When a clinic joins a management care organization, there are several benefits and effects that the organization undergoes. The main aim of a clinic joining a MCO is to ensure proper staffing, find a balance in its financial stability and to be able to effectively manage its patient volumes. According to Burns (2008), managed care organizations have programs that ensures patient outcomes are achieved through the provision of affordable, appropriate and extensive coverage of accessible benefits of prescription drugs. Clinics are thus able to choose from the numerous plans and programs to reduce their costs and be able to choose the best remuneration for their doctors and nurses.
There are several ways in which MCOs reduce costs for their clients. These methods vary from one program to another. The general methods used by MCOs include; the use of established formularies that ensure that the resources used for purchasing are concentrated in order to make most MCOs access appropriate drugs easily, the collaboration of MCOs and prescribers to enable the use of drugs that are based on principles and scientifically proven evidence, the implementation of management programs such as disease management and medication therapy, the use of products that are generic in most of the clinics that are recommended by the Food and Drug Administration and the use of contracts that are negotiated between the MCOs and the pharmaceutical manufacturers that ensure that the clinics get reduced prices for the drug products that they purchase.
There are several concerns about MCOs providing a lower quality of care compared to traditional fee-for-service (FFS) organizations. In the traditional fee for free services the hospitals and the individual providing the treatment in hospitals are paid for the work they perform. There are no set limits as to the job being done. The doctors can change the prices they charge for each time a patient visits the hospital. This does not benefit the patients as most insurance companies pay only a fraction of the total cost of the treatment. MCOs prices are determined by the policies and programs that are set. According to Musgrave (2006), the quality of medication by MCOs is argued to be lower because a patient can visit a hospital severally and the amount of money paid is the same. Doctors in hospitals also have to deal with a high number of patients and thus the hospital doctors feel overworked. The hospital facilities are also overstretched by the big number of patients being admitted.
When making a decision about what a company should chose in its plan to deliver quality healthcare plan, several questions must be considered by the sales representative of a particular company. One of the main questions that should be taken into consideration is the financial stability of the company. Is the clinic stable enough to join a particular MCO or does the clinic use the traditional fee for free service health? Does the medical clinic have enough facilities to cater for the patients in the MCOs?
The evolution of consumer driven health plans and the MCOs have positively affected the healthcare environment especially in integrating the financial and delivery of healthcare services. These programs have benefited the patients in that the patients are able to pay reduced prices whilst getting the best medical attention that they require. Clinics integrated in the MCOs also get reduced prices especially during the purchase of prescription drugs as they buy in bulk thus achieving huge economies of scale.
The relationships and roles between patients and physicians have changed in the MCOs and the fee for free services. In the MCOs the patients pay a reduced price thus frequent the hospitals. Doctors are able to monitor the patients over a long time. In the fee for free plan, the patients visits are not frequent as the doctors charge differently depending on the type of medication that the patient receives.
Burns, M. E. (2008). The prevalence and effects of medicaid managed care for adults with disabilities.
Musgrave, F. W. (2006). The economics of U.S. health care policy: The role of market forces. Armonk, N.Y: M.E. Sharpe.