Managed care plans

Managed care plans are a type of health insurance. 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 a patient’s choices usually cost less. A more flexible plan will likely cost more. There are three types of managed care plans:

• Health Maintenance Organizations (HMO) usually only pay for care within the network. You choose a primary care doctor who coordinates most of your care.
• Preferred Provider Organizations (PPO) usually pay more if you get care within the network. They still pay part of the cost if you go outside the network.
• Point of Service (POS) plans let you choose between an HMO or a PPO each time you need care.

Discuss the following prompts:

1. Define managed care. Describe the history and current status of managed care

2. Identify some key policy issues related to managed care

3. Define and describe HMOs, PPOs, and POS plans. Describe trends in each since the 1990s.

4. Discuss integrated delivery systems and their potential role in the U.S. healthcare system.