Provider profiling: doing it right

Published: May 1, 2000
Category: Bibliography > Papers
Authors: Diamond LH
Countries: United States
Language: null
Types: Care Management
Settings: Health Plan

Healthplan 41:74-79.

Medstat Group, Washington, DC, USA

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 your choices usually cost you less. If you want a flexible plan, it will probably 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

PMID: 11066253

Care Management,Attitude of Health Personnel,Benchmarking,Database Management Systems,Peer Group,Physicians/psychology,Physicians/standards,Quality Assurance,Health Care,Risk Adjustment,Utilization Review,United States

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