Discussion 4.2: Reimbursement and the Employer

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Although MCOs are responsible for contracting with providers to deliver services to their members, MCOs have various networks they offer to their employer group customers to achieve different goals, like local/national networks, cost control, limited/expansive access… There are costs associated with each of these options, whether a higher or lower cost. If you are working for an employer in making the health care purchasing decisions:

  • What options do employers have for compensating providers?
  • What role does reinsurance play in provider reimbursement?
  • What limitations exist (e.g., state or federal laws)?
  • Provide examples to support your ideas.

Please cite references in your post which should be 150-200 words.

 
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