chapter  2
10 Pages

A Managed Care Primer

A general definition of an MCO (or simply managed care), which also encompasses the MBHO, is a system that coordinates, through the authority of a contractual agreement with an insurer or employer organization, the delivery of medically necessary clinical services while monitoring and improving their quality and decreasing or managing the rate of increase in costs of the health care delivered to a defined population of consumers. These ambitious goals are achieved through the use of one or more of several common industry strategies. The first involves the alignment of financial incentives for consumers with the financial goal of the MCO, which is to encourage efficiency in service provision.