Managed Care: Plan Structure and Operation Checklist

Summary

This checklist outlines the key terms and concepts for reviewing a managed care contract. It differentiates between the types of managed care plans and how each kind is used. Managed care integrates the delivery of care with its financing. Some models of managed care are risk-bearing, so insurance regulators are involved with their regulation for reasons of solvency, consumer protection, and otherwise. Health care providers (e.g., physicians, clinics, hospitals, etc.) are also subject to regulation by their oversight authorities.