Systems that integrate the financing and delivery of appropriate health care services by means of arrangements with selected providers to furnish a comprehensive set of health-care services to members; explicit criteria for the selection of health-care providers; formal programs for ongoing quality assurance and utilization review; and significant financial incentives for members to use providers and procedures associated with the plan
Managed care is a health care plan that integrates the financing and delivery of health care services by using arrangements with selected health care providers to provide services for covered individuals. Plans are generally financed using capitation fees. There are significant financial incentives for members of the plan to use the health care providers associated with the plan. The plan includes formal programs for quality assurance and utilization review. Health maintenance organizations (HMOs), preferred provider organizations (PPOs), and point of service (POS) plans are examples of managed care.
Method for managing costs, use, and quality of the health care system. Includes health maintenance organizations (HMOs) and preferred provider organizations (PPOs).
Coordination of members use of health services in order to contain costs, improve quality or both. Care plan can be fully capitated, partially capitated , or fee-for-service.
A system of care that oversees all services to an individual to ensure that proper treatment is provided and treatment is not duplicated.
Used as a description for an entire array of programs. Generally, managed care implies that there is some form of influence in the delivery of health care by persons other than the caregiver and patient. It includes quality assurance, aggressive care management, coordination of care, control to manage costs, and peer review and data gathering and dissemination to providers. A primary care physician or other gatekeeper opens the door to the various specialists.
A broad term describing health and long term care coverage in which providers agree to negotiate payment levels for defined populations. Providers also typically agree to more aggressive utilization and quality assurance review than in traditional fee-for-service arrangements.
Term to describe various approaches to provide and pay for healthcare in an attempt to limit fees for health services and control or manage those services.
A health care system integrating the financing and delivery of health care services by a group of providers. In a managed care system, standards are set for efficiency and quality assurance. A coordinated approach to the design, financing and delivery of health care, which balances price and utilization controls with access to care. Also a general term for organizing doctors, hospitals and other providers into groups in order to enhance the cost-effectiveness and manage the quality of health care.
An organized method of providing healthcare services; it involves a 3rd party in the planning, approval, and monitoring of an HMO member’s healthcare.
A health care coverage system in which all medical treatment and payments are approved or denied by the insurer.
An insurance plan that requires patients to see doctors and hospitals that have a contract with the managed care company, except in the case of medical emergencies or urgently needed care if you are out of the plan's service area.
A system of delivering health care where care is delivered through a specified network of doctors and hospitals contracted with an HMO or Preferred Provider Organization.
Any system of delivering health services in which care is delivered by a specified network of doctors and hospitals who agree to comply with established care approaches. Providers may receive a capitated payment for providing all medically necessary care to enrollees or may be paid on a fee-for-service basis. Managed care often involves a defined delivery system of providers with some form of contractual arrangement with a health plan.
A general term that refers to an organized system of health care delivery in which the health care providers are affiliated with a health plan in such a way as to provide participants with quality, cost-effective care.
Method of organizing and financing health care services that emphasizes cost-effectiveness and coordination of care.
Refers to the prepaid health care sector (e.g., HMOs) in which care is provided under a fixed budget so costs can be "managed."
An organized system of health care services with the primary purpose of controlling costs. There are various types of managed care.
Health care systems that integrate the financing and delivery of appropriate health care services to covered individuals by arrangements with selected providers to furnish a comprehensive set of health care services.
A way to supervise the delivery of health care services. Managed care may specify which caregivers the insured family can see and may also limit the number of visits and kinds of services that are covered by insurance.
A health care plan such as a health maintenance organization (HMO), which contains costs by monitoring care to make sure it is appropriate and effective. Managed care programs include case management, incentives to use specific providers, limits on referrals to expensive specialists, and review/preauthorization of hospital care and other services for medical necessity. Most managed care plans are based on networks of doctors and hospitals which agree to provide their services at a discount to plan members.
Any health insurance that controls the use of health services by its enrolled members in order to contain costs, improve the quality of care or both. Examples are health maintenance organization (HMO's) and Preferred Provider Organizations (PPO's).
The provision of health services through a single point of entry and formal enrollment where patient care is managed to ensure an emphasis on quality preventive and primary care, a reduction in inappropriate use of services, control of costs, and management of risk. This concept has been applied to managed care organizations, which integrate the finance and delivery functions of health care.
A comprehensive approach to healthcare delivery that encompasses planning, educating, monitoring, coordinating, and controlling quality, access, and cost while considering the interests of patients, providers, and payers or a system that uses financial incentives and management controls to direct patients to providers who are responsible for giving appropriate care in cost-effective treatment settings. Such systems are created to control the cost of health care.
health care programs that impose some controls on the utilization of health care services and providers who offer such care, and/or the fees charged for such services. Managed care can by provided through HMOs, PPOs, and managed indemnity plans. The primary goal is to deliver cost-effective health care without sacrificing quality or access.
A health care delivery system that attempts to keep costs down by managing the care to eliminate unnecessary treatment and reduce expensive hospital care. The most familiar models are health maintenance organizations (HMOs) and preferred provider organizations (PPOs).
procedures used by organizations that assume risk for health services to control or influence variables in those services for a defined population; variables include cost, price, quality, and accessibility
Medical plans in which access to health-care services is managed to hold down unnecessary costs. The most common form of managed care is the health maintenance organization, or HMO, which restricts patients to the HMO's own stable of doctors. Premiums are lower than for traditional fee-for-service health care plans, and the charge for each doctor visit is modest. Some newer arrangements are the point-of-service and preferred-provider plans, which may charge the low per-visit price of an HMO for treatment by doctors in the plan's network and allow out-of-network treatment with reimbursement at about 70% of eligible costs.
A system of health care delivery where a primary physician or other provider directs and refers a patient's care. The goal of managed care is to deliver value by providing people access to quality, cost-effective health care.
Health care insurance provided through HMOs, PPOs, and managed indemnity programs, which places some controls on utilization of health care services. The primary goal is to deliver cost-effective health care without sacrificing quality or access.
A system of health care delivery aimed at managing the cost and quality of access to health care. Managed care is used by HMOs, PPOs, and managed indemnity plans to improve the delivery of services and contain costs.
A health care system that employs cost containment by limiting the reimbursement levels paid to providers or by reducing utilization in order to "manage" the cost, quality, and access to health care. Examples of managed care are Health maintenance organizations (HMOs) and Preferred provider organizations (PPOs).
a type of health care delivery that stresses controlling costs and active coordination and arrangement of health services. Under the provisions, providers are contracted and reimbursed by an insurer.
Control of utilization, quality and claims using a variety of current cost containment methods. The goal is to deliver cost effective health care without sacrificing quality or access.
The integration of health care and health insurance. Managed care is an attempt to control costs and improve quality by using a selected group of providers and, through policy and procedure, managing the care a member of the plan receives.
comprehensive medical care provided within one firm
A health care system under which providers are organized into a network in order to manage the cost, quality, and access to health care. Managed care organizations include Preferred Provider Organizations (PPOs) and Dental Health Maintenance Organizations (DHMOs).
Any health insurance that controls the use of health services by its enrolled members in order to contain health care costs, improve the quality of care or both. Examples are health maintenance organizations (HMOs) and Preferred Provider Organizations (PPOs).
An approach to controlling utilization, quality and cost of medical care using a variety of cost containment methods focused on incentives to choose less costly care and disincentives for choosing more costly care.
A term that applies to the integration of health care delivery and financing. Managed care plans, such as an HMO, manage or control what is spent on health care by closely monitoring how doctors and other medical professionals treat patients. Such organizations try to limit referrals to costly specialists and require preauthorization for hospital care and services to keep costs down.
Name given to a broad spectrum of techniques by which insurance companies attempt to reduce health care costs by participating in decisions concerning the treatment given to those they insure.
The way a health care system manages costs, use, and quality. All HMOs and PPOs, and even many fee-for-service plans, apply managed care techniques. Maximum Out-of-pocket – The maximum amount of money you will be required to pay in one year including all deductibles and co-insurance.
Comprehensive health care which is provided to participating members of an organized health care organization through the use of a network of health care providers and facilities; it uses a delivery system that secures cost effective health care.
a health care plan in which monthly premiums are paid for a complete package of services through an HMO (Health Maintenance Organization) or similar type of provider.
(usually referred to as In Network) â€“ Receiving care from a contracted provider. Indicates that a member is receiving healthcare from a network of physicians and facilities that has made arrangements with the memberâ€(tm)s health plan to hold down costs, meet quality guidelines, and direct the member to the most appropriate level of care. Managed care benefits apply when you stay within a network of healthcare providers. All of the healthcare providers in the health planâ€(tm)s network are listed in the health plan's Provider Directory. To find an In Network provider, use our â€œFind a Doctorâ€ search feature.
A medical or dental plan in which the list of care providers is determined by the insurance company. Member use is monitored and used as a factor in determining the cost of care. Managed-care plans tend to cost less than other plans because your selection is limited.
The aim of managed care is to control cost, quality or access to health care services. Ideally, managed care is designed to promote quality medical care while minimizing material and human resources. However, it may also create unnecessary pressures for care providers to spend less time per patient, use less expensive medications and fewer diagnostic tests and treatments. Health Maintenance Organizations, or HMOs, administer managed care to their enrollees. This means that cost, quality, and access to care are controlled by one business. [See Case Studies related to Managed Care
A system of providing health care through which access, cost and quality are controlled by direct interventions either before, during or after service delivery. Managed-care organizations use a variety of techniques, such as utilization review, quality-assurance programs and pre-admission certification to better manage the care delivered.
Managed care is a broad term encompassing many different types of health plans including HMOs. Managed care in an HMO is an organized and coordinated approach to providing health care. The goal is to provide quality care at a lower cost. The tools of managed care include utilization review, case management and provider networks.
A method of health care delivery that attempts to manage or coordinate health care utilization, access and costs by closely monitoring how physicians and other medical providers treat patients.
The generic name used for health care cost-containment provisions.
Any form of Health Benefit Plan that uses Network Providers to deliver care to Members. Typically, Benefits are determined by use of Network Providers.
Health care delivery arrangements that are designed to control health care costs and improve utilization of services.
A system of providing health care services to plan members through a defined network of health care providers who are responsible for providing "quality" care while controlling resource utilization, use of expensive technologies, and access to specialists. Managed care can include a variety of systems.
A system of healthcare delivery that influences the utilization and cost of services and measures performance. The goal is a system that delivers value by giving people access to quality, cost-effective healthcare.
The use of various techniques and procedures to manage access, quality and cost in health care services. Often associated with risk-based financing methods, such as capitation and case rates, that change the financial incentives in health systems. In public behavioral health care systems, the implementation of managed care usually involves some form of Medicaid waiver and has often included privatization efforts and large scale procurements.
A health care delivery system that provides services within a defined network of health care providers who are given the responsibility to manage and provide quality, cost-effective health care. Managed care plans, which may include but are not limited to Health Maintenance Organizations (HMOs), typically receive a prepaid rate for each member enrolled in the plan.
A kind of health insurance plan. Like an HMO, managed care plans can limit coverage to health care provided by doctors and hospitals that work for or contract with them - also called "network providers." Often managed care plans will require you to get permission (a "referral") from your family doctor before you get care from a specialist in their network. Some managed care plans will reduce coverage for your care if you go to a non-network provider or if you get specialist care without a referral.
An approach to health care financing, this insurance form attempts to control the use and cost of health care services. Offering incentives, implementing cost restrictions, influencing a consumers' choice of providers, establishing networks, and improving coordination of services are used as methods to manage costs.
A coordinated health care delivery system that promotes cost-effective care and emphasizes prevention and maintenance of health.
A concept that addresses how health care is contracted, provided and paid for. HMOs are examples of managed care in action.
A vast system and process that manages costs, use, and quality of the health care system. All HMOs and PPOs, and many fee-for-service plans, have a type of managed care.
An approach to controlling utilization, quality and cost of medical care using a variety of cost-containment methods, with an emphasis on creating incentives for employees to choose less expensive treatments and disincentives for employees to choose more expensive ones.
Any form of health plan that uses selective provider contracting to have patients seen by a network of contracted providers and that requires pre-authorization of certain services.
a health plan that places limits on which doctors and what kind of therapy and treatment a member may have and receive coverage.
represents an approach to funding health care services. Generally, managed care provides a specific level of funding to serve a population of people. Managed care programs often restrict clients to seeing providers from an approved list and may limit available services. 44
A term traditionally confused with the term HMO. A general term used to describe a system that focuses on improving quality and controlling prices. Managed Care includes HMOs, PPOs and POS plans.
A very broad term that generally refers to a system that manages the quality of health care, access to care, and the cost of that care. For example, a formulary controls the quality of medications dispensed to enrollees; a referral ensures that you see the right specialist for your condition; and going to a hospital that has an agreement with your plan can save both you and the plan money.
A general term for organizing doctors and hospitals into health care delivery networks with the intent of lowering costs and "managing" the medical care provided. HMOs were the earliest form of managed care. Today there are many different kinds of plans.
A means of providing health care services through a defined network of participating providers and facilities that are responsible for providing responsible, cost-effective health care.
A way to supervise the delivery of health care services. Managed care may specify the caregivers that the insured family can see. It may also limit the number of visits and kinds of services that will be covered. Other commonly used terms and acronyms related to Managed Care can be found on this site on Factsheet 22: Managed Care.
Assessment of nursing and social needs. Coordination of providers, oversight of services.
A system used by payers to control health care costs while ensuring accessible, effective, and efficient care for beneficiaries. The system uses gatekeepers, a preselected provider network, service preauthorization, case management, utilization review, and medical necessity review, as well as formal programs, such as provider credentialing and outcomes evaluation, to monitor quality; financial incentives are employed for beneficiaries to use the plan's providers and for providers to contain costs.
A term used to describe a set of tools to control costs primarily through resource allocation, volume discounts and service utilization limitations.
A term used to describe different types of insurance products. A typical element of Managed Care is that the purchaser of services tries to control utilization through strategies designed to keep patients out of hospitals and provide alternative care whenever appropriate.
Any system that manages healthcare delivery to control costs. Usually an insurance company or a doctor-hospital network acts an intermediate between the person seeking care and the physician.
In its broadest sense, a health care system in which a third party intervenes in the doctor-patient relationship to prevent over-utilization of medical resources by monitoring access to, and the quality and frequency of, medical care. Its purpose primarily is to contain medical costs. Managed care encompasses HMOs, PPOs, and other third-party administrative groups.
An organized system of health care that encourages providers to deliver the most appropriate care in the most effective manner. Managed care plans are also known as HMOs or coordinated health plans.
A system of health care delivery that links payment with the delivery of health care services with the aim of giving people access to quality, cost-effective health care.
A medical service system designed to better manage the cost and quality of medical services that insurance policy holders receive. Many managed care health insurance programs work with HMO and PPO boards to promote use of specific health treatment procedures. Managed care health insurance plans also educate and work with consumers to improve overall health by addressing disease prevention.
An effort to contain health care costs by limiting inappropriate or excessive utilization of health care services.
A health insurance plan that makes available to its members health care services performed by providers selected by the plan and which seeks to manage the cost, accessibility, and quality of care.
Generally a health care delivery system that links doctors, hospitals and an insurance plan to deliver care to the plan's members with the intent of improving quality and reducing costs. Health insurance can manage care in a number of ways, including requiring members to choose a primary care provider, to obtain the primary care provider's permission to see a specialist and to use only providers with the plan's network of providers.
A type of health insurance coverage that includes health maintenance organizations (HMOs), preferred provider organizations (PPOs), and point of service (POS) plans. All of these involve an arrangement between the insurer and a selected network of doctors, hospitals, and other healthcare providers.
the coordination of health care services in the attempt to produce high quality health care for the lowest possible cost. Examples are the use of primary care physicians as gatekeepers in HMO plans and pre-certification of care.
Medical insurance coverage provided by a health maintenance organization (see HMO).
A system of health care delivery where the health plan attempts to control or coordinate the use of health services by enrolled members to contain health care expenditures and/or improve quality. Types of managed care plans include HMOs, point-of-service (POS) plans, and preferred provider organizations (PPOs).
Term used to describe the coordination of financing and provision of health care to produce high-quality health care for the lowest possible cost.
Can best be described as the partnership of insurance and a health care delivery system. The basic goal of managed care is to coordinate all health care services received to maximize benefits and minimize costs. Managed care plans use their own network of health care providers and a system of prior approval from a primary care doctor in order to achieve this goal. Providers include: specialists, hospitals, skilled nursing facilities, therapists, and home health care agencies.
A system where the government pays a plan for each member enrolled, and the plan provides all or most of the person's care.
A healthcare delivery system under which physicians, hospitals and other healthcare professionals are organized into a group or “network” in order to manage the cost, quality and access to healthcare. Managed care organizations include PPO, HMO, EPO and POS.
A medical delivery system that attempts to manage the quality and cost of medical services that individuals receive. Most managed care systems offer HMOs and PPOs that individuals are encouraged to use for their health care services. Some managed care plans attempt to improve health quality, by emphasizing prevention of disease.
A system that manages or controls what it spends on health care by closely monitoring how physicians and other medical professionals treat patients. Various techniques for keeping costs down include limiting coverage to care provided by specially selected doctors and hospitals and requiring preauthorization for hospital care and other services.
A medical delivery system that manages healthcare and costs through a network of physicians, hospitals and other healthcare providers.
A system for delivering health care that combines the monitoring and management of services to obtain better results for the patient at lower cost. In managed care, administrators and managers work with doctors and nurses to help see that you—the patient—get good care at the lowest possible cost. When talking about managed care, most people are referring to health maintenance organizations (HMOs) and preferred provider organizations (PPOs).
health care cost containment through coordination of care through primary providers, use of provider networks, utilization review, preauthorization of services, and other means.
Many insurance companies now have managed care companies overseeing mental health benefits. This means that a therapist may have to have treatment approved or pre-certified by the managed care company who is overseeing the insurance benefits. Though the insurance may provide a certain amount of coverage, the managed care company oversees.
A method of integrating the financing and delivery of health care within a system that seeks to manage the cost, accessibility and quality of care.
A general term for organizing doctors, hospitals, and other providers into groups in order to enhance the quality and cost-effectiveness of health care. Managed Care Organizations include HMOs, PPOs, POSs, EPOs, etc.
Systems and techniques used to help direct the utilization, cost and quality of health care services.
A system of health care that combines delivery and payment; and influences utilization of services, by employing management techniques designed to promote the delivery of cost-effective health care.
A health plan in which your coverage comes from a group of approved doctors, hospitals and other providers, who have contracts (and therefore financial interests) with the managed care plan.
system of health care delivery that influences utilization and cost of services and measures performance. The goal is a system that delivers value by giving people access to high quality, cost-effective health care.
Dental plans are any kind of contractual arrangement where payment or reimbursement and/or utilization are controlled by a third party. This concept represents a cost containment system that directs the utilization of health care by a) restricting the type, level and frequency of treatment; b) limiting the access to care; c) controlling the level of reimbursement for services; and d) controlling referrals to other practitioners.
Refers to a cost containment system that directs the utilization of health benefits by: a. restricting the type, level and frequency of treatment; b. limiting the access to care; and c. controlling the level of reimbursement for services.
Managed Care is a concept under which an organization (like an HMO) delivers health care to enrolled members. It controls costs by closely supervising and reviewing the delivery of care.
Any health care delivery system that attempts to control or coordinate use of health services by its enrolled members in order to contain spending, improve quality, or both. Arrangements often involve patient education and disease prevention; formal programs for quality assurance and utilization review; a network of providers with some form of contract with the health plan to furnish a comprehensive set of services to enrollees; and financial incentives for providers and patients to use cost-effective treatments. HMOs and indemnity insurance plans with utilization review are both examples of managed care systems.
System in which patients need not find their own care. PCMs act as patient advocates, monitoring all care, avoiding needless care and referring patients to economical care sources. Such systems negotiate discounts with providers.
A recent concept of how patients are cared for byphysicians, outpatient facilities and hospitals, wherecost-effectiveness and outcomes of procedures are central components ofthe care program allowed. Managed care can include HMOs,preferred-provider programs, government programs and is spreading toindemnity programs.
The process of controlling health care costs while helping to ensure the quality of care.
A process to deliver cost-effective health care without sacrificing quality or access. Common characteristics include controlled access to providers, comprehensive case management, preventive care, risk taking, and high-quality care.
Ways to manage costs, use, and quality of the health care system. All HMOs and PPOs, and many fee-for-service plans, have managed care.
Health Care plans or PCCM s that coordinate a client's medical care for a prepaid premium or monthly management fee. See: Managed Care
a system of managing and financing health care delivery to reduce the cost of health care while preserving a high level of care and service. It is a combined clinical and administrative approach to health care delivery. If you choose an HMO insurance plan, you opt for managed care.
A method by which cost containment features are applied to a health plan either by limiting the reimbursement levels paid to providers or by reducing utilization.
Any form of Health Benefit Plan using a network of contracted providers and which may require pre-authorization for certain services.
Health plans that control the cost, use and quality of the health care system. These plans combine physicians, hospitals, and insurance plans into a single network. All HMOs and PPO, and many fee-for-service plans, have managed care.
A broad term that describes programs designed to manage the cost and quality of health care. Ideally, managed care provides a comprehensive system for patients to receive the care they need, when they need it, including preventative care. The plans vary from restrictive provider panels and low out of pocket amounts to fairly open provider panels and high out-of-pocket amounts.
An approach to delivering health and mental health services that seeks to improve the cost effectiveness of care (i.e., improved services at reduced cost) by monitoring service seeking and delivery. Methods include managing the overall delivery of care by selecting providers (for example, health maintenance organizations or other provider networks) and managing treatment decisions by individual providers for individual patients (for example, utilization review).
the name given to a broad spectrum of techniques that integrate payment for and delivery of health care and that seek to manage the cost, accessibility and quality of that care.
A system of health care wherein the stated goal is the delivery of cost-effective health care through the monitoring and recommendation of services.
Managed care is a concept that permits healthcare plans and employers to administer healthcare plans in a more efficient and cost effective manner. Examples of managed care include networks of providers, pre-certification, preventive care, and health education programs (refer to page 6).
a plan that puts limits on the number and types of treatments as well as the health care service providers and facilities that are covered. Each recognized provider agrees to a negotiated fee structure for health care procedures, thus lowering costs for both the insurance company and the insured.
A cost-containment method applied to a health plan that either limits the levels of reimbursement paid to providers or encourages reduced utilization.
The integration of both the financing and delivery of health care within a system that seeks to manage the accessibility, cost and quality of that care.
Managed care is an approach to health care that adds the cost of services to the model. Its goal is to provide high-quality health care at a reasonable cost.
Any system that manages healthcare delivery to control costs. Typically, managed care systems rely on a primary care physician who acts as a gatekeeper for other services, such as specialized medical care, surgery, or physical therapy
A general term for organizing doctors, hospitals, and other providers into groups under the claim that doing so improves the quality of care for patients and provides better control over the costs of healthcare. Managed care organizations include things like HMOs and PPOs.
a health care system under which physicians, hospitals, and other health care professionals are organized into a group or 'network' in order to manage the cost, quality and access to health care. Managed care organizations include Health Maintenance Organizations (HMOs).
A program that imposes controls on the utilization of health care services or the providers who offer such care.
An organized system for delivering comprehensive mental health services that allows the managed care entity to determine what services will be provided to an individual in return for a prearranged financial payment. Generally, managed care controls health care costs and discourages unnecessary hospitalization and overuse of specialists, and the health plan operates under contract to a payer.
The system that HMOs, PPOs and indemnity plan uses to provide quality health care while controlling the costs of medical services that individuals receive.
An organized way to manage costs, use, and quality of the health care system. The major types of managed care plans are health maintenance organizations (HMOs), point-of-service (POS) plans and preferred provider organizations (PPO's).
Health care services (all disciplines plus Home Medical Equipment and/or Infusion) coordinated by one central person who may be a case manager or clinical coordinator.
A generic term that refers to a system of health care in which patients, doctors and hospitals work together to manage care in return for improved quality and lower costs.
A health care system that imposes controls on the utilization of medical services and on the providers who render the care. It is provided through managed indemnity plans, preferred provider organizations (PPOs), exclusive provider organizations (EPOs), health maintenance organizations (HMOs) or any other cost-management environment.
A method of financing and delivering health care for a set fee using a network of physicians and other providers who have agreed to the set fees.
systems of health care in which there is administrative control over primary health services in an effort to reduce costs
Dental Plans that restrict the type, level and frequency of treatment; limit the access to care; and control the level of reimbursement for services. Examples of managed care plans are D.M.O. plans, capitation plans and closed panel plans.
This system integrates both the delivery and financing of appropriate health-care services. To "enhance the quality of care", this approach incorporates the following methods: A select number of providers (organized in a network) agree to provide comprehensive health-care services to members. Providers are selected according to very explicit standards (credentialing). Formal utilization review (UR) and quality assurance (QA) programs are established and employed. There are financial incentives for the consumer to choose network providers.
A system that integrates financing, delivery and measurement of appropriate medical care through 1) contracts with selected physicians, hospitals and pharmacy benefit networks to furnish a comprehensive set of health care services to enrolled members, usually for a predetermined monthly premium 2) utilization and quality controls that contracting providers agree to accept 3) financial incentives for patients to use providers and facilities associated with the plan and 4) in some cases an assumption of some financial risk by physicians. The goal is to provide value through a system that provides people access to quality, cost-effective health care.
Approaches that monitor and reduce medical costs using restrictions and market system alternatives.
A health care system that delivers appropriate health care services to covered individuals by arrangements with selected providers.
Arrangement between an employer or insurer and selected providers to provide comprehensive health care at a discount to members of the insured group and coordinate the financing and delivery of health care. Managed care uses medical protocols and procedures agreed on by the medical profession to be cost effective, also known as medical practice guidelines.
A system of health care where the goal is a system that delivers quality, cost effective health care through monitoring and recommending utilization of services, and cost of services.
Managed care is a concept in U.S. health care which rose to dominance during the presidency of Ronald Reagan, ostensibly as a means to control Medicare payouts. Ronald Reagan had supported legislation in California during his term as Governor there as a way to stem rapidly rising costs to California's Medicaid (named Medi-Cal) Program adopted earlier in his administration. The program was allowed as a Medicaid "waiver."