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Chapter 8: Managed Healthcare - Coggle Diagram
Chapter 8: Managed Healthcare
Parties
Managed Healthcare Orgainsation
Members
Hospitals
Insurance Company
Strategy for containing medical care costs while
Accessibility
Cost
Payment Methods
Capitation
Fixed amount paid to providers
by MHCO on monthly basis
Discounted Fee-For-Service
MHCO pays physicians percentage
of usual fees achieving discount
Salary
HMO hires doctors as their staff
with predetermined salary and bonuses
Fee schedule
Caps or limits on amount reimbursed
for covered procedures
Quality of care
Common MHCOs
Health Maintenance Orgainsation
Healthcare delivery system that provides
pre-paid comprehensive healthcare services
Types
Group Model
Two entities - HMO and group practice
Network Model
More than 1 group practice for more diverse choices
Mixed Model
combination of features of 2 or more of basic types of HMO
Preferred Provider Organisation
No need for referral
Richer benefits offered for seeing
network providers
Less restrictive than HMO but require
greater "out-of-pocket" payments
Point-of-Service HMO
Combination of PPO and HMO
Managed Healthcare Insurance
Benefits
P.P.S.E.H
Claims for out-of-network providers
Claimant's statement
Original medical bill