Question

What are the common characteristics of managed care organizations?

Identify and describe the three major types of managed care organization’s remuneration/payment plans to providers?

Answer 1

The common characteristics of managed care are as following

• To reduce unnecessary expenditures in healthcare organization
• It enables the delivery of healthcare services to the enrolled population by providing financing with the management
• It uses an information center
• Capitation is used to pay provider
• Control access to provider
• Preventive care
• Risk management
• Comprehensive utilization management
• High quality care

The three major type of managed care are

• Health Maintainace Organization (HMO): Here the primary care provider can be selected or preferred by the patient and the entire care of the patient depends in the provider order.They pay for care only with on network
• Preferred Provider Organization  (PPO):It pays more in the network .If a patient goes out of the network a part of tge cost is paid by it
• Point of Service (POS):It usually gives an option to choose HIM or PPO during each care needed.