Managed Care Definition

Managed care is a healthcare delivery system that aims to control costs and improve quality by coordinating medical services and resources. In managed care, healthcare services are provided through networks of healthcare providers who have agreed to provide services to members of a specific health insurance plan. Key features of managed care include utilization management, which involves assessing the appropriateness and necessity of healthcare services, and care coordination, which ensures that patients receive timely and appropriate care.

Managed care organizations (MCOs) often use techniques such as provider networks, preauthorization requirements, and financial incentives to encourage cost-effective healthcare delivery and quality outcomes. Managed care plans include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and point-of-service (POS) plans. These plans typically involve contractual arrangements between insurers and healthcare providers to manage costs while maintaining or improving healthcare quality for plan members.