Managed Care, Access, & Cost Quality Tradeoffs

Question 1

Health Maintenance Organization (HMO)

Answer 1

-Limit members to exclusive network

-Need referrals from Primary Care Doctor

-Least expensive option

-Tend to have lower or no annual deductibles

Question 2

Preferred Provider Organization (PPO)

Answer 2

-More expensive & more flexible

–Annual deductibles
–once annual deductibles met, plan covers 100% of services from remainder of year

-Physician network

-Out-of-network more expensive

-Utilization reviews & pre-authorizations

Question 3

Accountable Care Organizations (ACO)

Answer 3

-Networks of doctors, hospitals & other providers sharing medical & financial responsibility for patient care.

-Have financial incentives to promote care coordination

-Primary care physician oversees care