Discuss the different types of reviews used to assess managed care organizations.



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As a healthcare consumer who recently switched to a managed care health plan, you were very worried about the quality of the care provided to you. You were wondering if there were any reviews of these types of programs to determine the quality of healthcare services offered.

Activity

Discuss the different types of reviews used to assess managed care organizations.



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Explain the managed care principle and which program would enable them to still use their practitioners.



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For years, your parents had a traditional fee-for-service health insurance. They are now required to switch to a managed care product. They are very upset because they love their physicians. However, their physicians did tell them they had contracted with certain MCOs to provide services. Your parents were still confused.

Activity

Explain the managed care principle and which program would enable them to still use their practitioners.



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You had heard that the premiums for your health insurance plan may decrease as a result of the Affordable Care Act’s



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You had heard that the premiums for your health insurance plan may decrease as a result of the Affordable Care Act’s requirement that insurance companies spend a certain amount of their premium revenue on their plans. You were interested to find out if this was true.

Activity

Perform an Internet search on medical loss ratios. Describe the concept and why it could decrease the cost sharing of your health insurance coverage.



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CHAPTER 9 Managed Care Impact on Healthcare Delivery



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LEARNING OBJECTIVES

The student will be able to:

 Define managed care.

 Describe the network-based types of managed care organizations (MCOs).

 Discuss the history of managed care.

 Discuss four major goals of managed care.

 Assess the relationship of managed care with providers.

 Identify four cost-control methods of MCOs.



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Discuss one of the innovation methods you found on the website and its potential contribution to health care.



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Visit the www.cms.gov website and go to the innovation center. Discuss one of the innovation methods you found on the website and its potential contribution to health care.



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