Assignment: Managed Care Organizations

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Assignment: Managed Care Organizations

Assignment: Managed Care Organizations

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To better coordinate care, many hospitals have initiated a physician–hospital orga- nization (PHO), a joint venture capable of contracting with managed care organizations. Both integrated delivery systems and the more recent physician–hospital organizations have had limited success in coordinating and integrating healthcare.

In 2005, MedPAC reported that future government reimbursement for health services should be based on four criteria—one of which was high-quality, cost-effective care (MedPAC 2005). In 2006, President George W. Bush signed an executive order asking federally sponsored health plans, including Medicare, to adopt the four criteria. The concept of an accountable care organization (ACO), which emphasizes coordinated care and

integrated delivery

mandates provider accountability, was born in 2007 (Fisher et al. 2007). The ACO concept includes financial incentives for organizations that take responsibility for the quality and cost of patient care to a defined population. In 2009, MedPAC recommended that Medicare encourage the development of ACOs, and Section 3022 of the Affordable Care Act of 2010 encouraged the voluntary development of ACOs (Tuma 2010). By the end of 2015, 838 ACOs existed (Muhlestein and McClellan 2016).

IntroductIon Financial analysis and management reporting are integral parts of the management func- tions of control and financial management. Financial analysis includes methods used by investors, creditors, and management to evaluate the past, present, and future financial performance of a healthcare organization. On completion of the analysis, the information is reported to the appropriate stakeholders, inside and outside the organization, at which time the stakeholders take action in the form of decisions.

stePs In fInAncIAl AnAlysIs Financial analysis includes the following three steps:

1. Establish the facts about the organization.

2. Compare the facts about the organization over time and with facts about similar organizations.

3. Use perspective and judgment to make decisions regarding the comparisons.

Financial analysis by management can occur at any level—departmental, divisional, or organizational—within the organization.

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