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Molina Healthcare Case Study

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Molina Healthcare is one of the largest organization administrator in the United States for Medicaid, Medicare, and Marketplace for medical and dental programs. The organization was founded in 1980 by David Molina in Long Beach, California and remanded to be a family run the business until 2017. Molina Healthcare is a government-based health care program that provides care for medical and dental providers, members and Health Maintenance Organizations, also known as HMO. Currently, they have approximately 4 million members across the US they offer at a lower cost. Throughout the year, Molina Healthcare has created new ways to deliver effective care by working with state and local partners to raise awareness and effectiveness for oral health and promote oral health solutions. Molina Healthcare has a mission statement,
“To provide quality health care to people receiving government assistance.”
Which they currently stand by to this day. They are driven to ensure their mission aligns with the organization's goals internally and externally. Within the organization, they have begun to have an issue with the Customer Service Department. Since this organization is a third-party administrator, they are required to uphold certain guidelines by …show more content…
Quality Score is a major part of what the HMO looks at to determine if the company is maintaining their agreement. Directors and Account Executives had monthly meetings to review guideline criteria, which now has turned into a weekly meeting discussion. For several months, the department has not been able to maintain their quality scores for hold times. With the increase in multiple factors like membership and eligibility issues, members and providers currently have an average wait time of an hour. The requirement that is agreed upon remained no more than ten

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