Columbia Southern MCOs Vs ACOs Comparison Paper

1.

Managed care organizations or MCO refers to medical organizations that utilizes local or national networks that are participating providers by offering increased benefits in the form of co pays and lower deductibles. This organization steer members to the in network participating provider listing. The purpose of the managed care organization is to provide members with services performed by providers that are working together to provide the only necessary treatments in the most cost-effective manner possible. Many managed care plans will require their member to select a primary care physician and obtain a referral before receiving in network specialty care. Participating providers agree to charge and receive lesser fees, however the popularity of these plans ensure the providers receive a steady stream of income and new patients. Some common managed care plans are PPOs, POS plans, or HMOs.

Accountable Care Organizations or ACOs originated from the Affordable Care Act. ACOs are groups of doctors, hospitals, and healthcare providers that collaborate to ensure the highest quality treatment for a population segment. Providers and pairs are incentivized to work together to improve care quality while reducing costs through efficient practices. “ACOs are accountable to the patients they serve and to third-party payers for the quality, appropriateness, efficiency and safety of the healthcare they provide.” (Haughom, 2014)

The ACO and MCO both strive to provide the highest quality medical care possible. However they differ in that in the ACO network the doctors talk to each other and share information about the patient in the MCO once referred out, it is up to the patient to bring back out of network care information to the PCM. Both MCOs and ACOs can convert and merge into one entity to the best medical needs of their consumers. They share similarities to the point where they can provide joint efforts to the best interest of the consumers.

2.

Managed Care Options (MCOs) are a health care delivery system designed to control costs, increase patient satisfaction, and monitor quality of healthcare services. MCOs are the healthcare delivery system in which large companies are contracted by Medicaid to provide health benefits and services (through provider networks) at a set per member per month (capitation) payment for service (Medicaid.gov, 2019). States utilize MCOs to lower Medicaid program costs and manage utilization of health services.

Accountable care organizations (ACOs) were established in concert with the Affordable Care Act (ACA) in 2012 as an initiative to improve the healthcare delivery system. ACOs are essentially a collaborative effort amongst providers and points of care (not contracted by large companies like MCOs) which agree to cooperate and are contracted by Medicare (BrainForestTV, 2014). To establish an ACO there must be voluntary participation of at least 5,000 patients for at least 3 years. ACOs utilize the same electronic health record system and establish visibility and archive of patient history which allows for a data archive. It is required that analysis as to whether or not patient care is efficient and appropriate is conducted as well as preventative healthcare to reduce admissions for preventable or advanced chronic illness is minimized. This accountability is trackable and allows for improvement in quality of care and decreased costs which are recognized through monetary incentives for providers. The intent of the ACO is better outcomes for patients at lower costs to the Medicare system.

MCOs in some states are implementing initiatives to incentivize realignments that produce better patient outcomes, quality of care, and increase accountability (Medicaid.gov, 2019). This is a way that they are similar to ACOs to coordinate and integrate care to produce high quality care at lower costs. MCOs are run by the insurer and have the ability to deny claims and is able to dictate what healthcare providers are allowed to do whereas ACOs are run by providers and do not have that issue to contend with.

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