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The term managed care or managed healthcare is used in the United States to describe a group of activities intended to reduce the cost of providing health care and providing American health insurance while improving the quality of that care ("managed care techniques"). It has become the predominant system of delivering and receiving American ...
Medicare managed care plans are often known as Medicare Part C or Medicare Advantage plans. Medicare care managed care plans are an optional coverage choice for people with Medicare. Managed care ...
In the United States, an independent practice association ( IPA) is an association of independent physicians, or other organizations that contracts with independent care delivery organizations, and provides services to managed care organizations on a negotiated per capita rate, flat retainer fee, or negotiated fee-for-service basis. [1] [2]
Kaiser Permanente ( / ˈkaɪzər pɜːrməˈnɛnteɪ /; KP) is an American integrated managed care consortium, based in Oakland, California, United States, founded in 1945 by industrialist Henry J. Kaiser and physician Sidney Garfield. Kaiser Permanente is made up of three distinct but interdependent groups of entities: the Kaiser Foundation ...
Under managed care, a primary care provider (PCP) wields considerable power. ... This approach is sound, according to the American Medical Association, which suggests similar criteria in its ...
A health maintenance organization, or an HMO, is a common type of health insurance plan. If you’re a member of an HMO, your insurance company agrees to pay for your health care when you use a ...
It is an organization that provides or arranges managed care for health insurance, self-funded health care benefit plans, individuals, and other entities, acting as a liaison with health care providers (hospitals, doctors, etc.) on a prepaid basis. The US Health Maintenance Organization Act of 1973 required employers with 25 or more employees ...
Utilization management. Utilization management (UM) or utilization review is the use of managed care techniques such as prior authorization that allow payers, particularly health insurance companies, to manage the cost of health care benefits by assessing its appropriateness before it is provided using evidence-based criteria or guidelines.