494:
criticism led many states to pass laws mandating managed-care standards. Meanwhile, insurers responded to public demands and political pressure by beginning to offer other plan options with more comprehensive care networks—according to one analysis, between the years 1970 and 2005, the share of personal health expenditures paid directly out-of-pocket by U.S. consumers fell from about 40 percent to 15 percent. So, although consumers faced rising health insurance premiums over the period, lower out-of-pocket costs likely encouraged consumers to use more health care. Data indicating whether this increase in use was due to voluntary or optional service purchases or the sudden access lower-income citizens had to basic healthcare is not available here at this time.
490:
proliferated and quickly became nearly ubiquitous in the U.S. However, this rapid growth led to a consumer backlash. Because many managed care health plans are provided by for-profit companies, their cost-control efforts are driven by the need to generate profits and not providing health care. In a 2004 poll by the Kaiser Family
Foundation, a majority of those polled said they believed that managed care decreased the time doctors spend with patients, made it harder for people who are sick to see specialists, and had failed to produce significant health care savings. These public perceptions have been fairly consistent in polling since 1997. In response, close to 900 state laws were passed regulating managed care in the 1990s.
439:. While managed care techniques were pioneered by health maintenance organizations, they are now used by a variety of private health benefit programs. Managed care is now nearly ubiquitous in the U.S., but has attracted controversy because it has had mixed results in its overall goal of controlling medical costs. Proponents and critics are also sharply divided on managed care's overall impact on U.S. health care delivery, which underperforms in terms of quality and is among the worst with regard to access, efficiency, and equity in the developed world.
963:, places healthcare providers in the role of micro-health insurers, assuming the responsibility for managing the unknown future health care costs of their patients. Small insurers, like individual consumers, tend to have annual costs that fluctuate far more than larger insurers. The term "Professional Caregiver Insurance Risk" explains the inefficiencies in health care finance that result when insurance risks are inefficiently transferred to health care providers who are expected to
890:
are provided. After the deductible is met, the coinsurance benefits apply. If the PPO plan is an 80% coinsurance plan with a $ 1,000 deductible, the patient pays 100% of the allowed provider fee up to $ 1,000. The insurer will pay 80% of the other fees, and the patient will pay the remaining 20%. Charges above the allowed amount are not payable by the patient or insurer but written off as a discount by the physician.
821:(PCP) responsible for the overall care of members assigned. Specialty services require a specific referral from the PCP to the specialist. Non-emergency hospital admissions also require specific pre-authorization by the PCP. Typically, services are not covered if performed by a provider not an employee of or specifically approved by the HMO unless it defines the situation to be an emergency.
864:, which in this context means a set amount for each enrolled person assigned to that physician or group of physicians, whether or not that person seeks care. The contract is not usually exclusive so individual doctors or the group may sign contracts with multiple HMOs. Physicians who participate in IPAs usually also serve
478:
with a prepaid plan with Baylor
Hospital, spreading to other hospitals over the next several decades; these plans were largely independent of each other and controlled by statewide hospitals and physicians until the 1970s, when they became nonprofits before being converted into for-profit corporations such as
922:
There are basically two types of health insurance: fee-for-service (indemnity) and managed care. Policies may vary from low cost to all-inclusive to meet different demands of customers, depending on needs, preferences, and budget. Fee-for-service is a traditional kind of health care policy: insurance
889:
In terms of using such a plan, unlike an HMO plan, which has a copayment cost share feature (a nominal payment generally paid at the time of service), a PPO generally does not have a copayment but offers a deductible and a coinsurance feature. The deductible must be paid in full before any benefits
477:
plan (essentially an HMO), and a plan which paid service providers, such as the Blue Cross and Blue Shield Plans. One of the earliest examples is a 1910 "prepaid group plan" in Tacoma, Washington for lumber mills. Blue Cross (hospital care) and Blue Shield (professional service) plans began in 1929
764:
As of 2017, Medicaid and
Medicare have become an increasingly large part of the private health insurance industry, particularly with the rise of Medicare Advantage programs. As of 2018, two-thirds of Medicaid enrollees are in plans administered by private companies for a set fee. These may involve
967:
in return for their capitation payments. As Cox (2006) demonstrates, providers cannot be adequately compensated for their insurance risks without forcing managed care organizations to become price uncompetitive vis-a-vis risk retaining insurers. Cox (2010) shows that smaller insurers have lower
947:
The overall impact of managed care remains widely debated. Proponents argue that it has increased efficiency, improved overall standards, and led to a better understanding of the relationship and quality. They argue that there is no consistent, direct correlation between the cost of care and its
885:
Rather than contract with the various insurers and third party administrators, providers may contract with preferred provider organizations. A membership allows a substantial discount below their regularly charged rates from the designated professionals partnered with the organization. Preferred
617:
can fine insurers with outdated directories. As a condition of participation, UnitedHealthcare requires that providers notify them of changes, but also has a
Professional Verification Outreach program to proactively request information from providers. However, providers are burdened by having to
502:
By the late 1990s, U.S. per capita healthcare spending began to increase again, peaking around 2002. Despite managed care's mandate to control costs, U.S. healthcare expenditures have continued to outstrip the overall national income, rising about 2.4 percentage points faster than the annual GDP
955:
Critics of managed care argue that "for-profit" managed care has been an unsuccessful health policy, as it has contributed to higher health care costs (25–33% higher overhead at some of the largest HMOs), increased the number of uninsured citizens, driven away health care providers, and applied
926:
Fee-for-service coverage falls into Basic and Major
Medical Protection categories. Basic protection deals with costs of a hospital room, hospital services, care and supplies, cost of surgery in or out of hospital, and doctor visits. Major Medical Protection covers costs of serious illnesses and
816:
They are licensed at the state level, under a license that is known as a certificate of authority (COA), rather than under an insurance license. In 1972, the
National Association of Insurance Commissioners adopted the HMO Model Act, which was intended to provide a model regulatory structure for
910:
In terms of using such a plan, a POS plan has levels of progressively higher patient financial participation, as the patient moves away from the more managed features of the plan. For example, if patients stay in a network of providers and seeks a referral to use a specialist, they may have a
493:
The backlash featured vocal critics, including disgruntled patients and consumer-advocacy groups, who argued that managed care plans were controlling costs by denying medically necessary services to patients, even in life-threatening situations, or by providing low-quality care. The volume of
817:
states to use in authorizing the establishment of HMOs and in monitoring their operations. In practice, an HMO is a coordinated delivery system that combines both the financing and the delivery of health care for enrollees. In the design of the plan, each member is assigned a "gatekeeper", a
489:
Managed care plans are widely credited with subduing medical cost inflation in the late 1980s by reducing unnecessary hospitalizations, forcing providers to discount their rates, and causing the health care industry to become more efficient and competitive. Managed care plans and strategies
422:
through a variety of mechanisms, including: economic incentives for physicians and patients to select less costly forms of care; programs for reviewing the medical necessity of specific services; increased beneficiary cost sharing; controls on inpatient admissions and lengths of stay; the
968:
probabilities of modest profits than large insurers, higher probabilities of high losses than large insurers, provide lower benefits to policyholders, and have far higher surplus requirements. All these effects work against the viability of healthcare provider insurance risk assumption.
670:
There is a continuum of organizations that provide managed care, each operating with slightly different business models. Some organizations are made of physicians, and others are combinations of physicians, hospitals, and other providers. Here is a list of common organizations:
995:
Performance measurements can be burdensome on doctors; as of 2017, there were an estimated 900 performance measurements, of which 81 were covered by HEDIS, and providers used a combination of electronic health records and manual data entry to collect and report on the data.
886:
provider organizations themselves earn money by charging an access fee to the insurance company for the use of their network (unlike the usual insurance with premiums and corresponding payments paid fully or partially by the insurance provider to the medical doctor).
461:, was the first mainstream political leader to take deliberate steps to change American health care from its longstanding not-for-profit business principles into a for-profit model that would be driven by the insurance industry. In 1973, Congress passed the
661:
and a group of surgical centers over an out-of-network overbilling scheme and kickbacks for referrals, where Aetna was ultimately awarded $ 37 million. While Aetna has led the initiative, other health insurance companies have engaged in similar efforts.
648:
which may be developed in house, acquired from a vendor, or acquired and adapted to suit local conditions. Two commonly used UM criteria frameworks are the McKesson InterQual criteria and MCG (previously known as the
Milliman Care Guidelines).
423:
establishment of cost-sharing incentives for outpatient surgery; selective contracting with health care providers; and the intensive management of high-cost health care cases. The programs may be provided in a variety of settings, such as
602:, negotiates with providers in periodic contract negotiations; contracts may be discontinued from time to time. High-profile contract disputes can span provider networks across the nation, as in the case of a 2018 dispute between
568:
The techniques can be applied to both network-based benefit programs and benefit programs that are not based on a provider network. The use of managed care techniques without a provider network is sometimes described as "managed
948:
quality, pointing to a 2002 Juran
Institute study which estimated that the "cost of poor quality" caused by overuse, misuse, and waste amounts to 30 percent of all direct healthcare spending. The emerging practice of
1026:
The French healthcare system as it existed in the 1990s was cited as an "unmanaged" system, where patients could select their provider without the types of networks and utilization review found in the United States.
939:" health insurance plans now incorporate some managed care features, such as precertification for non-emergency hospital admissions and utilization reviews. They are sometimes described as "managed indemnity" plans.
927:
injuries, which usually require long-term treatment and rehabilitation period. Basic and Major
Medical Insurance coverage combined are called a Comprehensive Health Care Plan. Policies do not cover some services.
824:
Financial sanctions for use of emergency facilities in non-emergency situations were once an issue, but prudent layperson language now applies to all emergency-service utilization, and penalties are rare.
1483:
690:
518:
for the elderly and individuals with disabilities. The states pay a monthly capitated rate per member to the MCOs that provide comprehensive care and accept the risk of managing total costs.
992:(HEDIS) is a prominent set of measurements and reporting on it is often mandated by states as well as Medicare; as of 2017, HEDIS data was collected for plans covering 81% of the insured.
836:
effect on state common law tort lawsuits that "relate to" Employee
Benefit Plans, HMOs administering benefits through private employer health plans have been protected by federal law from
860:
An Independent Practice Association is a legal entity that contracts with a group of physicians to provide service to the HMO's members. Most often, the physicians are paid on a basis of
685:
243:
1121:
618:
maintain their information with multiple networks (e.g., competitors to UnitedHealthcare). The total cost of maintaining these directories is estimated at $ 2.1b annually, and a
644:
that allow payers to manage the cost of health care benefits by assessing its appropriateness before it is provided using evidence-based criteria or guidelines. UM criteria are
703:
732:. As of 2017, there were 907 health insurance companies in the United States, although the top 10 account for about 53% of revenue and the top 100 account for 95% of revenue.
675:
231:
1856:
473:
Before healthcare plans emerged, patients would simply pay for services out of pocket. In the period between 1910 and 1940, early healthcare plans formed into two models: a
1284:
907:
A POS plan uses some of the features of each of the above plans. Members of a POS plan do not make a choice about which system to use until the service is being used.
373:
1550:
657:
In the 21st century, commercial payers were increasingly using litigation against providers to combat alleged fraud or abuse. Examples included litigation between
514:
profiles more than 5,000 plans, including new consumer-driven health plans and health savings accounts. In addition, 26 states have contracts with MCOs to deliver
1755:
2115:
1992:
Cox, T. (2010). Legal and ethical implications of healthcare provider insurance risk assumption. JONAS Healthcare Law, Ethics and Regulation. 12(4): 106–16.
1881:
1494:
1384:
The value of provider networks and the role of out-of-network charges in rising health care costs: A survey of charges billed by out-of-network physicians,
225:
1690:
1805:
1664:
989:
590:
schemes are another method to share costs, where a health insurer will only pay a certain amount and anything above that must be paid out of pocket.
1640:
1600:
Mitus, A. J. (2008). The birth of InterQual: evidence-based decision support criteria that helped change healthcare. Prof Case Manag, 13(4), 228-233
1780:
219:
805:. As defined in the act, a federally-qualified HMO would, in exchange for a subscriber fee (premium), allow members access to a panel of employed
536:
One of the most characteristic forms of managed care is the use of a panel or network of healthcare providers to provide care to enrollees. Such
761:
Kaiser Permanente was the highest-ranked commercial plan by consumer satisfaction in 2018 with a different survey finding it tied with Humana.
453:
366:
1387:
1346:
88:
923:
companies pay medical staff fees for each service provided to an insured patient. Such plans offer a wide choice of doctors and hospitals.
893:
Because the patient is picking up a substantial portion of the "first dollars" of coverage, PPO are the least expensive types of coverage.
1965:
Cox, T. (2006). Professional caregiver insurance risk: A brief primer for nurse executives and decisionmakers. Nurse Leader, 4(2): 48–51.
1018:
A comparison of HEDIS metrics reported in 2006 and 2007 for Medicare Advantage and Medicare fee-for-service plans found a mixed picture.
981:
802:
462:
436:
406:
while improving the quality of that care ("managed care techniques"). It has become the predominant system of delivering and receiving
1008:
614:
249:
237:
1317:
629:; this is particularly common in emergency or hospital care, where the patient may not be notified that a provider is out of network.
984:
included a voluntary program of "federal qualification", which became popular, but over time this role was largely taken over by the
956:
downward pressure on quality (worse scores on 14 of 14 quality indicators reported to the National Committee for Quality Assurance).
584:
are used by insurers to keep costs down by incentivizing consumers to select cheaper providers and possibly utilize less healthcare.
359:
47:
17:
1738:
1366:
Managed Care: Integrating the Delivery and Financing of Health Care – Part A, Health Insurance Association of America, 1995, page 9
2133:
985:
1035:
In June 2021 Australian specialist doctors mounted a campaign to resist the introduction of US style managed care by health fund
142:
1932:
211:
82:
1281:
544:
Designated doctors and healthcare facilities, known as a provider network, which enrollees are required or incentivized to use
1057:
403:
155:
1229:
1262:
1830:
1394:
1292:
552:
507:
988:(NCQA), which began accrediting plans in 1991. Accreditation by the NCQA is often expected or require by employers. The
785:
There are several types of network-based managed care programs. They range from more restrictive to less restrictive:
1909:
1443:
1427:
1371:
1174:
1975:
1455:
855:
766:
680:
424:
407:
278:
914:
POS plans are becoming more popular because they offer more flexibility and freedom of choice than standard HMOs.
1904:
Peter R. Kongstvedt, "The Managed Health Care Handbook," Fourth Edition, Aspen Publishers, Inc., 2001, page 1322
1052:
880:
840:, on the grounds that the decisions regarding patient care are administrative rather than medical in nature. See
721:
428:
190:
184:
178:
33:
911:
copayment only. However, if they use an out of network provider but do not seek a referral, they will pay more.
1422:
Peter R. Kongstvedt, "The Managed Health Care Handbook," Fourth Edition, Aspen Publishers, Inc., 2001, page 3,
94:
1611:
1551:"UnitedHealthcare, Optum, Humana, MultiPlan and Quest Diagnostics launch blockchain provider director pilot"
465:, which encouraged rapid growth of Health Maintenance Organizations (HMOs), the first form of managed care.
2163:
2005:
1575:
160:
124:
1438:
Margaret E. Lynch, Editor, "Health Insurance Terminology," Health Insurance Association of America, 1992,
1518:
1214:
581:
548:
136:
1714:
1198:
1169:. Kongstvedt, Peter R. (Peter Reid) (6th ed.). Burlington, MA: Jones and Bartlett Learning. 2013.
1122:"Mirror, mirror on the wall: how the performance of the US health care system compares internationally"
1062:
751:
537:
338:
298:
113:
2158:
1456:"Reference Pricing: When Transparency Is Not Enough – The Source on HealthCare Price and Competition"
118:
1382:
1246:
316:
65:
813:. In return, the HMO received mandated market access and could receive federal development funds.
2079:
Brennan, Niall; Shepard, Mark (2010-11-01). "Comparing quality of care in the Medicare program".
1407:
964:
960:
949:
861:
474:
1307:, Kaiser Family Foundation Health Care Marketplace Project, September 2007, accessed 2007-10-05
1012:
818:
637:
527:
130:
73:
1108:
2153:
1072:
902:
321:
53:
1639:
Argiropoulos, Anthony; Herschman, Gary W.; Gibson, William; Kuder, rew (22 September 2017).
1269:, Kaiser Family Foundation Health Care Marketplace Project, August 2007, accessed 2007-10-05
510:, 90 percent of insured Americans are now enrolled in plans with some form of managed care.
1325:
798:
704:
List of United States insurance companies § Health insurance (major medical insurance)
198:
1921:
8:
977:
837:
729:
641:
607:
458:
411:
1641:"New Sheriffs in Town: Commercial Payers' Increasing Role in Addressing Fraud and Abuse"
1096:
2056:
2031:
1956:(Himmelstein, Woolhandler, Hellander, Wolfe, 1999; HMO honor roll, 1997; Kuttner, 1999)
1410:
1192:
1067:
833:
744:
725:
625:
When patients receive care from doctors who are out of network, they can be subject to
603:
599:
558:
457:) that Richard Nixon, advised by the "father of Health Maintenance Organizations", Dr.
283:
165:
1587:
1159:
2096:
2088:
2061:
2043:
1905:
1882:"Industry Giants Anthem, Centene Among The Lowest-Rated Medicaid Plans In California"
1439:
1423:
1367:
1226:
1180:
1170:
936:
770:
755:
645:
562:
531:
419:
410:
since its implementation in the early 1980s, and has been largely unaffected by the
2051:
1583:
1227:
Kaiser Public Opinion Spotlight: The Public, Managed Care, and Consumer Protections
1036:
1000:
952:
is being used to determine when lower-cost medicine may in fact be more effective.
793:
Proposed in the 1960s by Dr. Paul Elwood in the "Health Maintenance Strategy", the
713:
479:
1665:"Aetna Wages 'Scorched-Earth' Litigation Against Outlier Out-of-Network Providers"
2116:"The Rise of Managed Care in the United States: Lessons for French Health Policy"
1391:
1288:
1266:
1233:
865:
626:
587:
1857:"Private Medicaid Plans Receive Billions In Tax Dollars, With Little Oversight"
1259:
842:
806:
515:
344:
326:
1576:"Analyzing New Bipartisan Federal Legislation Limiting Surprise Medical Bills"
871:
IPAs usually have a governing board to determine the best forms of practices.
2147:
2092:
2047:
1184:
395:
268:
1160:"A History of Managed Health Care and Health Insurance in the United States"
2100:
2065:
736:
435:
The growth of managed care in the U.S. was spurred by the enactment of the
398:
to describe a group of activities intended to reduce the cost of providing
331:
1979:
999:
Aside from the NCQA, other organizations involved in quality include the
740:
640:(UM) or utilization review is the use of managed care techniques such as
399:
292:
1347:"States Turn to Managed Care To Constrain Medicaid Long-Term Care Costs"
1304:
619:
448:
777:
which tasked its companies with improving the health of its members.
570:
547:
Formal utilization review and quality improvement programs including
1806:"BCBS' customer satisfaction among lowest in industry, survey finds"
1612:"Hearst's New Health Division is a Departure from Magazines and TV"
1007:, Physician Consortium for Performance Improvement (PCPI), and the
810:
774:
512:
The National Directory of Managed Care Organizations, Sixth Edition
288:
59:
1030:
769:
system; in addition, the contracted companies may be evaluated on
451:
suggests in his analysis of the American healthcare system (i.e.,
244:
Health Information Technology for Economic and Clinical Health Act
1574:
Adler, Loren; Ginsburg, Paul B.; Hall, Mark; Trish, Erin (2018).
77:
1638:
2032:"Overview, History, and Objectives of Performance Measurement"
1526:
232:
Medicare Prescription Drug, Improvement, and Modernization Act
1615:
1040:
829:
717:
709:
658:
272:
2120:
Health Policy Reform, National Variations, and Globalization
1756:"More health systems launch insurance plans despite caveats"
1744:. FEDERAL INSURANCE OFFICE, U.S. DEPARTMENT OF THE TREASURY.
930:
613:
Maintaining up-to-date provider directories is necessary as
1077:
1004:
801:
as a fix to rising health care costs and set in law as the
1781:"17 commercial health plans ranked by customer experience"
1739:"Annual Report on the Insurance Industry (September 2018)"
2134:"ASO Warns for US-Style Managed Health Care in Australia"
1360:
849:
794:
2030:
McIntyre, Dennis; Rogers, Lisa; Heier, Ellen Jo (2001).
1349:. Agency for Healthcare Research and Quality. 2014-04-09
874:
788:
484:
1210:
1208:
1691:"4 things to know about the health insurance industry"
1573:
1976:"Professional Caregiver Insurance Risk Resource Page"
1484:"UnitedHealthcare Care Provider Administrative Guide"
1922:"Employer Health Benefits : 2006 Annual Survey"
1205:
959:
The most common managed care financial arrangement,
2029:
1217:, Nation's Business, July 1998, accessed 2007-10-05
226:
Health Insurance Portability and Accountability Act
1609:
1324:. America's Health Insurance Plans. Archived from
1291:, report prepared by Price Waterhouse Coopers for
62:/ State Health Insurance Assistance Program (SHIP)
1831:"Health insurers migrating to Medicare, Medicaid"
1408:"Survey Finds High Fees Common in Medical Care ,"
990:Healthcare Effectiveness Data and Information Set
917:
809:or a network of doctors and facilities including
735:Smaller regional or startup plans are offered by
622:initiative began in 2018 to share the directory.
506:Nevertheless, according to the trade association
2145:
1432:
1282:The Factors Fueling Rising Healthcare Costs 2006
697:
540:typically include one or more of the following:
220:Emergency Medical Treatment and Active Labor Act
1031:Opposition to Managed Care Schemes in Australia
2078:
1249:. National Council on Disability. 26 May 2015.
708:As of 2017, the largest commercial plans were
454:The Social Transformation of American Medicine
1715:"Facts + Statistics: Industry overview | III"
1247:"Appendix B. A Brief History of Managed Care"
367:
89:Program of All-Inclusive Care for the Elderly
1011:, with all these groups coordinating in the
497:
971:
868:patients not associated with managed care.
803:Health Maintenance Organization Act of 1973
773:statistics, as in the case of California's
437:Health Maintenance Organization Act of 1973
1519:"Envision and ER Costs | UnitedHealthcare"
1009:Agency for Healthcare Research and Quality
374:
360:
250:Patient Protection and Affordable Care Act
238:Patient Safety and Quality Improvement Act
2055:
2006:"HEDIS Is the Hassle That Became a Habit"
931:Managed care in indemnity insurance plans
896:
750:Provider-sponsored health plans can form
557:An emphasis on preventive care including
48:Federal Employees Health Benefits Program
1305:Trends in Health Care Costs and Spending
986:National Committee for Quality Assurance
606:and a major emergency room doctor group
1879:
1854:
1688:
1610:Sebastian, Michael (January 27, 2014).
832:Act passed in Congress in 1974 and its
14:
2146:
2113:
850:Independent practice association (IPA)
754:; the largest of these as of 2015 was
2000:
1998:
1634:
1632:
1545:
1543:
1478:
1476:
1277:
1275:
1058:Health insurance in the United States
875:Preferred provider organization (PPO)
789:Health maintenance organization (HMO)
691:Physician practice management company
632:
485:1980s expansion and subdued inflation
156:Health insurance in the United States
2081:The American Journal of Managed Care
1154:
1152:
1150:
1148:
1146:
1144:
1142:
593:
1978:. November 30, 2009. Archived from
1689:Haefner, Morgan (16 October 2017).
1295:, January 2006, accessed 2007-10-05
463:Health Maintenance Organization Act
83:Children's Health Insurance Program
24:
1995:
1629:
1540:
1473:
1272:
1127:. The Commonwealth Fund. June 2014
598:Insurance plan companies, such as
418:...intended to reduce unnecessary
25:
2175:
1855:Terhune, Chad (18 October 2018).
1588:10.1377/forefront.20180924.442050
1236:, June 2004, accessed 2007-10-05.
1215:The backlash against managed care
1167:Essentials of managed health care
1139:
1021:
1395:America's Health Insurance Plans
1293:America's Health Insurance Plans
980:became an important aspect. The
976:As managed care became popular,
856:Independent practice association
686:Management services organization
681:Independent practice association
665:
508:America's Health Insurance Plans
468:
429:Preferred Provider Organizations
425:Health Maintenance Organizations
279:Massachusetts health care reform
2126:
2107:
2072:
2023:
1986:
1968:
1959:
1950:
1938:from the original on 2007-09-27
1914:
1898:
1873:
1848:
1823:
1798:
1773:
1748:
1731:
1707:
1682:
1657:
1603:
1594:
1567:
1511:
1448:
1416:
1400:
1376:
1339:
1310:
1298:
1099:. National Library of Medicine.
1053:Healthcare in the United States
881:Preferred provider organization
576:
191:Preferred provider organization
185:Health maintenance organization
179:Exclusive provider organization
34:Healthcare in the United States
27:Type of health insurance system
1253:
1239:
1220:
1114:
1102:
1090:
918:Private fee-for-service (PFFS)
150:Private Fee-For-Service (PFFS)
95:Veterans Health Administration
70:Prescription Assistance (SPAP)
13:
1:
1810:www.beckershospitalreview.com
1785:www.beckershospitalreview.com
1695:www.beckershospitalreview.com
1083:
698:Industry in the United States
521:
161:Health insurance marketplaces
2036:Health Care Financing Review
1880:Terhune, Chad (2017-02-09).
1109:WHAT IS MANAGED HEALTH CARE?
797:concept was promoted by the
676:Group practice without walls
582:High-deductible health plans
125:Health reimbursement account
7:
1260:Health Care Costs: A Primer
1046:
828:Since the 1980s, under the
752:integrated delivery systems
652:
538:integrated delivery systems
137:High-deductible health plan
10:
2180:
1645:Epstein Becker & Green
1063:Independent medical review
942:
900:
878:
853:
701:
525:
442:
339:Fair Share Health Care Act
299:Vermont health care reform
114:Consumer-driven healthcare
42:Government health programs
498:1990s growth and ubiquity
404:American health insurance
311:Municipal health coverage
119:Flexible spending account
18:Managed care organization
1929:Kaiser Family Foundation
972:Performance measurements
780:
722:Health Care Service Corp
317:Healthcare in California
2114:Rodwin, Victor (1996).
1555:Healthcare Finance News
950:evidence-based medicine
935:Many "traditional" or "
143:Medical savings account
108:Private health coverage
1460:sourceonhealthcare.org
1197:: CS1 maint: others (
1013:National Quality Forum
897:Point of service (POS)
838:malpractice litigation
819:primary care physician
638:Utilization management
528:Utilization management
433:
347:(Howard Co., Maryland)
131:Health savings account
74:Military Health System
2010:Managed Care magazine
1886:California Healthline
1097:Managed Care Programs
1073:Medicaid managed care
903:Point of service plan
416:
322:Healthy San Francisco
54:Indian Health Service
1039:in association with
799:Nixon administration
408:American health care
199:Medical underwriting
2164:Health care quality
1322:HealthDecisions.org
978:health care quality
730:Centene Corporation
642:prior authorization
608:Envision Healthcare
559:wellness incentives
459:Paul M. Ellwood Jr.
412:Affordable Care Act
1812:. 14 November 2018
1411:The New York Times
1390:2012-02-26 at the
1287:2007-11-27 at the
1265:2007-11-27 at the
1232:2007-10-22 at the
1111:by Christine Tobin
1068:Medical care ratio
646:medical guidelines
633:Utilization review
604:UnitedHealth Group
600:UnitedHealth Group
549:disease management
392:managed healthcare
284:Oregon Health Plan
263:State level reform
212:Health care reform
166:Premium tax credit
1835:Modern Healthcare
1760:Modern Healthcare
1491:United Healthcare
1413:, August 11, 2009
771:population health
756:Kaiser Permanente
594:Provider networks
563:patient education
532:Medical necessity
420:health care costs
384:
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1001:Joint Commission
965:cover such costs
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866:fee-for-service
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1982:on 2009-11-30.
1967:
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1787:. 26 June 2018
1772:
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1580:Health Affairs
1566:
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1462:. 12 June 2018
1447:
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1022:Unmanaged care
1020:
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898:
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879:Main article:
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851:
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843:Cigna v. Calad
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1910:0-8342-1726-0
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1529:on 2018-11-25
1528:
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1500:on 2018-11-25
1496:
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1444:1-879143-13-5
1441:
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1428:0-8342-1726-0
1425:
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1406:Gina Kolata,
1403:
1397:, August 2009
1396:
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1389:
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1373:
1372:1-879143-26-7
1369:
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1328:on 2007-09-28
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2012:. 2017-01-14
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1860:
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1837:. 2019-03-29
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1809:
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1762:. 2011-09-07
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1671:. 2017-03-20
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1527:the original
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1490:
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1459:
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1341:
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1326:the original
1321:
1318:"Fast Facts"
1312:
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1129:. Retrieved
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577:Cost sharing
567:
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503:since 1970.
501:
492:
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446:
434:
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391:
388:managed care
387:
385:
332:My Health LA
173:Managed care
172:
2042:(3): 7–21.
1719:www.iii.org
1523:www.uhc.com
767:value-based
741:Moda Health
400:health care
293:Connecticut
2148:Categories
2016:2019-06-12
1891:2019-05-27
1866:2019-05-27
1841:2019-05-27
1816:2019-05-18
1791:2019-05-18
1766:2019-05-27
1724:2019-06-24
1700:2018-11-25
1675:2019-04-16
1669:AIS Health
1650:2019-04-16
1560:2018-11-25
1533:2018-11-25
1504:2018-11-25
1466:2019-06-04
1353:2014-04-14
1332:2007-07-18
1084:References
961:capitation
862:capitation
834:preemptive
807:physicians
620:blockchain
526:See also:
522:Techniques
449:Paul Starr
341:(Maryland)
2093:1936-2692
2048:0195-8631
1621:April 14,
1193:cite book
1185:759084209
1131:August 5,
937:indemnity
811:hospitals
571:indemnity
475:capitated
414:of 2010.
386:The term
2122:: 39–58.
2101:21348555
2066:25372047
1942:22 March
1933:Archived
1931:. 2006.
1388:Archived
1285:Archived
1263:Archived
1230:Archived
1047:See also
846:, 2004.
775:Medi-Cal
653:Lawsuits
289:SustiNet
76:(MHS) /
66:Medicare
60:Medicaid
2057:4194707
943:Impacts
745:Premera
480:Anthem.
443:History
78:Tricare
50:(FEHBP)
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743:, and
728:, and
714:Anthem
252:(2010)
246:(2009)
240:(2005)
234:(2003)
228:(1996)
222:(1986)
175:(CCP)
139:(HDHP)
133:(HSA)
91:(PACE)
85:(CHIP)
1936:(PDF)
1925:(PDF)
1742:(PDF)
1616:AdAge
1498:(PDF)
1487:(PDF)
1163:(PDF)
1125:(PDF)
1041:Cigna
830:ERISA
781:Types
718:Cigna
710:Aetna
693:(PPM)
659:Aetna
273:Maine
193:(PPO)
187:(HMO)
181:(EPO)
145:(MSA)
127:(HRA)
121:(FSA)
97:(VHA)
56:(IHS)
2097:PMID
2089:ISSN
2062:PMID
2044:ISSN
1944:2021
1906:ISBN
1623:2018
1440:ISBN
1424:ISBN
1368:ISBN
1199:link
1181:OCLC
1171:ISBN
1133:2018
1078:URAC
1005:URAC
561:and
551:and
530:and
447:Dr.
427:and
2052:PMC
1861:NPR
1584:doi
795:HMO
615:CMS
573:".
390:or
214:law
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