Florida National University Managed Care Organization Scenario Discussion
I’m working on a nursing discussion question and need an explanation to help me study.
You are the director of a home health agency that has recently become part of a managed care system. In the past, only a physician’s order was necessary for authorization from the Medicare system, but now, approval must come from the managed care organization (MCO). In the past, public health certified nurses (all Bachelor of Science in Nursing graduates) have acted as case managers for their assigned caseload. Now, the MCO case manager has taken over this role, creating much conflict among the staff. In addition, there is pressure from your board to cut costs by using more nonprofessionals who are less skilled for some of the home care. You realize that unless you do so, your agency will not survive financially.
You have visited other home health agencies and researched your options carefully. You have decided that you must use some type of team approach.
DQ: Develop a plan, objectives, and a time frame for implementation. In your plan, discuss who will be most affected by your changes. As a change agent, what will be your most important role?