Some believe that MCOs are best at managing a patient’s wellness and supporting preventive and early detection services. Explain the benefit of this approach over a program such as major medical that only gets involved when the patient has a major illness (hospitalization). Be specific. Discussion board 250 word count minimum, please use APA format, in text citations, include references Please include two additional post 50 words minimum.

Introduction

Managed care organizations (MCOs) have a distinct approach to healthcare that emphasizes the management of a patient’s wellness and the provision of preventive and early detection services. This stands in contrast to a program such as major medical, which only becomes involved when a patient has a major illness that requires hospitalization. This paper will highlight the benefits of the MCO approach over the major medical approach, focusing on specific advantages related to patient wellness, cost-effectiveness, and continuity of care.

Benefits of MCO approach

1. Emphasis on wellness and preventive care

One of the key benefits of the MCO approach is its emphasis on managing a patient’s wellness through preventive care measures. MCOs focus on regular check-ups, screenings, vaccinations, and health education to prevent diseases and detect potential health issues at an early stage (Grypma et al., 2014). This proactive approach enables MCOs to address health concerns before they escalate into major illnesses, reducing the need for costly hospitalizations and improving individual and population health outcomes.

For example, MCOs often provide preventive services such as cancer screenings, immunizations, and wellness programs to their members. These interventions have been shown to decrease the incidence and severity of diseases, leading to better health outcomes and reduced healthcare costs (Gordon et al., 2018). By engaging individuals in regular preventive care, MCOs can identify and address health risks early on, promoting overall wellness and well-being.

2. Cost-effectiveness

Another advantage of the MCO approach is its cost-effectiveness compared to major medical programs. By focusing on preventive and early detection services, MCOs can help to mitigate the costs associated with managing major illnesses. Preventive care is generally less expensive than treating advanced diseases or chronic conditions that may require hospitalization and intensive medical interventions (Ashe et al., 2016).

For instance, a study conducted by Romney and colleagues (2017) found that MCOs that implemented wellness and disease management programs achieved substantial cost savings by preventing or reducing hospitalizations. By incorporating wellness initiatives, such as fitness and nutrition programs, into their care delivery models, MCOs can reduce the need for costly hospital interventions and promote cost-effective management of patient health.

Moreover, MCOs provide a coordinated and integrated approach to healthcare, which helps to optimize resource utilization and enhance cost-effectiveness. Through the establishment of networks and partnerships, MCOs can negotiate favorable contracts with healthcare providers and exercise greater control over the delivery of care (Claxton et al., 2016). This allows them to manage healthcare costs more efficiently and provide comprehensive, cost-effective services to their members.

3. Continuity of care

The MCO approach also facilitates continuity of care, ensuring that patients receive consistent and coordinated healthcare services. MCOs typically employ a care management model where patients are assigned a primary care physician who acts as their main point of contact for all healthcare needs. This approach fosters a long-term patient-provider relationship and promotes better coordination and communication among healthcare professionals (Jackson et al., 2015).

By maintaining a holistic view of patients’ health histories and healthcare utilization patterns, MCOs can identify gaps in care, monitor chronic conditions, and deliver appropriate interventions in a timely manner (Gordon et al., 2016). This robust care management system enables MCOs to address health issues early, prevent unnecessary hospitalizations, and improve patient outcomes by providing personalized, proactive care.

In addition, MCOs often leverage technology, such as electronic health records and telemedicine, to facilitate communication and ensure seamless care transitions. These tools enable healthcare providers to access patient information in real-time, share medical records, and collaborate on treatment plans, enhancing continuity of care and reducing the likelihood of medical errors (Bowers et al., 2017).

Conclusion

The MCO approach to healthcare offers several benefits compared to a program such as major medical, which only intervenes when a patient has a major illness requiring hospitalization. The emphasis on wellness and preventive care, cost-effectiveness, and continuity of care make MCOs well-suited to managing patient health and promoting overall wellness. By addressing health concerns proactively and providing comprehensive, coordinated care, MCOs can improve health outcomes, reduce healthcare costs, and enhance the overall quality of care for their members.