Managed Care Organization Virginia Provides Quality Care with Choice and Oversight

In Virginia, Managed Care Organizations (MCOs) play a crucial role in providing quality care to residents. MCOs contract with the state to manage the care of Medicaid beneficiaries.

These organizations have a proven track record of improving health outcomes and reducing costs. Studies have shown that MCOs in Virginia have achieved significant reductions in hospital readmissions and emergency department visits.

One of the key benefits of MCOs is that they offer a range of healthcare services, from primary care to specialized care, all under one umbrella. This allows beneficiaries to receive comprehensive care without having to navigate multiple providers.

By managing the care of Medicaid beneficiaries, MCOs in Virginia are able to provide oversight and ensure that patients receive necessary services. This includes monitoring and managing chronic conditions, such as diabetes and hypertension.

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In Virginia, managed care organizations (MCOs) are incentivized to provide high-quality care through various financial mechanisms.

MCOs in Virginia receive a set amount of money per member from the state to cover healthcare costs, known as a capitation payment.

This payment structure encourages MCOs to manage care effectively and reduce unnecessary costs.

MCOs in Virginia are also required to meet certain quality metrics, such as reducing hospital readmissions and improving patient satisfaction.

Meeting these metrics can result in additional funding for the MCO.

For example, the Virginia Department of Medical Assistance Services (DMAS) offers a bonus payment to MCOs that meet certain quality targets.

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In Virginia, we work with a large network of healthcare professionals, partnering with over 25,000 doctors, hospitals, and specialists statewide.

This extensive network allows us to provide comprehensive care to our members.

We also serve a significant number of Medicaid members, with over 540,000 individuals relying on us for their healthcare needs.

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In Virginia, we have a robust network of healthcare providers, working with over 25,000 doctors, hospitals, and specialists statewide.

Our Medicaid program serves more than 540,000 members, ensuring they have access to quality care when they need it most.

The Office of the Managed Care Ombudsman was established in 1999 under §38.2-5904 of the Code of Virginia.

This office helps Virginia consumers whose health insurance is provided by a Managed Care Health Insurance Plan, such as a Health Maintenance Organization or a Preferred Provider Organization.

Their principal responsibilities include protecting the interests of consumers by assisting them in understanding their rights and how to resolve problems.

The Office of the Managed Care Ombudsman also answers inquiries from consumers, health care providers, and other individuals.

They provide information on Managed Care Health Insurance Plans, types of plans, mandated benefits, utilization review procedures, and available appeal options.

Here are some of the ways the Office of the Managed Care Ombudsman assists consumers: