HLT 308V Reflective Analysis: Risk Management and the Role of Managed Care

HLT 308V Reflective Analysis: Risk Management and the Role of Managed Care

Requires Lopeswrite

Assessment Description

The purpose of this assignment is to analyze the role of managed care organizations within health care and risk management programs.

Reflect on and evaluate the role that the managed care organization (MCO) plays in today’s health care environment by developing a 250‐500-word response that addresses the following:

  1. What is a health care organization’s administrative role in executing risk management policies and ensuring compliance with managed care organization (MCO) standards?
  2. What value do the regulatory statutes of a typical MCO provide to a health care organization? Consider how strategies pertaining to policies such as conflict resolution and risk management affect patients as well as employees and employers.
  3. What MCO responsibilities relevant to the Patient Protection and Affordable Care Act (ACA) and Center for Medicare and Medicaid Services (CMS) focus on fraud, waste, and abuse laws?

In addition to your textbook, you are required to support your analysis with a minimum of two peer‐reviewed references.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.

RUBRIC – HLT 308V Reflective Analysis: Risk Management and the Role of Managed Care

Reflective Analysis: Risk Management and the Role of Managed Care – Rubric

Rubric Criteria

Ensuring Compliance With MCO Risk Management Standards

Criteria Description

Administrative Role of a Health Care Organization in Ensuring Compliance With Managed Care Organization (MCO) Risk Management Standards

  1. 5: Excellent

17.5 points

An assessment of the administrative role of a health care organization in ensuring compliance with MCO risk management standards is comprehensive. The submission further incorporates analysis of supporting evidence insightfully and provides specific examples with relevance. Level of detail is appropriate.

 

Value of MCO Regulatory Statutes to a Health Care Organization

17.5 points

Criteria Description

Value of MCO Regulatory Statutes to a Health Care Organization

  1. 5: Excellent

17.5 points

An explanation of the value MCO regulatory statutes provide to a health care organization is present and comprehensive. The submission further incorporates analysis of supporting evidence insightfully and provides specific examples with relevance. Level of detail is appropriate.

 

MCO Responsibilities Relative to ACA and CMS Focus on Fraud, Waste, and Abuse Laws

Criteria Description

MCO Responsibilities Relative to ACA and CMS Focus on Fraud, Waste, and Abuse Laws

  1. 5: Excellent

A description of the MCO responsibilities relative to the ACA and CMS focus on fraud, waste, and abuse laws is comprehensive. The submission further incorporates analysis of supporting evidence insightfully and provides specific examples with relevance. Level of detail is appropriate.

 

Thesis Development and Purpose

Criteria Description

Thesis Development and Purpose

  1. 5: Excellent

3.5 points

Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.

Argument Logic and Construction

Criteria Description

Argument Logic and Construction

  1. 5: Excellent

 

Clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.

 

Mechanics of Writing (includes spelling, punctuation, grammar, language use)

Criteria Description

Mechanics of Writing (includes spelling, punctuation, grammar, language use)

  1. 5: Excellent

3.5 points

Writer is clearly in command of standard, written, academic English.

 

Paper Format (use of appropriate style for the major and assignment)

Criteria Description

Paper Format (use of appropriate style for the major and assignment)

  1. 5: Excellent

3.5 points

All format elements are correct.

 

Documentation of Sources

Criteria Description

Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)

  1. 5: Excellent

3.5 points

Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.

RESOURCES

College of Nursing and Health Care Professionals: Do We Know What Our Future Is?

Watch the video “College of Nursing and Health Care Professionals: Do We Know What Our Future Is?”

http://lc.gcumedia.com/zwebassets/courseMaterialPages/nur508_healthcare-reform-video-series-v1.1.php

 

Network Strategies: Finding a Better Path Through Coordinated Care

Read “Network Strategies: Finding a Better Path Through Coordinated Care,” by Horn, from Benefits Magazine (2015).

https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=bth&AN=102649158&site=ehost-live&scope=site

 

Legal and Ethical Essentials of Health Care Administration

Read Chapters 18, 19, and 26 in Legal and Ethical Essentials of Health Care Administration.

View Resource

 

Assessing Changes to Medicaid Managed Care Regulations: Facilitating Integration of Physical and Behavioral Health Care

Read “Assessing Changes to Medicaid Managed Care Regulations: Facilitating Integration of Physical and Behavioral Health Care,” b

… Read More

https://www.commonwealthfund.org/publications/issue-briefs/2017/oct/assessing-changes-medicaid-managed-care-regulations-facilitating

 

EMTALA: A Shifting Landscape

View the presentation “EMTALA: A Shifting Landscape,” located on the American Bar Association (ABA) website.

https://www.americanbar.org/content/dam/aba/administrative/healthlaw/EMTALA_4_10_18.authcheckdam.pdf

 

Chapter 10: EMTALA and Managed Care

Read “Chapter 10: EMTALA and Managed Care,” by Moffat, from EMTALA Answer Book (2015).

https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=bth&AN=99912645&site=ehost-live&scope=site

 

The Health Care Fraud and Abuse Control Program Protects Consumers and Taxpayers by Combating Health Care Fraud

Read “The Health Care Fraud and Abuse Control Program Protects Consumers and Taxpayers by Combating Health Care Fraud,” from the

… Read More

https://www.cms.gov/newsroom/fact-sheets/health-care-fraud-and-abuse-control-program-protects-consumers-and-taxpayers-combating-health-care