Question

As MCOs continue to find ways to distinguish themselves in the market place, many seek to obtain accreditation for different services and different reasons.

A) What role does accreditation play in managed care?
B) Why would an organization pursue accreditation?
C) What impact does accreditation have on the administration of an MCO?

Answer 1

Accreditation plays a key role in managed care as it ensures that the managed care organization meets certain standards and regulations. Organizations pursue accreditation to demonstrate their commitment to quality improvement and patient safety, gain a competitive advantage, and meet reimbursement requirements. Accreditation impacts the administration of an MCO by requiring the implementation of policies and procedures that align with accreditation standards and driving continuous improvement and accountability.

Step-by-step explanation:

A) Accreditation plays a key role in managed care as it is a process by which an external organization evaluates the quality and safety of healthcare services provided by the managed care organization (MCO). It ensures that the MCO meets certain standards and regulations set by accrediting bodies, such as the National Committee for Quality Assurance (NCQA) or the Joint Commission. Accreditation helps to establish credibility and trust with patients, employers, and other stakeholders.

B) An organization may pursue accreditation for several reasons. Firstly, it demonstrates a commitment to quality improvement and patient safety. Accreditation also provides a competitive advantage in the marketplace, as it differentiates the MCO from others that may not be accredited. Furthermore, some insurance companies and government programs require accreditation for reimbursement purposes.

C) Accreditation has a significant impact on the administration of an MCO. It requires the MCO to implement policies, procedures, and systems that align with the accreditation standards. This includes ensuring appropriate utilization management, care coordination, quality measurement, and patient safety measures. Accreditation also involves ongoing monitoring and reporting of performance indicators, which helps to drive continuous improvement and accountability within the MCO.

Answer 2

The answers to the questions above are explained below.

Step-by-step explanation:

A MANAGED CARE ORGANIZATION (MCO) is a health care provider or a group or organization of medical service providers who provides health care services for those on connected insurance plans.

MANAGED CARE ORGANIZATION (MCO) whose goal is to provide appropriate, cost-effective medical treatment.

A) Accreditation plays the following roles in managed care:

1. ACCREDITATION improves the overall quality of care in healthcare facilities.

2. ACCREDITATION improve patient outcomes and it stimulates continuous improvement.

3. ACCREDITATION raises community confidence in the services provided by the health care organization.

4. ACCREDITATION promotes the health, safety and welfare of the society. It achieves this, by assuring competent public health professionals.

5. ACCREDITATION ensures educational requirements reflect the current training needs of the profession.

6. ACCREDITATION promotes its national reputation and represents peer recognition.

7. ACCREDITATION helps to maintain compliance with healthcare laws and regulations.

B) An organization would pursue ACCREDITATION because:

1. ACCREDITATION reflects an agency's dedication and commitment to meeting standards that demonstrate a higher level of performance and dedication to improving patient outcomes and safety.

2. ACCREDITATION stimulates continuous improvement.

3. ACCREDITATION helps an organization maintains compliance with healthcare laws and regulations and keep up to date with industry standards.

4. ACCREDITATION of an organization is granted when an organization meets national health, quality and safety standards. Hence, organizations pursue ACCREDITATION to make patients who are treated at the facility be assured they are receiving the best care.

C) The impact accreditation have on the administration of an MCO are the following:

1. It raises community confidence in the services provided by the health care organization.

2. It ensures that organization meets regulations and standards set by a recognized, external organization.