Managed Care Flashcards
1
Q
Managed Care - general idea
A
the payer makes decisions about service providers, services covered, tx location and length of service
2
Q
Managed Care - delivery / financing of services
A
- plans apply to covered enrollees
- only selected providers can provide services (there is a panel of providers who meet specific standards)
- there is ongoing review of services for quality and need
- service outcomes are measured and tracked
3
Q
features of managed care
A
- access to providers is limited
- efficiency is rewarded. efficiency means: discounts, bundling (case-based payment), capitation (per member per month)
- quality improvement methods include utilization and peer reviews, benchmarking, clinical pathways, outcomes measurement, case management
4
Q
goals of managed care
A
- best quality for lowest cost
- standardized practice with durable and predicable outcome
- continuum of coordinated and integrated care
- outcomes effective
- focus on prevention / health promotion
5
Q
types of managed care
A
6
Q
managed care definition
A
a system that integrates the financing and delivery of health services
