Managed Care - Assumptions . The most appropriate healthcare is not always delivered by professionals who are well-informed Healthcare services are not always delivered in a suited environment and/or timely manner that best accommodates the patient’s health status. Managed Care - Review .
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1. Oversight of the medical care given
2. Contractual relationships/organization
3. Rules/algorithms tied to covered benefits
1. Plans want to expand market share
2. Start to lower price to do so
3. Other plans match lower prices
4. Price wars lead to multi-year contract development
1. Due to insulation of capitating risk to providers and time lag on
FFS claims, considerable time elapses before financial
pressures know from lowered premium
2. Due to multi-year contracts and price pressures nothing much
can be done about the problem as it becomes apparent