ABSTRACT
Managed care is a term commonly used to describe an array of health care delivery and payment systems, including health maintenance organizations (HMOs), preferred provider organizations (PPOs), and point-of-service plans (gatekeeper PPOs). The term managed care has produced an expectation of cost containment by limitations imposed on access and exertion of external controls, and theoretically can include any medical expense plan that attempts to contain costs by controlling the behavior of participants. Elements of managed care can be seen in many traditional medical expense programs. Methods employed by these plans usually discount payment, restrict choice to those providers who agree to accept discounted fees, and may have some rudimentary forms of utilization management. Payment methods also will separate a true managed care plan from a managed care lookalike. In order to understand managed care concepts, it is important that one understand the many acronyms and definitions which have developed with the industry.
