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    Managed Care and Accountable Care Organizations

                Mod 2 Discussion


    1. Please share your experience on selecting a managed care plan. Please discuss the advantages and disadvantages of your MCO plan.


    1. Many argue that there is no consistent, direct correlation between the cost of care and its quality in a managed care program. Do you agree or disagree?


    1. Do you think patient’s choice of provider and access to care will be limited under ACOs?


    1. In what ways can an ACO succeed in both delivering high-quality care and spending health care dollars more wisely?





Subject Nursing Pages 3 Style APA


Managed Care and Accountable Care Organizations

I selected the Health Management Organizations plan which is often managed by care organizations for enhancement of healthcare related services to all parties within the HM (Finkler, 2016).

Advantages and Disadvantages My MCO plan

Pros of a Health Maintenance Organization

  • There is allowance of building up long lasting relations with other primary care physicians.
  • Minimal deductibles and co pays.
  • Low drug prescription prices because HMO plan take full advantage of reducing bulky prescription rates for drugs.

Cons of a Health Maintenance Organization

  • Most HMO’s have restrictions which mostly interfere with a patient’s treatment pattern and equally restricts them from seeking medical assistance from other facilities.
  • In cases of patients with pre-existing conditions, HMO’s might not cover for all treatment expenses in relation to specific injuries, and it might take quite some time before all treatment and hospital procedures are catered and covered for.
  • Patients are put on waiting for a long period of time compared to holding an indemnity insurance plan.

Question 2

Yes, I agree that there is no direct correlation between the cost care and its quality in a managed care program since insurer owned plan have reduced costs within the reform markets while the insurers in other markets have different rates of cost reduction.


Yes, the patient’s choice of provider and access to care will be limited under ACOs since, despite most of the ACOs giving financial incentives within all health care organization aim at reducing costs while aiding in quality improvement, most of the ACO systems do fail (Baier, 2015). 

ACOs will also limit a provider’s choice since they mostly undermine entrepreneurship and competition forums yet such systems are the backbones to most developmental achievements. Healthcare units can, therefore, only get rid of such and positively transform through creation of incentives for achieving high quality of care services while minimizing on the quantity of services offered to medical procedures (Illich, 2016).

Question 4

  • Through preservation of equitable fee to cater for service provider reimbursement in order to encourage volume driven productions instead of outcomes.
  • Through restriction of favoritism to large players who in turn monopolize and consolidate markets leading to reduction in competition (Westling, 2017).
  • Increasing the roles played by all primary care providers.



Baier, R. R., Wysocki, A., Gravenstein, S., Cooper, E., Mor, V., & Clark, M. (2015). A Qualitative Study of Choosing Home Health Care After Hospitalization: The Unintended Consequences of ‘Patient Choice’ Requirements. Journal of general internal medicine, 30(5), 634-640.

Finkler, S. A., Smith, D. L., Calabrese, T. D., & Purtell, R. M. (2016). Financial management for public, health, and not-for-profit organizations. CQ Press.

Illich, I., & Sen, A. (2016). Make the Patient the True Customer for Health Care. The Patient as Agent of Health and Health Care: Autonomy in Patient-Centered Care for Chronic Conditions, 305.

Westling, C. R., Walsh, T., & Nelson, W. A. (2017). Perceived Ethics Dilemmas Among Pioneer Accountable Care Organizations. Journal of Healthcare Management, 62(1), 18-27.



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