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PAM-Uninsured - Coggle Diagram

- - - - due to large discounts and utilization plans
  - - - Received large discounts by channeling patients in in-network providers
      - Ration expensive medical care with utilization management
      - capitation over fee-for-service
    - - initiate with primary care physician- gatekeeper model
      - prior authorization for specialist or prescription
      - pre-certification for hospital admission
      - step therapy for drugs (cheaper drugs shouldn't work)
  - - - Backlash- customers wanted PPO's aka broader health plans
      - MDs and hospitals created larger networks which allowed them to gain control again
      - Increasing use of medical technology
  - - - as a result of patients rationing they PAY A LOT AT POINT OF CARE (PHARMACY/PHYSICIAN'S OFFICE)