Insurance story

Insurance story: Are Managed Care Organization (MCO) insurance companies or hospitals?

MCO are insurance companies that deliver healthcare services to enrolled members at reduced costs. They work with providers (Hospitals) Providers who receive a set fee per patient. MCOs encourages early detection to reduce expensive interventions. For patients, MCOs often result in lower out-of-pocket expenses due to negotiated rates with clinicians and more control over access to expensive services. Eg. UnitedHealthcare

Accountable care organizations are providers who are formal groups of physicians, hospitals, or other care providers that voluntarily work together to deliver coordinated care to a defined population of patients. ACOs are a key part of the move toward value-based care. Eg Aetna - Carilion Clinic ACO

A Group Purchasing Organization (GPO) is a non-profit entity that helps healthcare providers, such as hospitals and clinics, save money by aggregating purchasing volume and negotiating better prices from manufacturers, distributors, and suppliers. eg. McKesson Pharmaceutical

An Integrated Delivery Network (IDN) is a provider that owns and operates a network of one or more healthcare facilities, often including hospitals, physician groups, and other outpatient facilities, to provide a comprehensive continuum of care. Eg. HCA Healthcare

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