RISK MANAGEMENT POLICIES

Throughout this course, you have identified, examined, and provided individual as well as collaborative analysis on multiple facets of risk management in the health care setting.

Addressing the knowledge you have gained, and building on that knowledge to add your evaluation of the role that the managed care organization (MCO) plays in today’s health care environment, develop a 250-500 word reflection to incorporate the following:

  1. What is a health care organization’s administrative role regarding oversight of risk management policies and ensuring compliance with managed care organization (MCOs) standards?
  2. What is your assessment of the value provided to an organization that stems from the regulatory statutes of a typical MCO? Consider the establishment of conflict resolution and risk management strategies within the health care organization from the employer/employee perspective as well as in regards to patient conflict circumstances.
  3. What MCO responsibilities pertain to the Patient Protection and Affordable Care Act (PPACA) and Center for Medicare and Medicaid Services (CMS) focus on fraud, waste, and abuse laws?

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

Rubric:

 1
Unsatisfactory
0.00%
2
Less than Satisfactory
65.00%
3
Satisfactory
75.00%
4
Good
85.00%
5
Excellent
100.00%
70.0 %Content 
20.0 %Explains the Administrative Role of a Health Care Organization Regarding Oversight of Risk Management Policies and Ensuring Compliance With Managed Care Organization (MCO) StandardsNot included.An explanation of the administrative role of a health care organization regarding oversight of risk management policies and ensuring compliance with MCO standards is somewhat present, but the information provided is incomplete, inaccurate, or otherwise deficient.An explanation of a health care organization’s administrative role regarding oversight of risk management policies and ensuring compliance with MCO standards is present, but minimal detail or support is provided for one or more components.An explanation of a health care organization’s administrative role regarding oversight of risk management policies and ensuring compliance with MCO standards is present, and is incorporated in full. The submission encompasses essential details and provides appropriate support.An explanation of a health care organization’s administrative role regarding oversight of risk management policies and ensuring compliance with MCO standards is present and comprehensive. The submission further incorporates analysis of supporting evidence insightfully and provides specific examples with relevance. Level of detail is appropriate. 
20.0 %Discussion Regarding Assessment of the Value Provided to an Organization That Stems From the Following Aspects of a Typical MCO: Regulatory Statutes, Inclusive of Conflict Resolution and Risk Management Strategies From the Employer/Employee Perspective and Patient Conflict CircumstancesNot included.A discussion regarding assessment of the value provided to an organization that stems from a typical MCO (regulatory statutes, inclusive of conflict resolution and risk management strategies from the employer/employee perspective and patient conflict circumstances) is somewhat present, but the information provided is incomplete, inaccurate, or otherwise deficient.A discussion regarding assessment of the value provided to an organization that stems from a typical MCO (regulatory statutes, inclusive of conflict resolution and risk management strategies from the employer/employee perspective and patient conflict circumstances) is present, but minimal detail or support is provided for one or more components.A discussion regarding assessment of the value provided to an organization that stems from a typical MCO (regulatory statutes, inclusive of conflict resolution and risk management strategies from the employer/employee perspective and patient conflict circumstances) is present and incorporated in full. The submission encompasses essential details and provides appropriate support.A discussion regarding assessment of the value provided to an organization that stems from a typical MCO (regulatory statutes, inclusive of conflict resolution and risk management strategies from the employer/employee perspective and patient conflict circumstances) is present and comprehensive. The submission further incorporates analysis of supporting evidence insightfully and provides specific examples with relevance. Level of detail is appropriate. 
20.0 %Describes MCO Responsibilities Pertaining to the Patient Protection and Affordable Care Act (PPACA) and Center for Medicare and Medicaid Services (CMS) Focus on Fraud, Waste, and Abuse LawsNot included.A description of MCO responsibilities pertaining to PPACA and CMS focus on fraud, waste, and abuse laws is somewhat present, but the information provided is incomplete, inaccurate, or otherwise deficient.A description of MCO responsibilities pertaining to PPACA and CMS focus on fraud, waste, and abuse laws is present, but minimal detail or support is provided for one or more components.A description of MCO responsibilities pertaining to PPACA and CMS focus on fraud, waste, and abuse laws is present and incorporated in full. The submission encompasses essential details and provides appropriate support.A description of MCO responsibilities pertaining to PPACA and CMS focus on fraud, waste, and abuse laws is present and comprehensive. The submission further incorporates analysis of supporting evidence insightfully and provides specific examples with relevance. Level of detail is appropriate. 
10.0 %Discussion Addresses Course Content and LearningA discussion that addresses course content and learning is not provided.A discussion addressing course content and learning is somewhat present, but the information provided is incomplete, inaccurate, or otherwise deficient.A discussion addressing course content and learning is present, but minimal detail or support is provided for one or more components.A discussion addressing course content and learning is present and incorporated in full. The submission encompasses essential details and provides appropriate support.A discussion addressing course content and learning is present and comprehensive. The submission further incorporates analysis of supporting evidence insightfully and provides specific examples with relevance. Level of detail is appropriate. 
20.0 %Organization and Effectiveness 
7.0 %Thesis Development and PurposePaper lacks any discernible overall purpose or organizing claim.Thesis is insufficiently developed or vague. Purpose is not clear.Thesis is apparent and appropriate to purpose.Thesis is clear and forecasts the development of the paper. Thesis is descriptive and reflective of the arguments and appropriate to the purpose.Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear. 
8.0 %Argument Logic and ConstructionStatement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources.Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility.Argument is orderly, but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis.Argument shows logical progression. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative.Clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative. 
5.0 %Mechanics of Writing (includes spelling, punctuation, grammar, language use)Surface 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. 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.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.Writer is clearly in command of standard, written, academic English. 
10.0 %Format 
5.0 %Paper Format (use of appropriate style for the major and assignment)Template is not used appropriately, or documentation format is rarely followed correctly.Appropriate template is used, but some elements are missing or mistaken. A lack of control with formatting is apparent.Appropriate template is used. Formatting is correct, although some minor errors may be present.Appropriate template is fully used. There are virtually no errors in formatting style.All format elements are correct. 
5.0 %Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)Sources 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.

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