Explain selective contracting and give an example of competition, managed care plans and outcomes.

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Explain selective contracting and give an example of competition, managed care plans and outcomes.

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Answer 1

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Selective contracting is one of the medical practice used by medical insurer to control costs in an managed care environment . It reduces the freedom for choosing the healthcare providers. In this health insurers contracts with some providers not with all . It is of two types :-

- preferred means patients can go to healthcare providers other than the providers who are in contract with health insurer ,but they are partially reimbursed for this .

- exclusive means twhen patients go to providers other than those who are in contract with health insurer . They are not at all reimbursed.

Managed care organisation frequently contract with a panel of healthcare providers . They recieve a set of amount for the number of patients covered by the plan . Examples of competition manged care plans and outcomes are :-

- HMO's( health maintainence organisation )

- PPO's (preferred provider organisation )

- POS (point of service)

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Answer 2

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Explain selective contracting and give an example of competition, managed care plans and outcomes.

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Let's start by defining the various contracting approaches as mentioned in our textbook, Essentials of Managed...

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Explain selective contracting and give an example of competition, managed care plans and outcomes.

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