Managed care

 Response 1

 This paper has interesting facts and I agree with the ideas that the appeal and grievances allow the members to make complaints and to ensure that their needs, as well as their rights, are met.  I would also like to shed light on these aspects and say that the managed care organization (MCO)  should manage potential problems concerning the quality and access to healthcare as stated in federal and State laws (Kongstvedt, 2003).  MCO should also understand that members can raise simple and complex issues such as lack of satisfaction, unprofessional behaviors, and more.  MCO should know that members have the right to make an appeal and to express grievances for the purpose of finding satisfaction. On the other hand, members should understand that there are rules and procedures or there is a specific timeline for tracking the mechanism and responding to the complaints (Kongstvedt, 2003).  Thus, the managed health organization and the members should cooperate so that the physicians can offer quality services and the members can receive quality care.

 

Response 2

 I agree that the marketing guidelines and specific rules that Medicare and Medicaid use provides marketing opportunities. The guidelines help the enrollees gain detailed information concerning the services offered,  benefit structure,  marketing requirements,  Medicare and Medicaid products, Medicare and Medicaid coverage,  and other important information that help the enrollees make a choice plan and an informed decision  (Kongstvedt, 2003). I would like to shed light on this area and say that managed care is playing a significant roles in the Medicare and Medicaid in promoting care coordinated care and controlling cost.  Coordinated care means that the programs are able to provide a different type of health services, benefit packages, and sufficing access.

 

 

Reference

Kongstvedt, P. R. (2003). Managed care: What it is and how it works. Gaithersburg, MD: Aspen

Publishers.