Managed Care : A Complex Health Care System

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Managed Care is a complex health care system in which physicians, hospitals, and other healthcare professionals organize in an interrelated system of people and facilities that communicate with one another and work together as a unit, commonly referred to as a network. This network coordinates and arranges health care services and benefits for a specific group of individuals, referred as enrollees, for the purpose of managing costs, quality, and access to health care. The Managed care program may be provided in a variety of settings, such as Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO). In Health Maintenance Organization, the insurance company will only pay for care within the network. The member will pick a primary care provider who coordinates most of their care. Preferred Provider Organization (PPO) usually pays more if the member will get care within the network, but they still pay a portion if the member will go outside. And Point of Service (POS) plans let you choose between an HMO and a PPO each time you need care (Merrick, 2013). Managed Care Organizations (MCOs) performs three functions: (1) set up the contracts and organization of the health care providers who furnish medical care to the enrollees, (2) establish the list of covered benefits tied to managed care rules, and (3) oversee the healthcare they provide. Managed care greatly influenced the practice of medicine and that the enactment of the Affordable Care Act greatly
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