What is Managed Care?

Managed care refers to a healthcare option in which the provider manages the care of the individual for a fixed fee, emphasizing wellness and prevention rather than the cure. The goal of managed care is to provide better quality healthcare at lesser costs. Managed care uses a network of established medical resources to provide care, including regular doctors and facilities.

Managed care is a healthcare delivery system that seeks to control healthcare costs while improving the quality of care provided to patients. It is a system that integrates the financing and delivery of healthcare services, often through contracts between healthcare providers and insurance companies or government programs.

In a managed care system, healthcare providers are organized into networks or groups that are responsible for coordinating and managing the healthcare services provided to patients. This may include primary care physicians, specialists, hospitals, and other healthcare facilities.

Managed care organizations (MCOs) typically use a range of strategies to control costs and improve quality, including:

  • Utilization management: Managing the use of healthcare services to ensure that they are appropriate, medically necessary, and cost-effective.
  • Disease management: Providing proactive care and education to patients with chronic conditions to prevent complications and reduce costs.
  • Provider network management: Negotiating contracts with healthcare providers to ensure that patients have access to high-quality, cost-effective care.
  • Case management: Coordinating care for patients with complex medical needs to ensure that they receive appropriate and timely care.

    Managed care systems may be structured in a variety of ways, including health maintenance organizations (HMOs), preferred provider organizations (PPOs), and accountable care organizations (ACOs). These structures may differ in terms of provider reimbursement, patient cost-sharing, and other aspects of the healthcare delivery system.

    The goal of managed care is to provide high-quality, cost-effective care to patients while ensuring that healthcare providers are appropriately compensated for their services. However, managed care has also been criticized for its potential to limit patient choice and restrict access to certain types of care or providers.