What is managed care?

I need a detailed answer. PLease also indicate the difference between HMO and PPO plans. How would the CEO of a hospital deal with a situation when his senior physicans are against adopting the managed care plan because it may be a threat to their practice by reducing their patients, whereas, the managed care plan is profitable for the hospital.

The Preferred Provider Organization (PPO) plans give you the freedom to visit any licensed provider. You don't need to choose a primary care physician (PCP) and you don't need a referral to see a specialist.
Health Maintenance Organization (HMO)
Managed care plans are responsible for covering all emergency services for enrollees, regardless of where the emergency occurred and was treated. State emergency services are services provided in a hospital, clinic, or other facility that is equipped to furnish the required care, after the sudden onset of a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) so that the absence of immediate medical attention could reasonably be expected to result in one of these three conditions:
1. Placing the patient's health in serious jeopardy;
2. Serious impairment of bodily functions; or
3. Serious dysfunction of any bodily organ or part.

Providers who render emergency care to a patient enrolled in a managed care plan must obtain approval from the plan within the time frame specified by the plan, which is usually within 24 hours of service. The provider will be reimbursed only when the provider has made a good faith effort to obtain approval from the plan within the time frame specified.

I didnt answer the 2nd part of your question, because you answered it yourself. Report It