Managed Care Organizations

Managed care organizations (MCO’s) are companies that have contracts with people or with other companies to provide healthcare services to the subscribers through a panel of participating healthcare providers. MCO’s concentrate at providing health coverage in the form or packages or health plans that are highly customizable, consumer-driven, affordable, cost-effective and accessible. There is a certain quality standard that is assured by the MCO’s. All forms of inappropriate and unnecessary health services are prevented.

The health plans would also consider other services, including employment safety, employment rehabilitation, early return to work, dispute resolution, etc (ODVA, 2010). In this paper, we would evaluate three of the top-most American MCO’s including Aetna, Humana and United Health. Aetna is one of US’s leading health insurance providers that specialize in providing general health, dental, group insurance, disability insurance, pharmacy and drug insurance and worker insurance.

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Aetna not only ensures health but also financial securities for its member’s that subscribe to insurance from the company. The members are offered various options for better decision-making. Today more than 18 million people have health insurance and 14 million have dental insurance with Aetna. About 966000 healthcare professionals from 5000 hospitals form a part of the Aetna network. Aetna hugely concentrates on providing consumer-directed health plans. Aetna has a range for plans meant for individuals, families, and employees.

These include general medical insurance, dental insurance, health expense fund, Medicare Insurance, Mental Health Insurance, Wellness Health plans, Eye insurance, Pet health insurance, student health insurance, disability insurance, Pharmacy plans, international health plans, customized insurance plans, etc. For employers, Aetna providers several options for its employers based on the number of employers and the types of insurance sought by the business organizations depending on the risks that may be persistent to the employers.

These include pharmacy drug plans, vision insurance, pet insurance and international insurance. Aetna also providers insurance for part-time and seasonal workers. Diverse solutions are available at Aetna (Aetna, 2010). Humana is a US health insurance company founded in the year 1961 and having more than 11. 5 million customers. Humana tries to concentrate on insurance innovations and ideas that can ensure greater choice and control of health of the consumers. Customers are given greater amount of freedom to choose from a wide choice of plans. The customers can choose based on the healthcare needs and the budgets.

The various plans that are available include individual family health insurance plans, dental insurance, Group health insurance, Medicare Insurance plans, specialty health insurance plans, vision care plans, emergency care plans, veteran and military service plans, etc. Humana also has various wellness plans that would be available to the enrollers. These include wellness information, wellness calendar, pregnancy and lactation information services, fitness programs, chronic disease services, personal nurse services, newsletters, reduction of error and improvement of patient safety, etc.

Employers can choose from a number of group insurance plans including traditional plans, consumer-directed plans, creation of the HSA (Healthcare spending accounts), retirement health plans, prescription drug plans, etc. The employers can choose the plans based on the requirement of the employees (Humana, 2010). United Health on the other hand concentrates greater on developing innovative ideas so that people can live healthier lives. They have a much larger customer and network hospital base. United Health has several plans for individual health, wellness, Medicare Plans, Medicare Part D (for prescription drugs), Elderly care, Medicaid, etc.

The employees can also select from a wide range of products for their employees including group health insurance, specialty health coverage, international health insurance, pharmacy benefit management, and several other integrated health solutions. The company tries to improve the access, affordability, quality and simplicity for healthcare (United Health, 2010). Overall, United Health Group seems to having a greater number of individuals and employers subscribed in the US, and offers diverse, innovative and cost-effective plans.

In 2007, it was adjudged by Business Insurance publication to be the best MCO in the US. References Aetna (2010). (2010). Home Page, Retrieved on May 29, 2010, from Web site: http://www. aetna. com/ Humana (2010). Home Page, Retrieved on May 29, 2010, from Web site: http://www. humana. com/ ODVA (2010). Managed care organization services, Retrieved on May 29, 2010, from Web site: http://www. oregonwcd. org/compliance/ioac/mco/mcoserv. html United Health Group (2010). Home Page, Retrieved on May 29, 2010, from Web site: http://www. unitedhealthgroup. com/


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