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  2. Managed care - Wikipedia

    en.wikipedia.org/wiki/Managed_care

    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]

  3. What to know about Medicare managed care plans - AOL

    www.aol.com/know-medicare-managed-care-plans...

    The term “managed care” originally involved prepaid health plans, typically health maintenance organizations (HMOs). However, the term expanded to include preferred provider organizations (PPOs).

  4. Case management (US healthcare system) - Wikipedia

    en.wikipedia.org/wiki/Case_management_(US...

    The generic model used in the United States is the chronic care model, which holds that health care does not only involve change in the patient and that high-quality disease care counts the community, the health system, self-management support, delivery system design, decision support, and clinical information systems as important elements in ...

  5. Health maintenance organization - Wikipedia

    en.wikipedia.org/wiki/Health_maintenance...

    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 ...

  6. Health insurance in the United States - Wikipedia

    en.wikipedia.org/wiki/Health_insurance_in_the...

    In addition to medical expense insurance, "health insurance" may also refer to insurance covering disability or long-term nursing or custodial care needs. Different health insurance provides different levels of financial protection and the scope of coverage can vary widely, with more than 40% of insured individuals reporting that their plans do ...

  7. Utilization management - Wikipedia

    en.wikipedia.org/wiki/Utilization_management

    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.

  8. Preferred provider organization - Wikipedia

    en.wikipedia.org/wiki/Preferred_provider...

    In U.S. health insurance, a preferred provider organization (PPO), sometimes referred to as a participating provider organization or preferred provider option, is a managed care organization of medical doctors, hospitals, and other health care providers who have agreed with an insurer or a third-party administrator to provide health care at ...

  9. Health insurance - Wikipedia

    en.wikipedia.org/wiki/Health_insurance

    A health insurance policy is a insurance contract between an insurance provider (e.g. an insurance company or a government) and an individual or his/her sponsor (that is an employer or a community organization).

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