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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]
Managed care delivery systems grew rapidly in the Medicaid program during the 1990s. In 1991, 2.7 million beneficiaries were enrolled in some form of managed care. Currently, managed care is the most common health care delivery system in Medicaid. In 2007, nearly two-thirds of all Medicaid beneficiaries are enrolled in some form of managed care ...
In the United States, an independent practice association (IPA) is an association of independent physicians, or other organizations that contracts with independent care delivery organizations, and provides services to managed care organizations on a negotiated per capita rate, flat retainer fee, or negotiated fee-for-service basis. [1] [2]
The term “managed care” originally involved prepaid health plans, typically health maintenance organizations (HMOs). However, the term expanded to include preferred provider organizations (PPOs).
In the network model, an HMO will contract with any combination of groups, IPAs (Independent Practice Associations), and individual physicians. Since 1990, most HMOs run by managed care organizations with other lines of business (such as PPO, POS and indemnity) use the network model.
Primary Care Case Management (PCCM) is a system of managed care in the US used by state Medicaid agencies, in which a primary care provider is responsible for approving and monitoring the care of enrolled Medicaid beneficiaries, typically for a small monthly case management fee in addition to fee-for-service reimbursement for treatment. [1]
Proposition 35 would spell out how the tax on health insurance providers like Anthem Blue Cross and L.A. Care, known as managed care organizations, can be used.
On August 21, 2003, TriWest was awarded the TRICARE Managed Care Support Contract for the TRICARE West Region. The five-year contract, valued at approximately $10 billion, expanded TriWest's service area to 21 states and 2.7 million beneficiaries with the addition of Alaska, California, Hawaii, northern Idaho, Oregon, and Washington. [4]