Understanding Managed Care: A Comprehensive Guide for Insurance Agents

Understanding Managed Care: A Comprehensive Guide for Insurance Agents

In an era of escalating health expenditures, a growing consensus among patients, physicians, and insurance companies has emerged, advocating for a departure from the conventional fee-for-service models toward the adoption of managed care. This healthcare system places a strong emphasis on optimizing quality, controlling costs, and efficiently utilizing resources to curtail unnecessary services while maximizing positive patient outcomes. As the healthcare landscape continues to evolve, the shift toward managed care is a promising solution to address the challenges posed by escalating expenses and ensure a more effective and sustainable approach to healthcare delivery.

Features of a Managed Care Plan

While the managed-care model has its own complexities, simplifying managed care comes down to a few common characteristics. Most plans have preventive care incentives, encouraging patients to get routine screenings and annual checkups. These services often come at no cost to the patient while helping to identify potential health issues down the road. 

Another element of managed care revolves around having a primary care provider and provider networks. Patients can choose a primary physician they consult for regular checkups before seeing a specialist within the provider network. It provides a main point of contact for the patient to coordinate healthcare needs while having facilities and specialists within the same network for better care management. These plans often include prescription drug tiers. Because most generics have the same formula and ingredients, patients can cut costs by choosing them instead of a name brand.

Types of Managed Care Plans

Considered an umbrella term, managed care looks different depending on the organization and type of insurance. While they may have different costs and offer varying services, low costs and quality of care serve as the core elements. Common plans and organizations include:

  • Preferred Provider Organization: This plan allows people to see any preferred doctor, although an in-network doctor typically costs less. Some of these plans require no referrals while still providing preventive care coverage.
  • Health Maintenance Organization: This plan requires patients to use in-network providers and see a primary physician before seeking specialty care. While these typically cost less, they provide less flexibility.
  • Point of Service: Considered a hybrid plan, it incorporates the flexibility of a PPO but often requires sharing more of the cost. Staying within the network helps keep the costs lower.

Benefits of Managed Care

This type of care rewards providers by collaborating and providing access to high-quality patient care. While it comes with a value-based care risk, managed care offers a better way to offset costs for patients with underlying conditions via risk adjustment scores. 

With a focus on preventive care, these plans aim to reduce the chances of a hidden condition becoming a chronic disease. Encouraging patients to get regular healthcare checkups enables physicians and nurses more time to focus on the specific needs of patients with health issues, ensuring they get the proper services they need. For patients, fewer limitations enable getting the appropriate care at more affordable costs and improving their overall health by taking a proactive approach without paying out of pocket.

While managed care continues to gain popularity, keeping it sustainable requires a continued focus on quality care, ultimately leading to long-term cost savings.

About Connected Risk Solutions

At Connected Risk Solutions, we use our expertise and experience to provide insurance information and programs to those who serve long-term care and senior living facilities. Since 2007, we’ve been offering insurance and risk management plans designed to help our agents give their clients the ability to achieve continued growth while simultaneously protecting against loss, containing costs and increasing profitability. With three offices to serve you in Chicago, Illinois; Phoenix, Arizona; and Burlington, Connecticut, we do everything we can to make your experience with us as professional and transparent as possible. To learn more, contact us at (877) 890-9301.

About Connected Risk Solutions

At Connected Risk Solutions, we provide our agent partners with bold solutions for comprehensive insurance and risk management that are unmatched in the industry. We have market connections and collective decades of industry experience, including deep specialization in healthcare liability and managed care E&O, cyber and tech liability, management and professional liability, as well as captive management and risk management. We strive to develop creative solutions no other wholesaler can match and to help our agent partners give their clients the ability to achieve continued growth while simultaneously protecting against loss.

Our specialists, located in offices throughout the country, are responsive and engaged. To learn more, connect with us.

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