Managed Care and Quality-A Managed Care Organization (MCO)

Managed Care and Quality

A Managed Care Organization (MCO) is a generic term used to refer to a managed care plan. The main purpose of an MCO is to provide the infrastructure for the delivery and administration of care within a managed care system. In other words, the MCO is an organization that arranges to deliver health care services without having to use insurance companies or third party administrators. One of the main goals is to provide quality care at reasonable prices. One tool used to do this is through a gatekeeper system. Gatekeeper is an informal, but widely used term that refers to a primary care physician (PCP) responsible for referrals or authorizations for non-emergency specialty care. The Gatekeeper is the provider of first contact. Gatekeeping refers to a method of coordinating and/or controlling utilization. This is a predominate feature of almost all HMOs.

Take a position on whether or not you agree with the notion that a person is forced to see a PCP before being referred to a specialist. Does this practice impede quality care? Can the delay in seeing a specialist cause greater harm to a patient? Please provide references and a min of 250+ words.

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