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Managed Care Organizations

The Managed Care market is constantly evolving, producing products that address increased demand by Employers, Center for Medicaid and Medicare Services, State and County Agencies and other funders for efficient and high quality administration to manage the rising cost of healthcare.  Over the past two decades the managed care market has focused on products that limit access to care, building limited provider networks and negotiating aggressive reimbursement models to contain healthcare costs.  These maneuvers have yielded limited success. 

For managed care organizations (MCOs), this translates to re-tooling their legacy products to meet increasing demands for flexibility, operational efficiency and reduced administrative costs along with integrating physical and specialty products such as behavioral health, using clinical best practices to manage utilization and care coordination and proactive outreach programs to engage members.  Additionally, using clinical analytics to identify individuals and areas of highest need, will result in improved proactive interventions and care.

Industry estimates show a sharp growth in managed care programs in both the commercial and public sector populations.  With limited resources and such predicted growth, it is important for MCOs to react now in leveraging all of their assets to efficiently manage these populations.