Example Of Managed Care Plans

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Managed care plans is a healthcare plan in which subscribers or users contract with the provider organization, which uses a designated group of providers meeting specific selection standards to furnish health care services for a monthly fee (Gitman, Joehnk, Billngsley, 2013, p. 329). They have contracts with health care providers and medical facilities to provide care for members at reduced costs. These providers make up the plan 's network. How much of your care the plan will pay for depends on the network 's rules. Plans that restrict your choices usually cost you less (MedlinePlus, 2015). There are different types of managed care plans: Health Maintenance organization (HMO), Preferred Provider Organization (PPO), and Point of Service (POS). …show more content…
The programs may be provided in a variety of settings, such as Health Maintenance Organizations and Preferred Provider Organizations (Merrick, 2013). This paper will examined the article written by Dr. Joav Merrick entitled “People with a Disability in Managed Care” and the pros and cons of Medicaid managed care plans.
The federal-state Medicaid program plays an integral part in financing health care services in the United States, accounting for 16 percent of total health spending and providing coverage for one out of every six Americans. More or less 9 million of 60 million US citizens who depend on Medicaid are nonelderly people with disabilities including children. The Affordable care Act of 2010 promises to focus attention on the importance on Medicaid financing of disability services, as well as the shift toward using managed care delivery systems (National Council on Disability, 2013).
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The performance of managed care plan for Medicaid populations has been successful where the rates paid were sufficient to cover costs. However, over time significant numbers of plans have refused to accept further enrollments due to the low capitation rates offered by some states. Thus, while managed care promise for controlling Medicaid spending, it is often hampered when managed care plans decide the rates being offered are not attractive (Cowen & Moorhead, 2014). In addition, an excessive desire to cut rates and limit profit may be counterproductive, as it may reduce quality and access and drive health insurers out of the MCO business (Book,

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