve operational purposes while others serve to meet regulatory and quality standard functions.  Refer to the readings of this week and answer the following questions:

  • Researcsh a Managed Care Organization [MCO] (e.g. Blue Cross Blue Shield, Aetna, Humana, etc.) online.  Discuss the similarities and differences between six medical management committees of an MCO.
  • Analyze the main role of each committee on the basis of your research.
  • Explain out of the six committiees, which committee do you feel is the least important.  State your resoning using specific examples from your research.
  • In addition, how is the information you found online similar and/or different from what is described in your readings

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