PUBHLTH 129 Chapter Notes - Chapter 9: Jones & Bartlett Learning, Managed Care, Medicaid Managed Care
15 Nov 2016
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Discuss the main types of managed care organizations. Managed care has become firmly entrenched in u. s. health care as both private and public third- party payers have turned to managed care organizations (mco) to realize cost savings. Only 1% of workers are enrolled in employer-sponsored conventional health insurance plans. Organizational consolidation of providers has been in response to the growing power of mcos. Manage utilization of health care: negotiate payment arrangements with providers. Capitation (per-member per-month): providers share the most risk in this arrangement. Discounted fees: fees are negotiated at discounts in exchange for a certain volume of business. Salaries are generally coupled with bonuses for efficiency. Accreditation and quality indicators: mcos are accredited by the national committee for quality assurance (ncqa, many mcos voluntarily furnish cost and quality information through healthcare. 4th edition also used a capitation arrangement: capitation was used in the 1940s by some large health plans in new york, california,
