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1). The HMO is a form of prepaid group of practice. A sponsoring organization public, private, professional, business, or consumer group employs doctors and other health professionals on salary to provide comprehensive health services. 2). PPO and IPA are associations of independent physicians who agree to combine their services and to contract with employers or insurers to serve their customers at reduced rates. 3).
Gatekeepers Primary care physicians who must see patients first and whose permission is needed for patients to see specialists. The idea is to utilize costly specialists only when clearly medically necessary. Sometimes, managed care networks also use nurses and physician assistants for initial patient contact and simple procedures. 4). Utilization review this is another key managed care practice. It requires some combination of second opinions before surgery or hospitalization, prior approval before a major procedure, and case management teams to coordinate all aspects of major and lengthy treatments. 5). Managed care insurance plans also restrict patient choice of providers in significant ways, providing significantly more generous reimbursement for use of physicians, hospitals, and other providers in the managed care network. 6).
Managed competition These include proposals for health care reform such as President Clintons failed plan. Government regulations could be used to induce or require many public and private insurance providers to use HMOs, PPOs, and other managed care devices. 7). Subscribers They pay a set fee each month, and all medical needs are covered without additional costs. Incentives to control costs are built into HMOs. 8). Utilization management practices - In traditional insurance plans account for another 40 percent of insured employees.
Free research essays on topics related to: managed, managed care, insurance, providers, physicians
Research essay sample on Managed Care Insurance Plans Physicians
