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EmblemHealth is one of the United States' largest nonprofit health plans. Headquartered at 55 Water Street in Lower Manhattan , New York City , [ 1 ] it is a multi-billion-dollar organization with over 3 million members.
Primary Care Case Management (PCCM), is a program of the United States government healthcare service Medicaid.It oversees the United States system of managed care 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 ...
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 – mostly, traditional health maintenance organizations (HMO) and primary care case management (PCCM) arrangements.
WellCare began operations in 1985 in Tampa, Florida as a Medicaid provider for the State of Florida. [5] In 1992, Kiran Patel, a cardiologist and entrepreneur, purchased the company. [6] [7] In 2002, Patel sold it to a New York investment group led by George Soros and Todd Farha. [7] Also in 2002, Todd Farha joined the company as CEO. [8] [9]
In the United States, Medicaid is a government program that provides health insurance for adults and children with limited income and resources. The program is partially funded and primarily managed by state governments, which also have wide latitude in determining eligibility and benefits, but the federal government sets baseline standards for state Medicaid programs and provides a ...
The most common managed care financial arrangement, capitation, places healthcare providers in the role of micro-health insurers, assuming the responsibility for managing the unknown future health care costs of their patients. Small insurers, like individual consumers, tend to have annual costs that fluctuate far more than larger insurers.
Within Medicaid, the FMAP can vary. For example, the FMAP for administrative activities is between 50 and 100%. [5] For provider payments, certain populations, programs, and services have enhanced FMAPs, such as the Children's Health Insurance Program, individuals enrolled in Medicaid Expansion, and certain women with breast or cervical cancer. [6]
Blue Cross Blue Shield Association, also known as BCBS, BCBSA, or The Blues, is a United States–based federation with 33 independent and locally operated BCBSA companies that provide health insurance to more than 115 million people in the U.S. as of 2022.
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