managed care organisation
managed care organisation
(1) A healthcare delivery system consisting of affiliated and/or owned hospitals, physicians and others, which provides a wide range of co-ordinated health services.(2) An umbrella term for health plans that provide healthcare in return for a pre-determined monthly fee and co-ordinate care through a defined network of physicians and hospitals.
Examples
HMO, point-of-service (POS).
Features
A panel of contracted providers; some type of limitations on benefits to subscribers who use non-contracted providers, unless authorised to do so; an authorisation system; one of several types of organisations that pay and organise services and service providers with some degree of management (i.e., with protocols and limitations).