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Risk Management and the Role of Managed Care

Healthcare organization administrators play a prominent role in identifying, and executing risks about patient healthcare policies and ensuring managed care organization (MCO) standards compliance. A healthcare setting is a critical area that requires proactive and reactive approaches to safeguard or minimize uncertain event damages, including injury to patients, workers, and visitors.

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Huang et al. (2018) emphasize that risk management and compliance improve patient care quality and minimize healthcare expenditure and employee workload. Healthcare risk management incorporates systems, processes, plans to control the occurrence of risks, and compliance with laws and guidelines governing healthcare functionalities. Therefore, it is crucial for every healthcare setting to develop its own evidence-based risk identification strategies corresponding to its daily activities and operational regulations.

Managed care organizational standards address conflict management between various healthcare settings, providing patient care safety and quality. Sometimes, different approaches to conflict management can positively or negatively give rise to a more or reduced context of the current disagreement. Scott and Gerardi (2019) argue that unsolved conflict can undermine healthcare operational efforts critical for patient safety and care quality. The strategies leaders utilize to manage risks and conflicts have a huge impact on employee productivity, affecting overall patient care delivery. Therefore, basing conflict approaches on organizational goals and objectives is vital to obtaining improved grievance processes, reducing costs, and ensuring collaborative healthcare mid-set.

Healthcare.gov HHS is a managed care organization responsible for administering Medicare, Medicaid, children’s insurance programs, and the US marketplace. Shachar and Curfman (2020) suggest that fraud, waste, and abuse in Medicare should be critical priorities in a healthcare setting. The Affordable Care Act passed in 2020 addresses the elements providing provisions to improve the federal government in combating improper payments in a healthcare setting. The ACA focuses on improving compliance with violations, and health programs data sharing and creates new healthcare requirements based on the claims evaluated (Shachar & Curfman, 2020). The ACA is significant in ensuring healthcare organizations comply with the available or revised laws and regulations concerning patient safety and care quality.

References

Huang, C., Iqbal, U., & Li, Y. (2018). Healthcare improvement measures in risk management and patient satisfaction. International Journal for Quality in Health Care, 30(1), 1-1.

Scott, C., & Gerardi, D. (2019). A Strategic Approach for Managing Conflict in Hospitals: Responding to the Joint Commission Leadership Standard, Part 1. The Joint Commission Journal on Quality and Patient Safety, 37(2), 59-69.

Shachar, C., & Curfman, G. (2020). Reconsidering Health Care Fraud and Abuse Laws. JAMA, 324(17), 1735.

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StudyCorgi. (2022, July 28). Risk Management and the Role of Managed Care. Retrieved from https://studycorgi.com/risk-management-and-the-role-of-managed-care/

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