Introduction
This article discusses various managed care plans available in the current healthcare landscape. Managed care is a method of contemporary healthcare delivery that relies on specialized managed care organizations integrated into the healthcare system to guide patients toward better health outcomes through individualized insurance plans and to transfer service delivery to outpatient settings (Fleming, 2015).
Types of Insurance Plans
Insurance companies and managed care organizations offer a range of health insurance plans. Some are exclusive to a specific healthcare network, which typically comprises hospitals, pharmacies, and individual doctors. Some plans do not force their consumers to utilize a specific network, but they nevertheless promote it by footing a larger portion of the bill. The following categories apply to managed care organizations: health maintenance organizations, preferred provider organizations, and points of service (Fleming, 2015).
Health Maintenance Organizations
Meeting the diverse needs of the people is the primary objective of diversifying insurance plans. Health maintenance organizations (HMOs) are types of health insurance that provide coverage for the costs of medical services and facilities with which they have a contractual relationship. HMOs typically only cover out-of-network services in emergencies.
Moreover, a Primary Care Provider (PCP) must be selected for an HMO plan because they will be responsible for all medical care. In this context, HMO members cannot consult with other experts without a PCP referral. Besides that, HMOs may geographically restrict their services (Fleming, 2015). Nonetheless, unlike other plan types, the costs of in-network services for HMOs are frequently lower. HMOs are renowned for their comprehensive healthcare strategy, emphasizing prevention and promoting healthy lifestyles.
Preferred Provider Organizations
Preferred provider organizations (PPOs) guarantee lower healthcare costs within the selected healthcare network, just as the two prior insurance plans do. But this time, users must pay more if they use an out-of-network service. On the other hand, there is a much wider variety of networks available to consumers, as well as a significantly larger number of networks (Fleming, 2015). Furthermore, PPO members can consult with any expert without a referral, so they do not need to select a PCP.
Point-of-Service
Point-of-service (POS) insurance is a hybrid type of managed care, as it incorporates features of both HMOs and PPOs. The HMOs passed on to the POSs the necessity of selecting a single PCP who will be entirely responsible for managing future care and referrals, the smaller network size, and the lower service rates within the selected healthcare network (Fleming, 2015). Users of the plan can choose between in- and out-of-network healthcare providers, much like PPOs do. PPO customers will pay a larger share of the medical service costs under the latter option.
Conclusion
Overall, the above evidence indicates how managed care organizations have shifted the focus of healthcare delivery to outpatient and non-hospital settings. In addition to significant service cost efficiency, the shift emphasizes a comprehensive approach to patient treatment (Niles, 2019). In this context, the health-illness continuum significantly broadens the scope of illness by considering the patient’s health, lifestyle, and psychological well-being. For instance, this practice is often employed in HMOs. Thus, to alleviate these negative effects, managed care plans offer various interventions and healthy lifestyle guidelines to increase the general population’s health levels.
References
Fleming, F. L. (2015). Managed Care Plans. In The Gale encyclopedia of senior health: A guide for seniors and their caregivers (pp. 1404-1406). Cengage Gale.
Niles, N. J. (2019). Basics of the U.S. health care system. Jones & Bartlett Learning.