Managed Care
Evolution of Managed Care
Growth and Transformation of Managed Care
Utilization Control Method in Managed Care.
Types of Managed Care Plans
100

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

100

This act was passed in response to concerns about escalating health care expenditures.

What is the Health Maintenance Organization Act of 1973.

100

These were new forms of managed care as competition grew amongst MCOs.

What are Preferred provider organizations, PPOs.

100

This is the arrangement that requires a primary care physician to coordinate all healthcare services needed by the enrollee.

What is a gatekeeper


100

This plan focuses on wellness care.

What are HMO plans

200

Since 1991, MCOs have been accredited by this organization. 

What is the National Committee for Quality Assurance, NCQA.

200

This is where the first known private health insurance plan was started.

What is Baylor University

200

This is equated with managed care.

What is private health insurance.

200

This is the medical necessity of certain treatments determined before the care is actually delivered.

What is prospective utilization review.

200

This model employs its own salaried physicians.

What is the staff model HMO.

300

This government agency rates the relative quality of Medicare Advantage Plans, Part C.

What is the Center for Medicare and Medicaid Services

300

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

300

Employers began offering this in the mid 2000s.  These plans have gained popularity amongst healthy people.

What is high-deductible health plans.

300

This occurs when decisions regarding appropriateness are made during the course of health care utilization.

What is concurrent utilization review.

300

This model contracts with more than one medical group practice.

What is the network model HMO.

400

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.


400

The objective of this law was to create this many HMO's

What is 1,700 HMO's.

400

This is part of Medicare that offers managed care plans.

What is Medicare Advantage Plan.

400

This is an important component of concurrent utilization review.

What is discharge planning.

400

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.

500

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

500

In the 1980s these states saw a fast growth in managed care.

What is California and Minnesota.

500

What act gave the states the authority to implement mandatory managed care enrollments.

What is the Balanced Budget Act of 1997.

500

This review determines the appropriateness of utilization after services have already been delivered.

What is retrospective utilization review.

500

This plan combines features of classic HMOs with some of the characteristics of patient choice found in PPOs.

What are Point of Service Plans.