Reflective Analysis: Risk Management and the Role of Managed Care.

Reflect on and evaluate the role that the managed care organization (MCO) plays in today’s health care environment by developing a 500-word response that addresses the following:What is a health care organization’s administrative role in executing risk management policies and ensuring compliance with managed care organization (MCO) standards?What value do the regulatory statutes of a typical MCO provide to a health care organization? Consider how strategies pertaining to policies such as conflict resolution and risk management affect patients as well as employees and employers.What MCO responsibilities relevant to the Patient Protection and Affordable Care Act (ACA) and the Center for Medicare and Medicaid Services (CMS) focus on fraud, waste, and abuse laws?you are required to support your analysis with a minimum of two peer‐reviewed references.RUBRIC:Administrative Role of a Health Care Organization in Ensuring Compliance With Managed Care Organization (MCO) Risk Management Standards25.0An assessment of the administrative role of a health care organization in ensuring compliance with MCO risk management standards is not included.An assessment of the administrative role of a health care organization in ensuring compliance with MCO risk management standards is partially incorporated, but the information provided is incomplete, inaccurate, or otherwise deficient.An assessment of the administrative role of a health care organization in ensuring compliance with MCO risk management standards is present, but minimal detail or support is provided for one or more components.An assessment of the administrative role of a health care organization in ensuring compliance with MCO risk management standards is incorporated in full. The submission encompasses essential details and provides appropriate support.An assessment of the administrative role of a health care organization in ensuring compliance with MCO risk management standards is comprehensive. The submission further incorporates the analysis of supporting evidence insightfully and provides specific examples with relevance. The level of detail is appropriate.Value of MCO Regulatory Statutes to a Health Care Organization25.0An explanation of the value MCO regulatory statutes provide to a health care organization is not included.An explanation of the value MCO regulatory statutes provide to a health care organization is partially incorporated, but the information provided is incomplete, inaccurate, or otherwise deficient.An explanation of the value MCO regulatory statutes provide to a health care organization is present, but minimal detail or support is provided for one or more components.An explanation of the value MCO regulatory statutes provide to a health care organization is incorporated in full. The submission encompasses essential details and provides appropriate support.An explanation of the value MCO regulatory statutes provide to a health care organization is present and comprehensive. The submission further incorporates the analysis of supporting evidence insightfully and provides specific examples with relevance. The level of detail is appropriate.MCO Responsibilities Relative to ACA and CMS Focus on Fraud, Waste, and Abuse Laws25.0A description of the MCO responsibilities relative to the ACA and CMS focus on fraud, waste, and abuse laws is not included.A description of the MCO responsibilities relative to the ACA and CMS focus on fraud, waste, and abuse laws is partially incorporated, but the information provided is incomplete, inaccurate, or otherwise deficient.A description of the MCO responsibilities relative to the ACA and CMS focus on fraud, waste, and abuse laws are present, but minimal detail or support is provided for one or more components.A description of the MCO responsibilities relative to the ACA and CMS focus on fraud, waste, and abuse laws are incorporated in full. The submission encompasses essential details and provides appropriate support.A description of the MCO responsibilities relative to the ACA and CMS focus on fraud, waste, and abuse laws are comprehensive. The submission further incorporates the analysis of supporting evidence insightfully and provides specific examples with relevance. The level of detail is appropriate.Thesis Development and Purpose5.0Paper lacks any discernible overall purpose or organizing claim.The thesis is insufficiently developed or vague. The purpose is not clear.The thesis is apparent and appropriate for the purpose.The thesis is clear and forecasts the development of the paper. The thesis is descriptive and reflective of the arguments and appropriate to the purpose.The thesis is comprehensive and contains the essence of the paper. A thesis statement makes the purpose of the paper clear.Argument Logic and Construction5.0The statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. The argument is incoherent and uses noncredible sources.The sufficient justification of claims is lacking. The argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility.The argument is orderly but may have a few inconsistencies. The argument presents minimal justification for claims. Argument logically, but not thoroughly, supports the purpose. The sources used are credible. Introduction and conclusion bracket the thesis.The argument shows logical progression. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative.The clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.Mechanics of Writing (includes spelling, punctuation, grammar, language use)5.0Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used.Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register) or word choice are present. The sentence structure is correct but not varied.Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct and varied sentence structure and audience-appropriate language are employed.The prose is largely free of mechanical errors, although a few may be present. The writer uses a variety of effective sentence structures and figures of speech.The writer is clearly in command of standard, written, academic English.Paper Format (use of appropriate style for the major and assignment)5.0Template is not used appropriately, or documentation format is rarely followed correctly.An appropriate template is used, but some elements are missing or mistaken. A lack of control with formatting is apparent.An appropriate template is used. Formatting is correct, although some minor errors may be present.An appropriate template is fully used. There are virtually no errors in the formatting style.All format elements are correct.Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)5.0Sources are not documented.Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors.Sources are documented, as appropriate to assignment and style, although some formatting errors may be present.Sources are documented, as appropriate to assignment and style, and format is mostly correct.Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.