Managed Care Models

Managed Care Models

According to Honsberger et al. (2018), a managed care organization (MCO) refers to a specific health plan that entails an interdisciplinary team of healthcare practitioners providing care services to a community. MCOs cover all services offered by the relevant insurer, such as Medicaid (Honsberger et al., 2018). Additionally, MCOs adhere to the provisions of the Affordable Care Act (Honsberger et al., 2018). Aetna Better Health is an example of a managed care organization that operates in the states of Texas and Virginia.

Aetna Better Health in the state of Texas offers various programs and services. For instance, it offers Medicaid (STAR) and Children’s Health Insurance Program (CHIP) services. These services include medical management, pharmacy services, behavioral health, maternal-child health, and Texas Health Steps (Aetna Better Health, n.d.-a). Medical management aims at availing affordable healthcare services to the community. Examples of services offered under this program include management of chronic diseases, quality, utilization, and care management (Aetna Better Health, n.d.-a). Pharmacy management avails both prescription and over-the-counter medications. Texas Health Steps is a program that provides preventive healthcare services to eligible members from the point of birth to the age of 20 years (Aetna Better Health, n.d.-a).

On the other hand, Aetna Better Health in the state of Virginia offers Medicaid, Family Access to Medical Insurance Security (FAMIS), and Commonwealth Coordinated Care Plus (CCC Plus) services. FAMIS targets children aged below 19 years whose parents do not qualify for Medicaid (Aetna Better Health, n.d.-b). CCC Plus targets those aged above 65 years and people living with disabilities (Aetna Better Health, n.d.-b). The specific types of services offered include behavioral and mental health, chronic disease management, dental care, pharmacy services, and health programs (Aetna Better Health, n.d.-b).

References

Aetna Better Health. (n.d.-a). Aetna Better Health of Texas. https://www.aetnabetterhealth.com/texas/providers/index.html

Aetna Better Health. (n.d.-b). Aetna Better Health of Virginia. https://www.aetnabetterhealth.com/virginia/index.html

Honsberger, K., Normile, B., Schwalberg, R., & Vanlandeghem, K. (2018). How States Structure Medicaid Managed Care to Meet the Unique Needs of Children and Youth with Special Health Care Needs. A Publication of the National Academy for State Health Policy. https://www.nashp.org/wp-content/uploads/2018/04/How-States-Structure-Medicaid-Managed-Care.pdf

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The continuum of managed care models helps to understand the level of control for access, quality, and costs for each model. It is also true that managed care models are influenced by the market they serve. The geographic region impacts the design of managed care models. For the Week 2 discussion, address the following, keeping in mind the above information:

Managed Care Models

Identify an MCO functioning in both your area and in some other parts of the country (for example, BCBS of California and BCBS of Georgia).
Compare the organizations relative to the type of managed care products each offers.
To support your work, refer to the readings and relevant outside research. As in all assignments, cite your sources in your work and provide references for the citations in APA format.

Your initial posting should be addressed at 150-300 words. Submit your document to this Discussion Area by the due date assigned. Be sure to cite your sources using APA format.

Respond to your peers throughout the unit. Justify your answers with examples, research, and reasoning. Follow-up posts need to be submitted by the end of the week.