MCOs

You are a new physician setting up your own practice in a new town. You are researching the different MCOs offered in your area and are considering becoming a physician for one of these networks. You have also invited the sales representatives of several health plans to speak with you about the benefits of choosing their plans.

Based on the above scenario, answer the following questions:

• What effects would joining a MCO have on your clinic regarding staffing, patient volume, and financial stability?
• What policies and procedures should be used by the MCOs to reduce costs for their clientele?
• Discuss the ethical issues or concerns about MCOs providing a lower quality of care compared to traditional fee-for-service (FFS) organizations?
• What are some of the questions you would ask each representative about his or her company’s specific plan that will help you make a decision?
• Do you believe that the evolution of MCOs and consumer driven health plans (CDHPs) has affected the healthcare environment today by integrating the financing and delivery of healthcare services? If yes, how?
• How have the roles and relationships between physicians and patients changed by each of these types of plans?