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Reflective Analysis: Risk Management and the Role of Managed Care
Stephany Tudor
Grand Canyon University
308V: HLT
Professor Huff
May 16, 2025
, 2
Reflective Analysis: Risk Management and the Role of Managed Care
Managed care organizations play a vital role in healthcare by improving quality of care
while simultaneously controlling the cost of care. One source states “managed care organizations
are integrated entities in the healthcare system, since the 1970s, managed care organizations
have shaped healthcare delivery in the United States” (Heaton, 2023). This organization was
created to address the mounting healthcare cost and the dwindling quality of healthcare services
being offered. Managed care organizations play a vital role in today’s healthcare environment by
providing standards for healthcare administrators, regulatory statutes, standards relating to fraud,
waste and abuse, and promote a culture of transparency.
Healthcare administrator’s role
Healthcare administrators have a critical role to play in the healthcare environment.
Healthcare administrators must execute risk management policies and ensure compliance with
managed care organization standards. Healthcare administrators have a role in every aspect of
risk management. This includes policy development and implementation to minimize patient
risks, training and education to ensure staff is knowledgeable on all policies, and monitoring
and evaluating the risk management plan making changes when necessary. One source states
“due to the dynamic and multifaceted nature of risk management in healthcare, the role is
constantly evolving” (Catalyst, 2018). Administrators must consistently change with the ever-
changing landscape of risk management. Administrators must also ensure compliance with
managed care organizations standards this includes understanding the standards, these standards
relate to quality-of-care patient safety and cost efficiency. Administrators must also ensure all
policies comply with standards, conduct audits of care to ensure standards are being met, and
report to the managed care organization on compliance.
Reflective Analysis: Risk Management and the Role of Managed Care
Stephany Tudor
Grand Canyon University
308V: HLT
Professor Huff
May 16, 2025
, 2
Reflective Analysis: Risk Management and the Role of Managed Care
Managed care organizations play a vital role in healthcare by improving quality of care
while simultaneously controlling the cost of care. One source states “managed care organizations
are integrated entities in the healthcare system, since the 1970s, managed care organizations
have shaped healthcare delivery in the United States” (Heaton, 2023). This organization was
created to address the mounting healthcare cost and the dwindling quality of healthcare services
being offered. Managed care organizations play a vital role in today’s healthcare environment by
providing standards for healthcare administrators, regulatory statutes, standards relating to fraud,
waste and abuse, and promote a culture of transparency.
Healthcare administrator’s role
Healthcare administrators have a critical role to play in the healthcare environment.
Healthcare administrators must execute risk management policies and ensure compliance with
managed care organization standards. Healthcare administrators have a role in every aspect of
risk management. This includes policy development and implementation to minimize patient
risks, training and education to ensure staff is knowledgeable on all policies, and monitoring
and evaluating the risk management plan making changes when necessary. One source states
“due to the dynamic and multifaceted nature of risk management in healthcare, the role is
constantly evolving” (Catalyst, 2018). Administrators must consistently change with the ever-
changing landscape of risk management. Administrators must also ensure compliance with
managed care organizations standards this includes understanding the standards, these standards
relate to quality-of-care patient safety and cost efficiency. Administrators must also ensure all
policies comply with standards, conduct audits of care to ensure standards are being met, and
report to the managed care organization on compliance.
