Under a payment arrangement in which physicians are paid a fixed salary and performance-based bonuses, risk is shifted from the MCO to the physicians
Under a payment arrangement in which physicians are paid a fixed salary and performance-based bonuses, risk is shifted from the MCO to the physicians
The percentage of premium spent on administration, marketing, and profits is the medical loss ratio
The HMO Act of 1973 had failed to achieve its objective of creating 1,700 HMOs
All MCOs are now required to be accredited by the National Committee for Quality Assurance.
Utilization is better controlled under a closed-panel plan than under an open-panel plan.
Case management is mainly recommended for patients who need secondary and tertiary care more often than primary care.
Disease management is highly individualized.
One distinguishing feature of HMOs is that they use discounted fees as the primary method of paying providers.
By law, an HMO is prohibited from having an exclusive contract with a group practice.
In the IPA model, the IPA rather than the HMO contracts with the physicians.
The majority of Medicaid beneficiaries are enrolled in managed care.
In the 1990s, managed care was widely credited for enabling small employers to offer health insurance coverage to their employees.
Research shows that quality of care has declined as managed care has continued to grow.
The objective of horizontal integration is to control the geographic distribution of a service.
Diversification is not achieved through horizontal integration.
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