Managed Care Plan Flashcards, test questions and answers

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What is Managed Care Plan?

Managed Care Plan is a type of health care system that seeks to increase quality of care and reduce costs by carefully managing the services provided. It does this by focusing on preventive care, emphasizing early diagnosis and treatment, improving patient access to services, and controlling utilization of medical resources. The goal of managed care is to provide high-quality healthcare at an affordable cost. Managed Care Plans are typically offered through employer-sponsored health insurance plans or public programs like Medicare or Medicaid. In general, these plans use contracts between providers and insurers to control costs while still providing necessary services. To do this, they set up networks of participating doctors and hospitals that have agreed to accept their plan’s payment terms for certain covered services. These networks can be large (national) or small (local). Participants in the network agree not only on which types of treatments will be paid for but also how much each provider will be paid for each service provided; this helps them keep costs down since providers must compete based on price rather than quality alone. Additionally, managed care plans often limit coverage to specific drugs and treatments as a way to save money while still providing adequate healthcare options. In addition to using contracted networks and limiting coverage, Managed Care Plans also monitor utilization by requiring prior authorization before certain tests or procedures can be performed; they may also require regular visits with primary care physicians who then coordinate specialty referrals when needed; this ensures that patients get appropriate levels of care without overusing resources such as emergency room visits or unnecessary surgeries/procedures. Managed Care Plans have had mixed results overall in terms of reducing total healthcare spending while maintaining quality standards among participants; however, many employers view them as attractive options due their potential cost savings compared with traditional fee-for-service models where there is no incentive for providers to control usage other than what is required under federal law (e.g., avoiding unnecessary testing).