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Question Description

Medical Management Committees

Managed care is a complex system involved in the financing and delivery of health care. The main goals of this system are to control access, quality, and cost of health care. MCOs have complex relationships or contracts with buyers (employers or individuals), providers (health care facilities and physicians), and consumers (patients). To this end, there is a need for complex management structures to organize and oversee these relationships.

There are six different medical management committees typically formed within an MCO. Some serve operational purposes while others serve to meet regulatory and quality standard functions. Refer to the readings of this week and answer the following questions:

  • Research a Managed Care Organization [MCO] (e.g. Blue Cross Blue Shield, Aetna, Humana, etc.) online. Discuss the similarities and differences between six medical management committees of an MCO.
  • Analyze the main role of each committee on the basis of your research.
  • Explain out of the six committees, which committee do you feel is the least important. State your reasoning using specific examples from your research.
  • In addition, how is the information you found online similar and/or different from what is described in your readings?

After answering the above questions, read the following information:

The development of MCOs has been influenced by the type of market they serve. For example, BCBS companies moved from primarily a service plan provider to a multiproduct line that includes HMO, PPO, and consumer choice plans. In addition, various types of managed care organizations have emerged due to forces imposed by the state and the federal governments, such as the HMO Act of 1973. Answer the following questions keeping in mind the above information:

  • Examine how public policy has impacted the growth of managed care.
  • Evaluate the impact of one federal and one state-level policy.
  • Compare and contrast the ways the policy caused the managed care market to grow or retract.

To support your work, use your course and textbook readings and also use the South University Online Library. As in all assignments, cite your sources in your work and provide references for the citations in APA format.

Tutor Answer

bene
School: Cornell University

Attached.

Running head: AETNA INCOPORATION MANAGED CARE ORGANIZATION

Aetna Incorporation Managed Care organization
Name
Institutional Affiliation

1

AETNA INCOPORATION MANAGED CARE ORGANIZATION

2

Similarities and Difference in the committees of Aetna Incorporation
Audit committee and committee on compensation and talent management of Aetna
managed care organization follow the New York Stock Exchange listing standards to ensure
members meet the independence and financial requirement of the health plan. According to
Cotton et al.,(2016), Investment and finance committee together with medical affairs committee
are have similar goal to ensure the Board of Aetna oversees the policies as...

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