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This model is an example of a closed-panel HMO, meaning that contracted physicians may only see HMO patients. Previously this type of HMO was common, although currently it is nearly inactive. [7] In the group model, the HMO does not employ the physicians directly, but contracts with a multi-specialty physician group practice. Individual ...
Many "traditional" or "indemnity" health insurance plans now incorporate some managed care features, such as precertification for non-emergency hospital admissions and utilization reviews. They are sometimes described as "managed indemnity" plans.
Optum's been the leader in showing how a managed care organization with an ambulatory care delivery platform and a pharmacy benefit manager all in house can lower or maintain and bend cost trend and then drive better market share gains in their health insurance business.
Utilization management (UM) or utilization review is the use of managed care techniques such as prior authorization that allow payers, particularly health insurance companies, to manage the cost of health care benefits by assessing its medical appropriateness before it is provided, by using evidence-based criteria or guidelines.
The Health Insurance Review and Assessment Service (Korean: 건강보험심사평가원; Hanja: 健康保險審査評價院) - HIRA in short - is a government agency under Ministry of Health and Welfare responsible for claims review and quality assessment of the National Health Insurance. [1]