Discussion Reply- Response 1-2 paragraphs with 1-2 references

Wannie Brown

Managed care provides reasonably good healthcare and can merge clinical, financial, and administrative processes to administer availability, costs, and the value of healthcare (Casto & Forrestal, 2015). “Managed care organizations (MCOs) have the goal of trying to manage care while offering enrollees a variety of plans that include medical services such as behavioral health, prenatal and various testing. One benefit of an MCO is the financial incentive to both the patient and the organization. PPO Still has the fee-for-service aspects, which is a benefit for providers. Patients receive quality healthcare at reasonable costs while following the rules of the MCO in choosing a primary care physician (PCP) within the MCO's network as well as obtaining the appropriate referral for additional testing and services” (Casto & Forrestal, 2015).

As an healthcare administrator, I would make recommendations for Preferred Provider Organization (PPO) because they are best in the hospital settings being that they are able to cover large groups of members and provide healthcare services (Casto & Forrestal, 2015). “PPO is an appealing plan due to its many positive aspects of being decentralized, having flexibility in choices for members, negotiated fees, financial incentives, no capitation, limited financial risks for the providers, and no regulation under the HMO requirements” (Casto & Forrestal, 2015). PPO gives the option of healthcare services at a reduced or fixed rate. It provides flexibility of using healthcare services of any provider, or hospital that is in the plan.

Although PPO is good, there are also downside to it which is the negative characteristics of restriction in certain things. With PPO, members have limitation to providers that are in-network, if a patient use a service that is out of network, the bill may not be covered. There is a great uncertainty in referrals and high rates in reimburse.