A client states that she does not understand managed care organization

A client states that she does not understand managed care organization (MCO) health insurance. The nurse responds most appropriately by explaining that the MCO:

1. Reimburses nursing home funding
2. Focuses on health maintenance and primary care
3. Allows the individual to go to any physician that he desires
4. Requires a contractual agreement between the health provider and client’s em-ployer

ANSWER

ANS: 2
In a managed care organization (MCO), a primary care physician provides all care and the focus is on health maintenance and primary care.
Medicaid reimburses nursing home funding.
In a managed care organization, referral by the primary care physician is necessary for access to specialists and for hospitalization.
A PPO is limited to a contractual agreement between a set of providers and one or more pur-chasers.