Managed Care Organization Essay Example for Free

Managed Care Organization Essay USLegal.com A managed care organization (MCO) is a health care provider or a group or organization of medical service providers who offers managed care health plans. It is a health organization that contracts with insurers or self-insured employers and finances and delivers health care using a specific provider network and specific services and products. They provide a wide variety of quality and managed health care services to enrolled workers keeping medical costs down through preventative medicine, patient education, and in other ways. These organizations are certified by the director of the Department of Consumer and Business Services (DCBS). MCOs vary in their constitution as some organizations are made of physicians, while others are combinations of physicians, hospitals, and other providers. For instance, a group practice without walls, independent practice association, management services organization, and a physician practice management company are the common MCO’s. Patient Advocate Foundation Providers of care, such as hospitals, physicians, laboratories, clinics, etc., make up a managed care organization delivery system often known as an MCO. Seven common MCO models are: 1. Preferred Provider Organization (PPO) An arrangement whereby a third-party payer (health plan) contracts with a group of medical-care providers who furnish services at agreed-upon rates in return for prompt payment and a certain volume of patients, perhaps under contract with a private insurer. The services may be furnished at discounted rates, and the insured population may incur out-of-pocket expenses for covered services received outside the PPO if the outside charge exceeds the PPO payment rate. 2. Point-of-Service Plan (POS) Also known as an open-ended HMO, POS plans encourage, but do not require, members to choose a primary care physician. As in traditional HMOs, the primary care physician may act as a gatekeeper when making referrals; plan members may, however, opt to visit out-of-network providers at their discretion. Subscribers choosing not to use a network physician must pay higher deductibles and co-payments than those using network physicians. 3. Exclusive Provider Organization (EPO) A  network of providers that have agreed to provide services on a discounted basis. Enrollees typically do not need referrals for services from network providers (including specialists), but if a patient elects to seek care outside of the network, then he or she will not be reimbursed for the cost of the treatment. An EPO typically does not provide the preventive benefits and quality assurance monitor. 4. Physician-Hospital Organization (PHO) A contracted arrangement among physicians and hospital wherein a single entity, the Physician Hospital Organization, contracts to provide services to insurers subscribers. 5. Individual Practice Association (IPA) A formal organization of physicians or other providers through which they may enter into contractual relationships with health plans or employers to provide certain benefits or services. 6. Managed Indemnity Program A program in which the insurer pays for the cost of covered services after services have been rendered and uses various tools to monitor cost-effectiveness, such as precertification, second surgical opinion, case management, and utilization review. Also called managed fee-for-service programs. 7. Health Maintenance Organization (HMO) HMOs offer prepaid, comprehensive health coverage for both hospital and physician services. An HMO contracts with health care providers, e.g., physicians, hospitals, and other health professionals, and members are required to use participating providers for all health services. Model types include staff, group practice, network, and IPA. They differ in their financial and organizational arrangements between the HMO and its physicians. Some HMOs combine various attributes of the four principal models. WISCONSIN DEPARTMENT OF HEALTH SERVICES When a person decides to enroll in Family Care, they become a member of a managed care organization (MCO). MCOs operate the Family Care program and provide or coordinate services in the Family Care benefit. The Family Care benefit combines funding and services from a variety of existing programs into one flexible long-term care benefit, tailored to each individual’s needs, circumstances and preferences. View a list of items covered in the Family Care benefit package. In order to assure access to services, MCOs develop and manage a comprehensive network of long-term care services and support, either through purchase of service contracts with providers, or by  direct service provision by MCO employees. MCOs are responsible for assuring and continually improving the quality of care and services consumers receive. MCOs receive a per person per month payment to manage care for their members, who may be living in their own homes, group living situations, or nursing facilities. Some highlights of the Family Care benefit are: When a person decides to enroll in Family Care, they become a member of a managed care organization (MCO). MCOs operate the Family Care program and provide or coordinate services in the Family Care benefit. The Family Care benefit combines funding and services from a variety of existing programs into one flexible long-term care benefit, tailored to each individual’s needs, circumstances and preferences. View a list of items covered in the Family Care benefit package. In order to assure access to services, MCOs develop and manage a comprehensive network of long-term care services and support, either through purchase of service contracts with providers, or by direct service provision by MCO employees. MCOs are responsible for assuring and continually improving the quality of care and services consumers receive. MCOs receive a per person per month payment to manage care for their members, who may be living in their own homes, group living situations, or nursing facilities. Some highlights of the Family Care benefit are: People Receive Services Where They Live. MCO members receive Family Care services where they live, which may be in their own home or supported apartment, or in alternative residential settings such as Residential Care Apartment Complexes, Community-Based Residential Facilities, Adult Family Homes, Nursing Homes, or Intermediate Care Facilities for Individuals with Intellectual Disabilities. People Receive Interdisciplinary Case Management. Each member has support from an interdisciplinary team that consists of, at a minimum, a social worker/care manager and a Registered Nurse. Other professionals, as appropriate, also participate as members of the interdisciplinary team. The interdisciplinary team conducts a comprehensive  assessment of the member’s needs, abilities, preferences and values with the consumer and his or her representative, if any. The assessment looks at areas such as activities of daily living, physical health, nutrition, autonomy and self-determination, communication, and mental health and cognition. People Participate in Determining the Services They Receive. Members or their authorized representatives take an active role with the interdisciplinary team in developing their care plans. MCOs provide support and information to assure members are making informed decisions about their needs and the services they receive. Members may also participate in the Self-Directed Supports component of Family Care, in which they have increased control over their long-term care budgets and providers. People Receive Family Care Services that Include: Long-Term Care Services that have traditionally been part of the Medicaid Waiver programs or the Community Options Program. These include services such as adult day care, home modifications, home delivered meals and supportive home care. Health Care Services that help people achieve their long-term care outcomes. These services include home health, skilled nursing, mental health services, and occupational, physical and speech therapy. For Medicaid recipients, health care services not included in Family Care are available through the Medicaid fee-for-service program. People Receive Help Coordinating Their Primary Health Care. In addition to assuring that people get the health and long-term care services in the Family Care benefit package, the MCO interdisciplinary teams also help members coordinate all their health care, including, if needed, helping members get to and communicate with their physicians and helping them manage their treatments and medications. People Receive Services to Help Achieve Their Employment Objectives. Services such as daily living skills training, day treatment, pre-vocational services and supported employment are included in the Family Care benefit package. Other Family Care services such as transportation and personal care also help people meet their employment goals. People Receive the Services that Best Achieve Their Outcomes. The MCO is not restricted to providing only the specific services listed in the Family Care benefit package. The MCO interdisciplinary care management team and the member may decide that other services, treatments or supports are  more likely to help the member achieve his or her outcomes, and the MCO would then authorize those services in the member’s care plan. For a complete list of the services that must be offered by MCOs, refer to the description of the long-term care benefit package in the Health and Community Supports Contract. People Receive Services Where They Live. MCO members receive Family Care services where they live, which may be in their own home or supported apartment, or in alternative residential settings such as Residential Care Apartment Complexes, Community-Based Residential Facilities, Adult Family Homes, Nursing Homes, or Intermediate Care Facilities for Individuals with Intellectual Disabilities. People Receive Interdisciplinary Case Management. Each member has support from an interdisciplinary team that consists of, at a minimum, a social worker/care manager and a Registered Nurse. Other professionals, as appropriate, also participate as members of the interdisciplinary team. The interdisciplinary team conducts a comprehensive assessment of the member’s needs, abilities, preferences and values with the consumer and his or her representative, if any. The assessment looks at areas such as activities of daily living, physical health, nutrition, autonomy and self-determination, communication, and mental health and cognition. People Participate in Determining the Services They Receive. Members or their authorized representatives take an active role with the interdisciplinary team in developing their care plans. MCOs provide support and information to assure members are making informed decisions about their needs and the services they receive. Members may also participate in the Self-Directed Supports component of Family Care, in which they have increased control over their long-term care budgets and providers. People Receive Family Care Services that Include: Long-Term Care Services that have traditionally been part of the Medicaid Waiver programs or the Community Options Program. These include services such as adult day care, home modifications, home delivered meals and supportive home care. Health Care Services that help people achieve their long-term care outcomes. These services include home health, skilled nursing, mental health services, and occupational, physical and speech therapy. For Medicaid recipients, health care services not included in Family Care are available through the Medicaid fee-for-service program. People Receive Help Coordinating Their Primary Health Care. In addition to assuring that people get the health and long-term care services in the Family Care benefit package, the MCO interdisciplinary teams also help members coordinate all their health care, including, if needed, helping members get to and communicate with their physicians and helping them manage their treatments and medications. People Receive Services to Help Achieve Their Employment Objectives. Services such as daily living skills training, day treatment, pre-vocational services and supported employment are included in the Family Care benefit package. Other Family Care services such as transportation and personal care also help people meet their employment goals. People Receive the Services that Best Achieve Their Outcomes. The MCO is not restricted to providing only the specific services listed in the Family Care benefit package. The MCO interdisciplinary care management team and the member may decide that other services, treatments or supports are more likely to help the member achieve his or her outcomes, and the MCO would then authorize those services in the member’s care plan. For a complete list of the services that must be offered by MCOs, refer to the description of the long-term care benefit package in the Health and Community Supports Contract. A managed care organization (MCO) is a health care provider or a group of association of medical examination providers who proposes accomplished health plans. It is a health group that bonds with insurers or self-insured employers and funds and provides health care by means of a definite provider system and precise facilities and products. An MCO is an insurer that delivers both healthcare amenities and payment on behalf of services. They offer a comprehensive range of quality and managed health care services to the joined employees by keeping medical charges down through preventive medicine, patient teaching, and in additional ways. These organizations are certified by the director of the Department of Consumer and Business Services (DCBS). MCOs vary in their constitution as some organizations are made of physicians, while others are combinations of physicians, hospitals, and other providers. For instance, a group practice without walls, independent practice association, management services organization, and a physician practice management company are the common MCO’s.

Comparing God in Daisy Miller, Huck Finn, and Country of the Pointed Firs :: comparison compare contrast essays

Eliminating God in Daisy Miller, Huckleberry Finn, and The Country of the Pointed Firs      Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The evils of the Civil War and the rise of empiricism caused many to doubt in an omniscient, all-powerful God.   Under empiricism, any statements about metaphysical entities (e.g. God, Unicorns, Love, and Beauty) would be meaningless terms because they cannot be proven by the scientific method. But with a loss of faith in God, what becomes of morality?  Ã‚   This essay will examine how Emily Dickinson, Sarah Orne Jewett, Henry James and Mark Twain wrote literature in this age coupled with war, inhumanity and despair in God.   This essay will show that: (1) Dickinson destroys any reliance on the Bible and a possibility of knowing God, but argues that one should instead praise Nature, which is tangible; (2) Jewett eliminates the omniscient narrator (or God-like figure) in The Country of the Poited Firs , and instead makes readers see life as valuable only   through human experiences and reveals the comfort of Nature; (3) Henry James eliminates God i n Daisy Miller by removing the omniscient narrator and instead causing readers to play god, by being the judge of Daisy and Winterbourne; (4) Mark Twain uses Huckleberry Finn to question any reliance on God, by poking fun of prayer and church revivals, and instead encouraging one to seek morality in one's conscience.        Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Emily Dickinson learned versification through studying her church hymnal.   But rather than praise a God that has "hid his rare life" (338), she turned to praise Nature which was tangible and empirical.   Dickinson seemed to believe in a God: "I know that He exists" but the belief was greatly hindered by the existence of evil (primarily the atrocities brought on by the Civil War) wherein she penned that His right hand "is amputated now/ And God cannot be found" (1551).   This statement may not be as severe as Nietzche's "God is Dead," but one can probably imagine that Dickinson penned these words in tears. Because she believed that God could not be found, she attacked the Bible's ability to convey notions of God:   "The Bible is an antique Volume--/ Written by faded Men" (1545).   Dickinson found more companionship in her trusty dictionary (which helped define words) than a Bible (which was to define life).   To Dickinson, Nature was s upreme; Nature was tangible; Nature was real.   Dickinson needed empirical evidence and Nature provided it for her:   "'Nature' is what we see/ . Comparing God in Daisy Miller, Huck Finn, and Country of the Pointed Firs :: comparison compare contrast essays Eliminating God in Daisy Miller, Huckleberry Finn, and The Country of the Pointed Firs      Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The evils of the Civil War and the rise of empiricism caused many to doubt in an omniscient, all-powerful God.   Under empiricism, any statements about metaphysical entities (e.g. God, Unicorns, Love, and Beauty) would be meaningless terms because they cannot be proven by the scientific method. But with a loss of faith in God, what becomes of morality?  Ã‚   This essay will examine how Emily Dickinson, Sarah Orne Jewett, Henry James and Mark Twain wrote literature in this age coupled with war, inhumanity and despair in God.   This essay will show that: (1) Dickinson destroys any reliance on the Bible and a possibility of knowing God, but argues that one should instead praise Nature, which is tangible; (2) Jewett eliminates the omniscient narrator (or God-like figure) in The Country of the Poited Firs , and instead makes readers see life as valuable only   through human experiences and reveals the comfort of Nature; (3) Henry James eliminates God i n Daisy Miller by removing the omniscient narrator and instead causing readers to play god, by being the judge of Daisy and Winterbourne; (4) Mark Twain uses Huckleberry Finn to question any reliance on God, by poking fun of prayer and church revivals, and instead encouraging one to seek morality in one's conscience.        Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Emily Dickinson learned versification through studying her church hymnal.   But rather than praise a God that has "hid his rare life" (338), she turned to praise Nature which was tangible and empirical.   Dickinson seemed to believe in a God: "I know that He exists" but the belief was greatly hindered by the existence of evil (primarily the atrocities brought on by the Civil War) wherein she penned that His right hand "is amputated now/ And God cannot be found" (1551).   This statement may not be as severe as Nietzche's "God is Dead," but one can probably imagine that Dickinson penned these words in tears. Because she believed that God could not be found, she attacked the Bible's ability to convey notions of God:   "The Bible is an antique Volume--/ Written by faded Men" (1545).   Dickinson found more companionship in her trusty dictionary (which helped define words) than a Bible (which was to define life).   To Dickinson, Nature was s upreme; Nature was tangible; Nature was real.   Dickinson needed empirical evidence and Nature provided it for her:   "'Nature' is what we see/ .

Palliser Funiture Essay

Nowadays, Palliser Furniture Ltd. is a leading North American furniture company with local manufacturing facilities in Canada and Mexico, and they are dedicated to leader ship in design, service and customer value in the furniture industry. With a general agreement among manufacturers and retailers that the key success factors were: overall product quality and customer service, quick delivery and appropriate price, and innovative design. Palliser furniture did a good job on all of the aspects. Palliser outsources the raw leather from Brazil because Brazil has the best source of leather in the world. Also the raw leather was delivered from Brazil to Mexico to process such as cutting and swing which lower the cost of the furniture. The quality of the resources and powerful supplier is add-value for the value chain of the firm, and it can have a big impact on more efficiently integrating the activities within the firm. The quick delivery was another strategy for Palliser, which can be considered as a competitive advantage for the company. Compare with the rivals the Palliser is more focused on custom business, and was able to charge a slight premium for the service which directly eliminate customer’s inventory cost. This operation strategy is more flexible in terms of time and diversity. The design team of Palliser is passionate about the subtleties of style, and the collections reflect a carefully considered selection of pieces that represent quality feature extensive choice and impart innovation. Also, the developers carefully source and test materials to meet Palliser Furniture’s high standard for durability, safety and value. Overall, each department is integration through the whole company, which shows the management in Palliser Furniture Ltd is successful and effective as well.

Other Ways of Using the Spanish Preposition ‘A’

Although the Spanish preposition a is usually used to indicate motion toward and thus often translated as to, it also is frequently used to form phrases that can explain how something is done or to describe nouns as well as in time expressions. Using A to Mean ‘In the Style Of’ One common use of a is similar to its use in a few English phrases, such as a la carte and a la mode that come to us via French. This use indicates the way in which something is done or, less commonly, forms a phrase that functions as an adjective. Spanish phrases using a in this way usually cant be translated word for word, although it is often useful to think of a as meaning in the style of. Here are some examples of a being used in adverbial phrases (phrases that act like adverbs): Amar no es nada mà ¡s que andar a ciegas. (Love is nothing more than walking blindly.)Imà ¡genes de televisià ³n muestran a un soldado ejecutando a quemarropa a una madre. (Television images show a soldier executing a mother at point-blank range.)La actriz se casà ³ a escondidas. (The actress was secretly married.)La votacià ³n se hizo a mano alzada. (The voting was done by a show of hands.)El zumo y la leche se vende a galones. (Juice and milk are sold by the gallon.)El bebà © andaba a gatas, descubriendo el mundo. (The baby is walking on all fours, discovering the world.)El sentido del olfato es a menudo el primero en advertirnos acerca de un peligro que somos incapaces de ver. (The sense of smell is often the first to warn us of a danger that we are unable to see.) A similar construction can used to form adjectival phrases (phrases that describe nouns): Walter conocià ³ a Nadia en una cita a ciegas que le ha organizado su hermano. (Walter met Nadia on a blind date that his brother set up.)Nunca entre a una casa con un nià ±o a solas. (Never enter a house with a child alone.)Era el viaje a caballo mà ¡s largo de la historia. (It was the longest horseback ride in history.) ‘A La’ Phrases It is common to form adverbial (and sometimes adjectival) phrases by using a la followed by noun that has the form of a feminine adjective. These phrases typically of the meaning of in the _____ style and are most iften used with geographical terms. There are also a few phrases beginning with a lo followed by a masculine adjective or noun. Las papas fritas a la francesa se llaman chips en Inglaterra. (French-fried potatoes are called chips in England.)Hoy en Europa es imposible un liberalismo a la americana. (Today in Europe, an American-style liberalism is impossible.)Se sirve un desayuno a la mexicana. (They serve a Mexican-style breakfast.)A la moderna, optaron por no casarse. (In the way things are done today, they chose not to marry.)El cantante dijo adià ³s a lo grande. (The singer said goodbye in style.)Se lava a lo gato. (He washes himself like a cat (i.e., while barely getting wet). Using A for ‘At’ A can also be used to indicate how often something occurs or indicate relationships in much the same as as the English at when it isnt being used in the context of a location.  ¡Un paso a la vez! (One step at a time!)Venden a dos pesos el kilo. (They sell at two pesos per kilo.)El encontrar calidad en un producto a un precio bajo puede crear mà ¡s satisfaccià ³n. (Finding quality at a product at a low price can create more satisfaction.)Le agencia aceptarà ¡ a 10 por ciento de aspirantes a licenciatura. (The agency will accept applicants for licensing at a rate of 10 percent.) Using A in Time Expressions Many time expressions use a much like at and sometimes per is used: Patricia y yo salimos a las 9:30. (Patricia and I are leaving at 9:30.)Comienza a las cinco de la tarde. (It begins at 5 in the afternoon.)Muchos trabajamos 40 horas a la semana. (Many of us work 40 hours per week.) ¿Es posible amar a dos personas a mismo tiempo? (Is it possible to love two people at the same time?) Key Takeaways Although the common Spanish preposition a usually means to, it can be used in ways that dont refer to motion or location.An abundance of phrases beginning with a can function as adverbial or adjectival modifiers.A is also often used in time expressions, usually to mean at.