Research and determine which regulatory agencies/organizations govern financial reporting and solvency for different types of managed care organizations. Prepare a chart that compares/contrasts the approach of each agency. Your chart should include
A description of each agency
The type of healthcare organization impacted
Different aspects of its governance
Your chart should be prepared according to APA Requirements and include a minimum of three sources
Improvements in care-giving have led to increased pressure on health care providers to reduce expenses incurred and to improve the quality of health while protecting the market share. The concept of managed care considers the techniques used in managed care and the organizations that oversee various actions (Harris & Gordon, 2005). Managed care techniques can include financial incentives, promoting wellbeing, early identification of illnesses, educating patients, self-care, preventive health, and other aspects of utilization management. Different organizations are involved in the implementation of managed health techniques (Harris & Gordon, 2005). The regulation employed aim at stabilizing the insurance market, protecting patients’ access to quality care, and protecting caregivers from managed care policies (Gauthier & Rogal, 2001). Additionally, insurance regulations guarantee that consumers are issued and can renew health insurance as well as facilitate collective purchasing of health insurance (Gauthier & Rogal, 2001). Solvency involves the measures that a health care provider employs to meet financial stability in the long-term. Regulatory agencies provide for methodologies that are applicable in the management of finances to ensure sustainability and acknowledgeable health care financing (Gauthier & Rogal, 2001).This article aims at comparing and contrasting different regulatory agencies and organizations that govern financial reporting and solvency in different types of managed care organizations.
Types of Managed Care
Health Maintenance Organization (HMO). It comprises of a variety of health plans that facilitate contractual relationships with specific providers who give care to a specific population (Ladenheim, 2001). The use of HMOs ensures that health centers and medical practitioners are more productive and efficient (Gauthier & Rogal, 2001).
Preferred Provider Organizations (PPOs). The PPOs are organizations that are contracted to employer health benefits schemes and health insurance providers to purchase health care services for their clients from a specific group of incorporated providers (Harris & Gordon, 2005).
Independent practice (IPA). It consists of a group of medical personnel that form an entity to accept risk through contracting other organizations or engaging in marketing the collaboration as a health plan (Harris & Gordon, 2005).
Integrated delivery systems (IDS). Advancements in information technology have helped in the development of schemes to share clinical data that allow multiple providers to collaborate on health matters. Information sharing enhances efficiency in administrative functions such as billing and collection of data.
A chart to compare and contrast the approach of each agency….