Search Results for mco

...Peter D. Jacobson; Matthew L. Kanna This article provides an initial look at how managed care organizations(MCOs) might incorporate cost-effectiveness analysis (CEA) into their decision-making process and how the courts might respond. Because so few medical liability cases directly involve CEA, we...

... of managed care. Yet, real suf- fering has occurred, and some of it is attributable to bad decisions made by officials of managed care organizations (MCOs). But errors and insensitivity to patients were part of the indemnity landscape as well, and in spite of the publicity, there is no evidence...

... (e.g., mandatory external appeals, liability rights, and making managed care organization [MCO] medical directors subject to the dis- Journal of Health Politics, Policy and Law, Vol. 24, No. 5, October 1999. Copyright © 1999 by Duke University Press. 1062 Journal of Health Politics, Policy...

...Figure A1 Medicaid Commercial MCO Penetration and Medicaid Reporting Rates ...

..., vulnerable population where SDOH are likely to be substantial factors in overall health. Second, state contracts with Medicaid managed care organizations (MCOs), which managed benefits for over two-thirds of Medicaid members as of 2016 (CMS 2018a ), create an opportunity for states to embed incentives...

... organizations (MCOs) and the private sector, so the story goes, are not perfect, but the alternative—having legislatures man- age health resources and bureaucracies make health care decisions—is Funding provided by a Robert Wood Johnson Investigator award. Helpful comments were pro- vided by Diane...

... from these multiple perspectives, limiting the narrative to public officials, managed care organizations (MCOs), selected providers, and enrollee advocates. It is an innovative approach that yields a rich amount of information concerning the various groups. Bennett argues that these players, all...

... capitated managed care organizations (MCOs) and outlines several implementation challenges the CCO model faces. In 2009 House Bill 2009 established the Oregon Health Authority (OHA) as an independent agency. It also established the Patient-Centered Primary Care Home (PCPCH) program, to promote...

... (MCOs) were developed in the United States several decades ago largely as a response to escalating health care costs. Like “traditional” private health insurers of the 1960s and 1970s, most Weiner et al.  ■  Global Context of Managed Care, Private Insurance  1109   MCOs — such as health...

... care organization (MCO) that participates in Medicaid. ▪  Change in provider . This would occur when a person must change provider because his or her former provider is not in-network in the new program or carrier. This form of disruption, we should note, could occur even if the QHP and MCO are part...

...; Congressional Research Ser- vice 1993; Lewin–VHI 1995; Rowland et al. 1995). Under risk-based capitation programs, states contract with managed care organizations (MCOs)—which can include private health maintenance organizations (HMOs) or prepaid health plans (PHPs) such as federally qualified health...

... to contracting with managed care organizations (MCOs). In Connecticut’s case, the state actively recruited commercial MCOs to contract with the state to provide services to Medicaid recipients. This changed the constellation of actors in the policy network and traditional Medicaid safety-net pro- viders...

... or a Medicaid Managed Care Organization (MCO), 3) who is eligible to purchase plans, and 4) which benefits and providers will be covered and at what payment rates. Our goal is to clarify the implications of these choices with respect to the aforementioned goals and with respect to the tradeoffs each choice...

... organizations [HMOs] or managed care organizations [MCOs These entities take responsibility for both financ- ing and delivery of care; to do so at competitive prices, they must bring Journal of Health Politics, Policy and Law, Vol. 29, No. 6, December 2004. Copyright © 2004 by Duke University Press. 1046...

... and Reynolds 2014 ; Iowa Department of Human Services 2015d ). While the comprehensive nature of Iowa's Medicaid Modernization is unique among states, the program is generally consistent with national trends: as of 2014, thirty-nine states contracted with managed care organizations (MCOs) to provide...

... reduce patient access to providers, along with provider access to paying patients, so many providers have lobbied for AWP-FOC laws. In opposition are managed care organizations (MCOs), which want full freedom to contract selectively to control prices and utilization. This article comprehensively...

...- ically appropriate with little need to explain or justify their decisions. Over the past quarter century, managed care organizations (MCOs) have shifted power away from physicians to payers. MCOs required, in one way or another, that doctors and medical...

... annual growth rates, Democrats controlled the White House and both houses of Congress. When the Balanced Budget Act of 1997 (BBA) was enacted, legislation that was expected to significantly increase managed care organization (MCO) participation and beneficiary enrollment, it was passed on a remarkably...