Systems that integrate the financing and delivery of appropriate health care services by means of arrangements with selected providers to furnish a comprehensive set of health-care services to members; explicit criteria for the selection of health-care providers; formal programs for ongoing quality assurance and utilization review; and significant financial incentives for members to use providers and procedures associated with the plan
Managed care is a health care plan that integrates the financing and delivery of health care services by using arrangements with selected health care providers to provide services for covered individuals. Plans are generally financed using capitation fees. There are significant financial incentives for members of the plan to use the health care providers associated with the plan. The plan includes formal programs for quality assurance and utilization review. Health maintenance organizations (HMOs), preferred provider organizations (PPOs), and point of service (POS) plans are examples of managed care.
Method for managing costs, use, and quality of the health care system. Includes health maintenance organizations (HMOs) and preferred provider organizations (PPOs).