Explain which issue you believe poses the greatest challenge and discuss a strategy that could be leveraged to deal with this issue.

There are a great many issues associated with adapting to local conditions that U.S. Managed Care Organizations (MCOs) abroad have had to face. Issues include:
Lack of standardized coding systems
Established lines of physician income that are threatened by managed care
Cultural sensitivity
Explain which issue you believe poses the greatest challenge and discuss a strategy that could be leveraged to deal with this issue.