Managed Care Organization Support Healthcare Delivery

How the Managed Care Organization Started

The Health Maintenance Organization Act of 1973, an amendment of the Public Health Service Act of 1944, established the foundation for managed care organization and their comprehensive cost-saving methods. Managed care organizations are different integrated healthcare entities that were created to take on the responsibility of reducing a member’s overhead costs and expenses. Several breakthrough contributions by managed care organization have shaped healthcare delivery in the United States since the 1970s. The said advancements involved healthcare strategies such as preventative medicine, financial provisioning, and treatment guidelines.



The Influence They Have on Healthcare Delivery

A managed care organization is a health plan entity that is focused on managed care as a model to limit costs, while keeping quality of care high. Providers rely on every managed care organization to be effective in their processes. They need to understand their customary practices as managed care organization's policies can influence many aspects of healthcare delivery. Above all, it affects how and where a patient receives medical care and includes certain factors such as:

Health outcomes

Managed care organization have managed to grow and expand over the years because they have shown to improve every member’s health outcomes. They have achieved this by working with different healthcare providers to meet every healthcare demand.

Primary care providers (PCPs)

Managed care organization contract with various provider groups, including physicians, specialists, hospitals, labs, and other healthcare facilities to offer members with a plan that’s more cost-effective through care and services at reduced rates. 

Provider network

Managed care organizations can assist in selecting PCPs. As a member of a managed care system, PCP is the point of contact for the coordination of all of a member's healthcare needs. If specialized care or treatment is required, PCPs can refer patients to the appropriate specialists and facilities that are often within the same network.

Preventive care measures

Managed care organizations design preventive care strategies for every patient population. Preventive services, such as annual check-ups, routine screenings, and more can be expected in the coverage of the plan they formed.

The Most Essential Solutions for Managing Care

Managed care organizations or health plan companies, hospitals, and physicians have the ability to control costs, improve healthcare quality and patient outcomes. The options for healthcare organizations are endless. They can collaborate to create more effective programs, not just for themselves but ultimately for the population they serve.

Since its inception, MedVision has supported different healthcare entities, including managed care organization, through its signature web-based administrative platform QuickCap v7. QC7 can simplify complex business workflows and streamline processes through automation. With its customizable system, you can map out configurations that work specifically for your organization. Experience great convenience with tools and functionalities that help you with:

• Clinical decision support
• Capitation rates and provider contract planning
• Authorization and claims management
• Electronic data movement and transfers
• Benefit and health plan administration

Let QuickCap 7 boost every member’s healthcare delivery!

Reference:

Heaton, Joseph, and Prasanna Tadi. “Managed Care Organization - StatPearls - NCBI Bookshelf.” Managed Care Organization - StatPearls - NCBI Bookshelf. www.ncbi.nlm.nih.gov, March 9, 2022. https://www.ncbi.nlm.nih.gov/books/NBK557797/.

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