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MCO Monitoring Utilization

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MCO Monitoring Utilization
The various mechanisms used by MCOs to monitor and control utilization is as follows:

Choice Restriction: It enforce restrictions on where; from the patient can find medical care. Patients still have a choice of physicians who are either employees of the MCO or have established contracts with the MCO

Gate Keeping: Requires a primary care physician to direct all health care services wanted by an enrollee and take accountability for supervising utilization.

Case Management: is a structured method to evaluate and coordinate care, mainly for patients who have complex, potentially costly complications that require a range of services from several providers over a prolonged period.

Disease Management: is a population oriented strategy for
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