A broadly used term to describe any entity that utilizes managed care techniques for health care delivery. Can involve anything from a loose association of providers on a discounted fee-for-service arrangement to a highly-integrated provider organization utilizing a global capitated budget.
An entity that provides or contracts for managed care. Includes entities such as HMOs, PPOs, POS plans, EPOs, etc.
A private organization, system, or structure that provides health care.
Provides services to medically manage your workers' compensation claims. MCOs establish networks of health care providers that have been certified by BWC to serve you if you are injured at work.
a health care plan designed to provide medical services through groups of doctors, hospital and specialty providers
An exclusive provider network for work-related injuries or illness that includes a network of individual physicians and occupational therapy clinics.
Any insurance plan in which the client will need to have services approved by their plan's referring physician or medical group.
An umbrella term for health plans that provide health care in return for a set monthly payment and coordinate care through a network of physicians and hospitals. Health maintenance organizations and point-of-service plans are managed care organizations.
An entity that employs the methods of managed care for the purpose of controlling health care utilization and costs and improving access and quality. Some MCOs provide only administrative, and not clinical, services (see Administrative Services Only (ASO) Organization).
Refers to any type of organizational entity providing managed care such as an HMO, PPO, EPO, IDS etc.
multiple types of organizations including health insurers, medical groups, hospitals, and health systems accountable for the health of a group of people enrolled to receive health care services. MCOs seek improvements in care-effectiveness and cost-effectiveness. http://www.iha.org/gloss.htm
is an entity that has entered into a risk contract with a state Medicaid agency to provide a specified package of benefits to Medicaid enrollees in exchange for a monthly capitation payment on behalf of each enrollee. 45
A health plan that manages health care delivery by having a defined network of select providers who contract to provide health care services to members. See also HMO. See also point of service. See also PPO.
An umbrella term for HMOs and all health plans that provide health care in return for pre-set monthly payments and coordinate care through a defined network of primary care physicians and hospitals.
A health plan that uses financial incentives and management controls to direct patients to providers who are responsible for giving appropriate care in cost-effective treatment settings. The goal is to improve quality of care while controlling the cost of healthcare. Managed care organizations include health maintenance organizations (HMOs) and preferred provider organizations (PPOs).
A health plan that seeks to manage care. Generally, this involves contracting with health care providers to deliver health care services on a capitated (per-member per-month) basis. (For specific types of managed care organizations, see also health maintenance organization and independent practice association.
Any entity that utilizes certain concepts or techniques to manage the accessibility, cost and quality of health care. Also known as a managed care plan.
A managed care organization (MCO) is a system that integrates the financing and delivery of healthcare services to individuals. It commonly has the following elements: - Arrangements with selected providers to furnish a comprehensive set of healthcare services to members. - Explicit programs for ongoing quality assurance and utilization review. - Significant financial incentives for members to use providers and procedures covered by the plan.