Managed Care Plan

Question: Managed Care Plans Description

Answer: Buyers will consume more. Healthcare are compensated. This will maximize and charge the insurer resulting in higher premium to employer.

Question: Five Basic Characteristics of Managed Care Plan (1)

Answer: 1. Control Access to Providers (For Buyers):

(a) Encourage members to use specified Providers (Participants/Buyers) and (in-network)

(b) Controls costs by negotiating providers’ fees

“negotiate lower price”

Lower cost results in restriction

Question: Basic Characteristics of Managed Care Plan (2)

Answer: 2. Comprehensive Utilization Management:

Review the appropriateness and success of treatment behind contract of carriers and service providers

Question: Basic Characteristics of Managed Care (3)

Answer: 3. Preventive Care

Question: Basic Characteristics of Managed Care (4)

Answer: 4. Risk Sharing:

Service providers do not bear financial risk

(a) providers share in the financial consequences of medical decisions

(b) encourage cost-effective care offered by providers