A perfect storm of federal legislation, technological developments, consumer demands and rising costs have made the field of managed care more important than ever to healthcare companies, providers and professionals.
This makes it a vital topic within any online Healthcare Management Master of Business Administration degree program, especially as consumers acquire a vocabulary of new acronyms for the various types of managed care systems in the U.S. healthcare industry today.
The Types of Managed Care Systems
HMO. Standing for “health maintenance organization,” this is one of the most familiar terms to consumers. Insurers who establish an HMO directly employ healthcare providers in their networks, and people with policies with these insurers must use a professional within the HMO network to receive benefits. Patients are responsible only for a small copay. When patients opt for a provider outside of the network, they typically lose their insurance benefits.
MBHO. This stands for “managed behavioral healthcare organization.” This group specializes in mental healthcare. Often an HMO will contract with an MBHO in order to qualify as a “full service” HMO.
PPO. These are “preferred provider organizations,” and they provide more flexibility for doctors and hospitals in their networks. Healthcare providers in these networks do not work directly for the insurance company as they do in an HMO. The parties agree to a set list of payments for various services. Patients are responsible for a copay, and if they opt for a provider outside of the PPO, they are subject to a deductible as well as more of the total bill.
HDP. Those with “high deductible plans” must pay all charges until they meet deductibles. However, the Affordable Care Act now requires these plans to provide free preventative services even when policyholders have not met the deductible.
CHDP. This is simply a “consumer direct high payment” plan that individuals (rather than organizations) purchase.
POS. Some HMOs offer a POS (point of service), which can refer patients to a doctor outside of the HMO. Patients are responsible for paying a percentage of the bill.
Impact on Managed Care Professionals
As these systems illustrate, there is a wide variety of financial and contractual models in the U.S. healthcare system. This variety creates unique challenges for the professionals who design, implement and manage the systems. Good online healthcare MBA programs stay abreast of the developments in this area, including technological and consumer trends. For example, technologies, such as telemedicine, video conferencing, and text messaging are finding their way into managed care systems.
When choosing an online healthcare MBA program, be sure that its curriculum is current and its instructors familiar with the latest industry developments.
Learn more about the UT Tyler online MBA in Healthcare Management program.