managed care
Controlled healthcare system
Managed care is a system of healthcare delivery designed to control costs while maintaining quality.
Insurance companies or health organizations coordinate patient care through networks of approved providers, requiring referrals for specialists, and reviewing treatment decisions.
Her managed care plan required preauthorization for the MRI.
The term often carries connotations of bureaucratic interference in medical decisions.
Per-capita fixed payment
- formularyApproved medication inventory
- generic drugsUnbranded pharmaceutical equivalents
- prior authorizationInsurer's advance approval requirement
- rationingLimiting distribution during scarcity
gatekeeping · tiered pricing · resource allocation · length of stay · medical necessity · efficiency · risk sharing
health maintenance organization
Prepaid medical care network
- gatekeeperOne controlling entry
- capitationPer-capita fixed payment
- enrollmentAct of registering officially
- memberOne who belongs
subscriber · in-network · co-payments · preauthorization · quality assurance · IPA · point of service · wellness programs
Outside approved provider list
- open accessFree public scholarly content
- flexibilityAbility to adapt easily
- choiceAct of selecting
- co-insuranceShared claim payment arrangement
deductible · fee-for-service · specialists · freedom of choice · cost sharing
Contracted healthcare participants
- in-networkContracted with your insurer
- out-of-networkOutside approved provider list
- hospitalsInstitutions treating the sick
- clinicsOutpatient treatment facilities
Medical privacy statute
- accreditationOfficial quality approval
- state mandatesLaws imposed by states
- complianceAdhering to requirements
- patient rightsLegal protections for care recipients
appeals process · quality standards · federal oversight · licensing · consumer protection · ERISA · fiduciary duty
capitation
Per-capita fixed payment
- formularyApproved medication inventory
- generic drugsUnbranded pharmaceutical equivalents
- prior authorizationInsurer's advance approval requirement
rationing · gatekeeping · tiered pricing · resource allocation · length of stay · medical necessity · efficiency · risk sharing
health maintenance organization
Prepaid medical care network
- gatekeeperOne controlling entry
- capitationPer-capita fixed payment
- enrollmentAct of registering officially
member · subscriber · in-network · co-payments · preauthorization · quality assurance · IPA · point of service · wellness programs · annual physical
out-of-network
Outside approved provider list
- open accessFree public scholarly content
- flexibilityAbility to adapt easily
- choiceAct of selecting
co-insurance · deductible · fee-for-service · specialists · freedom of choice · cost sharing
provider network
Contracted healthcare participants
- in-networkContracted with your insurer
- out-of-networkOutside approved provider list
- hospitalsInstitutions treating the sick
HIPAA
Medical privacy statute
- accreditationOfficial quality approval
- state mandatesLaws imposed by states
- complianceAdhering to requirements
patient rights · appeals process · quality standards · federal oversight · licensing · consumer protection · ERISA · fiduciary duty
- healthcare systemshospital system, public hospitals, health plan, HMO, single payer
- health insurancepremium, deductible, copay, coverage, health insurance card
- mental health policymental health courts, involuntary commitment, crisis intervention, suicide prevention, deinstitutionalization
- health plansHMO, PPO, EPO, group plan, family plan
- healthcare programsMedicare, Medicaid, CMS, beneficiary, beneficiaries
- healthcaredoctors, nurses, hospitals, hospital, clinic
managed careopen access
Free public scholarly content
universal healthcare · socialized medicine · free healthcare
care, manage, caring, manager, management, managed, managing, cares, cared