Managed Care

  • Uncategorized


Theactuality of managed care consortiums in the American health careemporium may influence the provision of services to patients (Barr,2016). Through financial inducements to service givers, and byactively managing patients more than other insurers, managed careconsortiums may affect the cost, process, and after-effects of carefor the enrollees. The most significant point is the possibility ofmanaged care activities bringing about changes in the health caremarket-level in the management of non-managed care enrollees (Niles,2016).

Managedcare is a delivery arrangement in the health care industry that issystematized to oversee the utilization, cost, and quality ofhealthcare services (Niles, 2016). The benefits and other additionalservices are offered through outsourced agreements between managedcare consortiums and state Medicaid organizations. By contractingmanaged care organizations to provide these services, the state canreduce program costs and manage better the utilization of healthservices (Barr, 2016). The primary objectives of managed care are tobetter the health plan performance, improve the quality of servicesoffered, and their outcomes.

Thereare different types of managed care plans or programs available atvarious levels. These programs vary differently regardingrestrictions, processes, and features (Niles, 2016). They includepreferred giver organization, health maintenance agencies, andPoint-of-Service plans (Barr, 2016).

How Works

Managedcare offers curative and preventive services for different types ofdiseases and conditions, hence, a vital part of the overall healthcare of a person (Kongstvedt, 2016). Irrespective of the plan chosenby one, the following areas are of significant focus: selecting aprimary physician as the primary point of reference and gettingreferrals from the chief physician when the need to seek specializedcare arises (Kongstvedt, 2016). Also, enrollees can acquire priorauthorization in some cases and there is creation of management plansfor enrollees suffering from chronic conditions (Kongstvedt, 2016).


Managecare processes and plans not only increase profits, but they alsooffer excellent and low-cost services to individuals. While theimpact of this planned care is debatable, we can conclude that thissystem is a good step in the provision of low cost, adequate, andquality health care services to the people.


Barr,D. A. (2016). Introductionto US health policy: the organization, financing, and delivery ofhealth care in America.Baltimore: Johns Hopkins University Press.

Kongstvedt,P. R. (2016). Healthinsurance and managed care: what they are and how they work.Burlington, MA: Jones &amp Bartlett Learning.

Niles,N. J. (2016). Basicsof the U.S. health care system.Burlington, MA: Jones &amp Bartlett Learning.