Editor’s Note: Updated 5/28/19, Managed Care Organizations (MCOs) utilize an array of important techniques to decrease the cost of care. From provider networks to formal utilization review and quality improvement programs, MCO are becoming a popular option in healthcare organizations. If you are thinking of transitioning to an MCO, the case study outlined below is a great resource. Click HERE and discuss how BHM helps track claims data for payers.
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Currently states are making the transition to Managed Care, or allowing Managed Care Organizations to take the lead in providing healthcare to Medicaid recipients. In the Managed Care Model, states allocate a specific amount of money per individual for healthcare on an annual basis. The Managed Care Organization then provides care to individuals, and is responsible for payment of any charges above and beyond what was allocated for an individual. There are dozens of Managed Care Organizations which are expanding across the nation, with the “Big 10” currently covering the care for millions, and expected to expand when additional beneficiaries are Medicaid eligible under Healthcare Reform in 2014.
In fact an additional 16 million individuals are estimated to be enrolled in Managed Care Organizations, including all individuals whose income falls below 133% of the poverty level, but concerns continue to arise regarding the quality of care. From spotty provider networks, which cause patients to be unable to find a specialist in their area, to unreliable data which may prove to leave the MCOs at great financial risk, the verdict is still out on whether or not the move to Managed Care will be a successful one.
| LARGEST MEDICAID MANAGED-CARE PLANS |
| Company |
Enrollment
|
Potential enrollment growth from law
|
| UnitedHealthcare |
3.0 million
|
994,000
|
| Amerigroup |
1.9 million
|
608,000
|
| WellPoint |
1.7 million
|
570,000
|
| Molina Healthcare |
1.5 million
|
484,000
|
| Centene |
1.5 million
|
480,000
|
| WellCare |
1.3 million
|
NA
|
| Aetna |
1.2 million
|
346,000
|
| HealthNet |
896,000
|
285,000
|
| AmeriHealth |
775,000
|
NA
|
| Coventry |
462,000
|
133,000
|
|
Comments
We invite all comments in regard to this article. What are your thoughts on Medicare? What are your thoughts on the Affordable Care Act and Medicare? Do you think the system is working? Do you think Medicare should be regulated and administered at the individual state level? How will the healthcare insurance exchanges impact Medicare?
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Managed Care Organizations (MCOs) utilize an array of important techniques to decrease the cost of care. From provider networks to formal utilization review and quality improvement programs, MCO are becoming a popular option in healthcare organizations. If you are thinking of transitioning to an MCO, the case study outlined below is a great resource. Click HERE and discuss how BHM helps track claims data for payers.
