Managed Care: Plan Structure and Operation

Summary

This practice note discusses the background, structure, and operations of managed care plans. The concept of managing the delivery of healthcare is the hallmark of managed care and has existed in various forms for decades. The common threads of this management include the scope of medical services, accessing them, and financing them. This practice note focuses on the risk-bearing aspects of managed care most closely related to insurance dealing primarily with the financing of the delivery of services. In discussing those risk-bearing aspects, some of the organizational structures of managed care organizations, as all of them have risk-bearing implications, will also be addressed.