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Managed care plans and strategies proliferated and quickly became nearly ubiquitous in the U.S. However, this rapid growth led to a consumer backlash. Because many managed care health plans are provided by for-profit companies, their cost-control efforts are driven by the need to generate profits and not providing health care. [5]
Healthcare in the United States Government health programs Federal Employees Health Benefits Program (FEHBP) Indian Health Service (IHS) Medicaid / State Health Insurance Assistance Program (SHIP) Medicare Prescription Assistance (SPAP) Military Health System (MHS) / Tricare Children's Health Insurance Program (CHIP) Program of All-Inclusive Care for the Elderly (PACE) Veterans Health ...
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The amount of involvement an insurer can have in managing high cost cases depends on the structure of the benefit plan. In a tightly managed plan case management may be integral to the benefits program. In less tightly managed plan, participation in a case management program is often voluntary for patients. [5]
The Department of Managed Health Care (DMHC) is a regulatory body governing managed health care plans, including Health Maintenance Organizations (HMOs) and most Medi-Cal managed care plans in California. The DMHC was created as the first state department in the country solely dedicated to regulating managed health care plans and assisting ...
Nurse-managed health centers tend to be located in or near low-income communities. [6] Over half of the patients seen at nurse-managed health centers are females who come from racial/ethnic minority populations and are likely to have experienced health disparities. [8] Nurse-managed health centers are managed and staffed by advanced practice ...
In the United States, a health maintenance organization (HMO) is a medical insurance group that provides health services for a fixed annual fee. [1] It is an organization that provides or arranges managed care for health insurance , self-funded health care benefit plans, individuals, and other entities, acting as a liaison with health care ...
A health system, health care system or healthcare system is an organization of people, institutions, and resources that delivers health care services to meet the health needs of target populations. There is a wide variety of health systems around the world, with as many histories and organizational structures as there are countries.