Managed Care Plan

As far as insurance plans go, generally there are three plans a patient will have, they are Health Maintenance Organization (HM0), Preferred Provider Organization (PPO) and Point-of-Service (POS).

Managed care dominates health care in the United States. It is any health care delivery system that combines the functions of health insurance and the actual delivery of care, where costs and utilization of services are controlled by methods such as gatekeeping, case management, and utilization review. Different types of managed care plans came into development by three major factors. These factors include choice of providers, different ways of arranging the delivery of services, and payment and risk sharing. Types of managed care organizations include Health Maintenance Organizations (HMOs) which consist of five common models that differ according to how the HMO is related to the participating physicians, Preferred Provider Organizations

Another type of managed care program that was introduced is the Preferred Provider Organization (PPO). A PPO is comprised of a group of physicians, hospitals and other medical service providers who contract with employers, insurance companies or other plan sponsors. The PPO offers discounted pricing to these contracted organizations due to the high volume of business received. PPO’s typically have up-front cost sharing in the form of deductibles and/or co-insurance, which vary depending upon the actual plan chosen.

Compare the advantages and disadvantages of your choice to another of the other managed care organizations not yet

To attract Medicare patients, hospital must be contracted with Medicare. Hospital must also be contracted with private health insurance companies that provide Medicare Part A or Part B benefits. As per Kaiser Family Foundation, there are more than 55.5 million Medicare beneficiaries in the U.S. and Texas has more than 3 million. Hospital should have regular contact with senior citizens and can be made attractive to Medicare patients by offering sessions about healthy life style choices. Also offer regular disease management sessions, exercise group and organize social activities such as trips to mall, museums. Seniors should also be encouraged to take tour of the hospital.

Manage care are a contract with health care physicians and othe meidcal clinics that gives care to member at a lower price. The network plan is made by these providers. The cost of the care plan normally pays client son this network’s rule. Plans sometimes make your choices cost you less. A flexible plan is provided, it may cost you more. Theres three manage care plans: health maintence organization formally know as HMO normally pays the care in your network. You must choose your primary physician who will manages most of your care. Perferred provider orginaztion known as PPO normally pays more if you saty within your network and they still pay half of the cost outside the network. Point of serives POS plans give the oppurtunity to choose between HMO and PPO everytime you in need for

One of the benefits of the Managed Care is the lower costs. This help health cost down without sacrificing quality and can accomplished by contracting health care providers and able to refer the enrollee members to available of services and procedures at a discount rate. Another benefit is associated with the Managed Care is network of health care providers that are readily available to them. These health professionals and facilities have gone through accreditation process and their credentials and experiences carefully analyzed and essential capacity to serve members with quality care. The disadvantage of the Managed Care for some members is the rigidity of rules applies in the choice of health care provider; for example like HMO. Some enrollees

On the other hand PPO plan has a managed care option for beneficiaries who decided to have a greater provider flexibility, with my PPO coverage portion kicks in. Also

HMOs are a type of MCO that requires a PCP and the patient can only see their PCP, no care is covered including specialist care if it is outside the network. These thing help keep cost down. HMOs have two sub groups, the staff model and the group model. The staff model were the HMO owns the health care facility and pays the providers a salary, all care under this plan must be done in network (all owned by the HMO). The group model In the HMO system has a contract with a health care facility and the facilities providers and there is an agreement that the providers in the network that will only see the HMO’s patients. Then, there is the open panel where in this system providers agree to be PCP providers for a HMO and can also see other patients. The network model is when there is an agreement with healthcare facilities to accept the insurance and see the patients. The final type of HMO plan is the Independent Physician Association (IPA), the provider is paid an agreed price for the services and they see a high number of patients. Now to look at the PPO plans, for these plans contracts are made with providers for them to provide care to the patients as a preferred provider in the network. The providers agree to see the patients at their own office and are paid the agreed upon price for their services. There is no PCP or

You can choose between an HMO or a PPO each time you receive medical care. These plans offer more flexibility in choosing doctors and hospitals.

Preferred Provider Organization PPO – Member are not required to have a PCP, and usually don’t need a referral to see a specialist. Is less restricted than the HMOs. They can receive care from in or out of network providers. PPOs offer an incentive to obtain care from in-network providers by paying a higher percentage of costs.

A PPO is a preferred provider organization. A type of health plan that contracts with medical providers,

An HMO delivers all health services through a network of healthcare providers and facilities. A primary care doctor to manage the care and refer to specialists when we need one so the care is covered by the health plan; most HMOs will require a referral before we can see a specialist. The plan may require us to pay the amount of a deductible before it covers care beyond our essential benefits. There are no claim forms to fill out.

The right insurance for you is one that is affordable and has the most possible health coverage.

Preferred Provider Organizations (PPOs) consist of a network of hospitals, healthcare facilities, physicians and labs that patient may choose from for services and the services will be covered under the insurance policy. Managed care organizations (MCOs) began to proliferate during the 1980s. A Managed Care Organization (MCO) is part of a Family