Collection of Best Practices of Managed Care Organizations. The Results of aSurvey by the Health Care Financing Administration Office of Managed Care

摘要

The Division of Policy and Evaluation (DPandE) of the Health Care FinancingAdministration (HCFA) mounted this study to identify, document and disseminate some of those practices of some managed care organizations (MCOs) that knowledgeable observers judge to be especially effective or 'best practices.' MCOs were broadly defined as organizations that integrate the financing and delivery of health care. The design of the study is described in Appendix A. As the MCO Activities Model depicts, the viability of a managed care organizations in its fullest form is dependent on its providing the most appropriate health care services in a cost effective manner that results in both optimal clinical outcomes and satisfied members and providers. It is also dependent on administative support and managerial strength that ensure a strong market presence and the financially and strategically sound operating base for such services.