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Case managers working for health care providers typically do the following: Verify coverage & benefits with the health insurers to ensure the provider is appropriately paid; Coordinate the services associated with discharge or return home; Provide patient education; Provide post-care follow-up; and; Coordinate services with other health care ...
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.
Medicaid is a government program in the United States 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 significant ...
L.A. Care Health Plan (Local Initiative Health Authority for Los Angeles County) was created in 1997 by the State of California to provide health care services for Medi-Cal managed care beneficiaries, uninsured children and other vulnerable populations in Los Angeles County.
It is a nonprofit organization that connects healthcare providers and patients through its platform to enhance care coordination and patient outcomes. CRISP integrates health information from hospitals, laboratories, pharmacies, and other healthcare entities, enabling providers to access real-time patient data.
Medicaid managed care; Marietta Memorial Hospital Employee Health Benefit Plan v. DaVita Inc. Massachusetts health care reform; Maximus Inc. Mark McClellan; Medi-Cal; Medicaid coverage gap; Medicaid Drug Rebate Program; Medicaid Home and Community-Based Services Waivers; Medicaid waiver; Medical necessity; Medical savings account (United States ...
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 ...
The California Medical Assistance Program (Medi-Cal or MediCal) is the California implementation of the federal Medicaid program serving low-income individuals, including families, seniors, persons with disabilities, children in foster care, pregnant women, and childless adults with incomes below 138% of federal poverty level.