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Custom Accreditation in Managed Care Article Summary essay paper sample

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The article was written by Karen and Margaret in the year 2003. For the standardization of their arguments, the authors defined managed care in the context of a collective term used to describe the variety of strategies implemented by insurers in an attempt to control health and mental health care costs (Neuman & Ptak, 2003). Their aim was to describe the effects of managed care on the financing and delivery of services while at the same time exploring on accreditation as an option for those providing medical care services. According to the article, the social workers have to observe certain regulations and meet given standards to be able to work effectively in a managed care environment. They must familiarize themselves with the various regulations, standards, processes, and structures that are in use in order to be able to practice them (Neuman & Ptak, 2003).

The knowledge of existing regulatory and accreditation standards for MCOs has therefore become a very important tool for social workers. It enables them to meet the emerging concerns about quality of care and unethical practices. The MCOs’ accreditation scores are determined by reviewing the performance of the organization based on six main factors after which the reports are produced. Some of the considerations include the quality of management and improvement in the clinical outcomes. Second is the level at which an organization observes the rights and responsibilities of its members (Neuman & Ptak, 2003)

Even though there have been some efforts to hold MCOs responsible for the negative outcomes and policies, accreditation has continued to be accepted as a measure of ensuring quality and accountability in MCO’s.  It’s potential to protect consumers is increasingly being recognized. The authors observed that the social workers are increasingly using accreditation standards as the guidelines to their work (Neuman & Ptak, 2003). The article identified a number of on going accreditation initiatives like those by the American Accreditation of Health Care Commission (URAC). However, they acknowledged that the major player in the industry is the NCQA (Neuman & Ptak, 2003).

The article has also outlined the requirements on the part of MCOs such as their responsibility to ensure that the patients’ rights are respected. The authors have also highlighted on the need for and the challenges that may face advocating and appealing decisions. They also underlined the need for people to be made aware of their right to access information from the MCOs. The authors used a number of case studies to demonstrate such patients’ related rights. They concluded that managed care will continue to stay (Neuman & Ptak, 2003).

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