MANAGED CARE

Mohammad Sialvi

Mohammad Javed
Shannon Teichmann
Liliya Vizitiu

Pullo Samba

Management 139: Employee Benefits

Dr. Tom Heflin

Spring 2004

1. What is Managed Care?

a. Definition

i. Managed care is a term used to describe health care systems that integrate the financing and delivery of appropriate health care services to covered individuals by: arrangements with selected providers to furnish a comprehensive set of health care services; explicit standards for selection of health care providers; formal programs for ongoing quality assurance and utilization review; and significant financial incentives for members to use providers and procedures associated with the plan.

b. History

i. Private health insurance offered through employment was the dominant method of payment for health care

ii. Individual practices were scattered throughout the land

iii. Insurance companies gladly paid for whatever any doctor and the patient wanted

iv. As time went on some doctors formed group practices

c. Goals

i. The goal of managed care is to control skyrocketing health care costs without sacrificing the quality of care. Managed care pursues those goals in a number of ways. Most managed care plans establish a limited network of providers. In some cases, instead of being reimbursed for the specific care they give patients, these providers agree to fixed payments based on the number of members enrolled in the plan

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