We are Lucky to Have Health Managed Care

Contract compliance

Have you ever heard of a man known as Dr. Paul Elwood? He was part of the Health Maintenance Strategy in the 1960s, and he was also the man who came up with the concept of the HMO, or Health Maintenance Organization. The concept of the HMO was supported as well as greatly promoted by the Nixon administration while he was in office, and eventually was successfully pushed through, only to be remembered as the Health Organization Act of 1973.

This must have been one amazing idea, because it is still used and supported today within our healthcare system. HMOs are licensed at the state level, under something called a COA, or Certificate of Authority, rather than under some complicated insurance license. With a managed care system, provider networks can be used to reduce costs by negotiating fees from providers, selecting cost effective providers, and creating financial incentives for providers to practice more efficiently. This is a form of managed care checks and balances, and a way to make sure we as patents are not getting played around with, or over charged for a any services. Rather than signing a contract with countless insurers and unknown third party administrators, providers stick to preferred provider organizations.

Listed below are the various types of network based managed care programs besides HMO.

1. Managed Care in a Public Setting. MCPS.
This proposed system combines both social services and healthcare into a easier system that will give answer for those looking to balance the extreme challenges of balancing care, cost, and social conscience.

2. Independent Practice Association. IPA.
This is a legal entity that bonds a group of physicians to an HMO member, and under contract compliance, claims they must provide services to that HMO member.

3. Preferred Provider Organization. Ppo.
Instead of dealing with contracts with various insurers, third party administrators, and the nagging payment compliance of those people that do not truly care about you, this allows the option of turning to a preferred provider, which will offer a more personal connection.

4. Point of Service. POS.
This is a combination of all of the plans listed above. But the POS does not require you to choose which plan to go with until the point in which the service is needed.

5. Private Free for Service. PFFS.
Here, healthcare insurance policies may vary from low cost to all inclusive plans. This is good for meeting all the different types of demands that customers may have.

6.Managed Care in Indemnity Insurance Plans.
This is known as the traditional way of doing things, the original plan for health insurance. But today, it has accepted some of the newer managed care concepts into it.

As you can see, there are many different options when deciding which plan to go with. But it is always important to not think about what other people say is the best, it is what will be best for you, and your situation. Managed care reviews and payment reviews from others may steer you away from one or the other, but you must return to the original description of what that plan provides and base your choice off that and only that, because that is the only true non bias description.

19 thoughts on “We are Lucky to Have Health Managed Care

Leave a Reply