In preparing for this discussion, read Chapter 3 of the course text as well as the required document, The Final Rule for the Medicare Shared Savings Program. For your initial post, address the following in the discussion forum:
- Describe the roles, functions, and liabilities of the board in a managed care organization.
- Assess the main differences regarding Governance as well as Leadership and Management Structure between the Medicare Shared Savings Program and a managed care organization.
Your initial post should be at least 300 words. Support your response with a minimum of two credible sources that were published in the last five years
the required book is: Kongstvedt, P. R. (2012). Essentials of managed health care (6th ed.). Sudbury, MA: Jones and Bartlett Publishers
Expert Solution Preview
Introduction:
In the medical field, knowledge and understanding of different healthcare organizations are essential. In this discussion, we will explore the roles, functions, and liabilities of the board in a managed care organization, as well as assess the differences in governance, leadership, and management structure between the Medicare Shared Savings Program and a managed care organization.
Answer 1:
The board in a managed care organization has a crucial role in governing the organization. The board has the responsibility of appointing the CEO, setting the strategic direction of the organization, and ensuring that the organization is financially stable. Additionally, the board provides oversight over management to guarantee that the organization is complying with legal and regulatory requirements.
The board also has the function of improving the quality of healthcare provided by the organization. The board can achieve this by developing policies and procedures that ensure the organization delivers effective and efficient healthcare services to patients. The board also ensures that the organization is incorporating new technologies and best practices to improve healthcare outcomes.
Finally, the board is liable for any violations or legal issues that the organization may face. As such, the board must ensure that the organization is complying with all legal and regulatory requirements, and put in place mechanisms for accountable reporting and transparency to ensure the smooth running of the organization.
Answer 2:
The Medicare Shared Savings Program and a managed care organization differ significantly in governance, leadership, and management structure. Firstly, the structure of governance in the Medicare Shared Savings Program is set by the Centers for Medicare & Medicaid Services (CMS). On the other hand, a managed care organization has a board that runs the organization.
Secondly, the leadership structure is also different in the two organizations. In the Medicare Shared Savings Program, the main leadership comprises physicians, while in a managed care organization, the CEO is the primary leader. Additionally, the leadership structure in managed care organizations varies between for-profit and non-profit organizations.
Finally, the management structure in both organizations differs. The Medicare Shared Savings Program has a hierarchical management structure, with CMS being the ultimate authority. Alternatively, a managed care organization has a broader management structure, comprising both administrative and clinical staff who perform various functions under the supervision of the CEO.
Conclusion:
In conclusion, it is important to understand the roles, functions, and liabilities of the board in a managed care organization. It is also evident that there are significant differences between the governance, leadership, and management structure of the Medicare Shared Savings Program and a managed care organization. Understanding these differences will help healthcare professionals deliver quality healthcare services that meet legal and regulatory requirements.
