Managed care, also known as managed healthcare, is becoming a popular trend. It is not surprising since it comes with many benefits. However, many people do not understand what it is all about. So, what is managed care in healthcare? Read this article to find out!
What does managed care in healthcare mean?
Care management in healthcare means providing less expensive medical services without a drop in the quality of patient care. It is done through a system of contracted medical providers – the patient pays a set fee per month and uses the services of medical facilities that have an agreement with the managed care organizations (MCOs). As such, there are several kinds of managed care services.
Managed care in healthcare works as a type of medical insurance – you are provided with services for a set amount of money. Depending on the plan, a managed healthcare provider might cover all your treatment expenses or only a part of them.
What are the types of care management in healthcare?
Since we already know what is managed care in healthcare, now it is important to go through the available types of this service. There are different plans of managed healthcare. These differ mostly in who you can get your treatment from. Here are the most common healthcare management plan types:
- Health Maintenance Organizations (HMO) will cover your care only when using certain, contracted medical providers. In this type of medical care management, you need to choose your primary care doctor who will coordinate your treatments. They have to give you a referral before you go to a facility outside the company’s network. Additionally, preventive care is usually covered in 100% – as we have mentioned in our article on the future of healthcare, prevention is better than treatment and these organizations know it.
- Preferred Provider Organizations (PPO) will provide you with more funds if you are using the services within the care management provider’s network. However, they will still partially cover your expenses if you decide to use the service of a different medical facility. Moreover, you will not have to obtain a referral to do so. Similarly to the HMOs, these organizations usually pay 100% for preventive care.
- Point of Service (POS) plans are a combination of HMOs and PPOs – they are a bit more expensive, however they allow you to use the services of medical providers both inside and outside the network. Yet, to get the care outside the company’s providers, you will be required to have a referral.
- Exclusive Provider Organizations (EPO) are, similarly to the POSs, a mix of HMOs and PPOs. However, in the case of EPOs, you do not need to obtain a referral to go to a medical provider outside the network. EPOs are usually less expensive than POSs but cost more than HMOs.
What is managed care in healthcare? – conclusions
Managed care in healthcare is a type of medical insurance that aims at reducing the costs of healthcare while maintaining high quality. It is done by obliging the patient to use the services of particular in-network medical care providers. However, depending on the plan, the patient may have the flexibility to use other medical facilities, yet the system will cover a lower percent of costs in such cases.
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