Software Solutions for MCOs - Managed Care Organizations in Malaysia

Managed care is the most commonly used form of health care which also refers to solutions that help to save money on healthcare while allocating much better services for patients. At its base, managed care includes provider networks which involve providers agreeing to specific standards and costs. Furthermore, managed care target its attention on prevention and management of resources and helps patients while reigning in costs.


Most percentage of people get their healthcare services through managed care organization, but nearly single percentage truly knows the ins and outs of the health insurance program which are provided. Managed care organizations are plans that insurance companies set up as a framework for healthcare benefits, and the concept behind managed care is to drive behavior that minimizes the costs for benefits providers while also giving plan participants financial incentives to control their healthcare expenses.


Types of managed care organizations:

There are several types of managed care organizations, including the following:

  • Independent practice associations
  • Independent Physician or Practice Associations
  • Integrated Delivery Organizations
  • Physician Practice Management Companies
  • Group Purchasing Organizations
  • Accountable Care Organizations
  • Integrated Delivery Systems
  • Physician-Hospital Organizations
  • Management Services Organizations, which can include group administrative purchasing and investment and management styles


Managed care organizations fall into three main categories.

  • Health Maintenance Organizations require patients to have a family doctor who must provide referrals to other professionals in the same provider network.
  • Preferred Provider Organizations are the most common managed care organizations and they allow patients to seek care outside the network for a slightly higher cost.
  • Point of Service plans require patients to have a primary care doctor to oversee care and provide referrals, although out-of-network care is available at a slightly increased cost.


Benefits of Managed Care Organizations:

The most important advantage of managed care is to provides health care solutions for people whenever they need to speak with a medical provider. Immediate services can be accomplished, allowing people to take their health care into their own hands with a reasonable level of certainty.


1. It lowers the costs of health care for those who have access.

The goal of a managed care system is to keep the costs of health care as low as possible without sacrificing the quality of the care that is given. This is done by creating a network of providers that can provide care and referrals whenever there is a health need which needs to be addressed. When people stay within their network for care, procedures and services are usually provided at a discounted rate.

2. People can seek out care from within their network.

Referrals can be made quickly when services or procedures need to be completed and there is a network provider. Someone can visit their primary care provider one day, get a referral to a specialist and make an appointment for the next day, and potentially have a procedure completed the day after that. The speed at which managed care can provide an outcome is incredibly fast when it is well-managed by the patient.

3. Information moves rapidly within a network.

In the past, a patient would need to take copies of their medical records with them when referred to a specialist. If they did not, then they’d need to give their authorization to have their medical file transferred to the specialist. With the modern structures of managed care, one single authorization allows the network to access your file when seeing a provider. Even if your primary care provider is in one city and your specialist is in another and with a different company, you can still instantly access your data so that a treatment plan can be developed.

4. It keeps families together.

Managing health care requires the development of a relationship between patient and provider. Without this relationship, doctors and care providers don’t have all the information that may be necessary to make an accurate diagnosis. Because patients can choose their providers within a network, it is much easier to have an entire household or family see the same doctor.

5. There is a certain guarantee of care within the network.

Managed care networks require their providers to pass various accreditation processes so that patient care can be provided as effectively as possible. Although there is sometimes a push to hire younger, more inexperienced providers as a cost-savings measure, the accreditation mandate still provides patients with the peace of mind knowing that there must be at least a certain minimum guarantee for the care that they need.

6. Prescription management is much easier.

Many networks work with pharmaceutical agencies to ensure that needed prescriptions are available and affordable to those who need them. This process simplifies the refill process and, in some instances, can even lower costs.


Managed Care Services by Medilink:

Medilink’s integrated solution includes comprehensive claims and managed care services that provide connection. From the first contact and throughout the injury or illness, Medilink connects an injured employee with the customized care they need to recover. Our outcomes-focused approach includes identifying top-performing providers, coordinating the claims process and using clinicians, physicians, pharmacists and other clinical healthcare specialists to help improve the employee’s overall health and well-being.

Our integrated claims and managed care services include:

  • Medilink’s helps and ensure that injured employees receive high-quality care from experienced, top-performing medical providers associated with proven results.
  • Our clinical consultation team helps employees receive safe, appropriate care at the time of injury, with a triage process to direct them toward self-care, telemedicine or provider referral, and they work closely with our utilization review nurses to ensure the best treatment levels. Our behavioral health solutions identify and address psychosocial barriers to help ease the return to work process.
  • Our telephonic case management and field case management nurses work with our pharmacy utilization review and complex pharmacy management teams to drive positive outcomes on the path toward recovery.
  • Our in-house managed care services with customized private label programs that we have created which allows us to offer streamlined access and significant discounts, while maintaining management oversight, quality and ownership for state reporting.
  • Medilink’s experienced bill reviewers, clinicians and advanced technology work together to achieve the highest possible savings for our clients.