Managed Care
This is a mechanism for providing health care services to which a single organization takes on the management of financing, insurance and payment
What is Managed Care
This act was passed in response to concerns about escalating health care expenditures.
What is the Health Maintenance Organization Act of 1973.
These were new forms of managed care as competition grew amongst MCOs.
What are Preferred provider organizations, PPOs.
This is the arrangement that requires a primary care physician to coordinate all healthcare services needed by the enrollee.
What is a gatekeeper
This plan focuses on wellness care.
What are HMO plans
Since 1991, MCOs have been accredited by this organization.
What is the National Committee for Quality Assurance, NCQA.
This is where the first known private health insurance plan was started.
What is Baylor University
This is equated with managed care.
What is private health insurance.
This is the medical necessity of certain treatments determined before the care is actually delivered.
What is prospective utilization review.
This model employs its own salaried physicians.
What is the staff model HMO.
This government agency rates the relative quality of Medicare Advantage Plans, Part C.
What is the Center for Medicare and Medicaid Services
This plan started in California in 1942 when it was faced with the problem of providing health care to his 30,000 workers
What is the Kaiser Permanente Plan
Employers began offering this in the mid 2000s. These plans have gained popularity amongst healthy people.
What is high-deductible health plans.
This occurs when decisions regarding appropriateness are made during the course of health care utilization.
What is concurrent utilization review.
This model contracts with more than one medical group practice.
What is the network model HMO.
NCQA is referred to as a report card for managed care organizations. This is part of the national standards and performance .
What are the Healthcare Effectiveness Data and Information Set, HEIDS data.
The objective of this law was to create this many HMO's
What is 1,700 HMO's.
This is part of Medicare that offers managed care plans.
What is Medicare Advantage Plan.
This is an important component of concurrent utilization review.
What is discharge planning.
These plans were created by insurance companies in response to the growth of HMOs by offering out of network options for enrollees.
What are PPO plans.
This is the year that certain railroad,mining and lumbar companies located in isolated areas employed salaried physicians to care for their workers.
What is 1900s
In the 1980s these states saw a fast growth in managed care.
What is California and Minnesota.
What act gave the states the authority to implement mandatory managed care enrollments.
What is the Balanced Budget Act of 1997.
This review determines the appropriateness of utilization after services have already been delivered.
What is retrospective utilization review.
This plan combines features of classic HMOs with some of the characteristics of patient choice found in PPOs.
What are Point of Service Plans.