Risk management in health care institutions

Health Care Organizations and Managed Care Organizations (MCOs)

Health care organizations play an important role in ensuring management policies and managed care organizations are followed. Notwithstanding the fact that MCOs entail significant financial risks, states and health care organizations bear a significant risk since they bear public accountability for the deficiencies in MCO performance. State-specific hazards include the inability to keep MCOs accountable, excessive administrative costs, network adequacy, and the possibility of overpayments. Health-care organizations and Medicaid are frequently scrutinized by the media and federal government oversight bodies. They are tools of political campaigns and elections.

Ensuring Compliance with MCOs

Health care organizations have assisted some state governments to regain millions of dollars through imposition of liquidated damages as well as litigation. These have been attained through thorough audit of MCOs that help to unravel troublesome situations. Therefore, the state governments through the healthcare institutions assist in undertaking proper oversight thus are responsible for returning federal matching funds that may have been spent in a wrong manner (Kavaler & Spiegel, 2003). Some of the specific measures that can be undertaken by healthcare organizations to ensure compliance with MCOs include reviewing of system logs, ensuring proper maintenance of backup tapes, enacting proper disaster recovery initiatives, ensuring effective compliance with the HIPAA privacy, increase the rate of reimbursement and coming up with policies and procedures that minimizes cases of conflict.

Managing Conflicts in Healthcare Institutions

In my assessment of the value offered by organizations, MCOs regulatory statutes has established means of solving and managing conflicts in healthcare organizations. Conflicts are likely to occur in any organization and healthcare institutions are not excluded. Some of the negative consequences of conflict in healthcare institutions include increase in employee turnover, decline in patient satisfaction and emergence of dysfunctional team work. MCOs proposed strategies that I tend to support include training of the employees in conflict resolution skills so as to promote teamwork, addressing the specific needs of the employees and seeking to satisfy the patients through proper needs assessment (Kongstvedt, 2001). Healthcare offers a fascinating cultural variety in a number of ways that include ethnic diversity of the consumers of healthcare and service providers. Due to these diversities, potential barriers can emerge thus hindering smooth flow of activities. Through the sharing of collaborative and facilitative approaches, there is need to focus on specific interests so as to promote positive and long term solutions.

MCOs and the Patient Protection and Affordable Care Act (ACA)

MCO have a clear mandate and responsibilities in regards to the Patient Protection and Affordable Care Act. The body has a clear agenda in regards to combating fraud, waste and abuse that has marked the health care as well as controlling key federal programs that hiders the reduction of federal expenditures. The Affordable Care Act that was passed in 2010 has fraud, waste as well as abuse provisions that assist the federal government in dealing with improper Medicare and children health insurance programs (Youngberg, 1998). MCOs advance the ACA roles of increasing ensuring proper screening for the service providers who want to be part of the Medicaid and Medicare. Specific measures include enhancement of penalties for the violators, imposing of new requirements for claims, appropriation of additional funding for measures aimed at combating fraud and facilitation of data sharing among the different health care institutions.

References

Kavaler, F., & Spiegel, A. D. (2003). Risk management in health care institutions: A strategic approach. Sudbury, Mass: Jones and Bartlett Publishers.

Kongstvedt, P. R. P. R. (2001). The managed care handbook. Gaithersburg, Md: Aspen Publishers.

Youngberg, B. J. (1998). The Risk manager’s desk reference. Gaithersburg, Md: Aspen Publishers.