Types of managed care plans. Introduction: Healthcare can be defined as the efforts made by licensed and trained professional to restore or maintain emotional, mental and physical well-being. In other words, healthcare is about improvement and maintenance of health by recovery, treatment, prevention of injury, illness or diseases. Health management organization also known as HMOs is a type of managed care plan that make use of discounted schedule of rates for providers, should receive a referral for specialist, keep a track on visit of patient to restricted healthcare providers and provide incentive towards proactively taking action to prevent illness. The treatment under HMO are provided on a prepaid basis wherein a monthly fee also known as premium is paid by individual and care is provided for entire month. Health management organization only make payment towards the health care services within its network and does not provide cover outside its network. Preferred provider organization refers to the arrangement that provides medical care wherein subscribed clients are provided with medical facilities and professional care at subsidized rates. The healthcare and medical professional that provides their services to preferred provider organization are known as preferred providers. Unlike Health management organization, no prepayment is made by the members, the payment is made at discounted rate when the services are rendered. Preferred provider organization provides more coverage within its network, however unlike health management organization healthcare providers, hospital and doctors can also be used but with an additional cost. It can be concluded that the type of managed care plans are health management organization and preferred provider organization.

EBK HEALTHCARE FINANCE: AN INTRODUCTION

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ISBN: 9781567937428

Author: Gapenski

Publisher: YUZU

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Discuss the salient forces leading to the rise and fall of various types of managed care plans. Speculate on how current and future forces might lead to further changes.

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