Managed Care - Managed Care Techniques

Managed Care Techniques

One of the most characteristic forms of managed care is the use of a panel or network of health care providers to provide care to enrollees. Such integrated delivery systems typically include one or more of the following:

• A set of designated doctors and health care facilities, known as a provider network, which furnish an array of health care services to enrollees
• Explicit standards for selecting providers
• Formal utilization review and quality improvement programs
• An emphasis on preventive care
• Financial incentives to encourage enrollees to use care efficiently

Provider networks can be used to reduce costs by negotiating favorable fees from providers, selecting cost effective providers, and creating financial incentives for providers to practice more efficiently. A survey issued in 2009 by America's Health Insurance Plans found that patients going to out-of-network providers are sometimes charged extremely high fees. Other managed care techniques include disease management, case management, wellness incentives, patient education, utilization management and utilization review. These techniques can be applied to both network-based benefit programs and benefit programs that are not based on a provider network. The use of managed care techniques without a provider network is sometimes described as "managed indemnity."