The term managed care or managed healthcare is used in the United States to describe a group of activities intended to reduce the cost of providing health care and providing American health insurance while improving the quality of that care. It has become the predominant system of delivering and receiving American health care since its implementation in the early 1980s, and has been largely unaffected by the Affordable Care Act of 2010.
...intended to reduce unnecessary health care costs through a variety of mechanisms, including: economic incentives for physicians and patients to select less costly forms of care; programs for reviewing the medical necessity of specific services; increased beneficiary cost sharing; controls on inpatient admissions and lengths of stay; the establishment of cost-sharing incentives for outpatient surgery; selective contracting with health care providers; and the intensive management of high-cost health care cases. The programs may be provided in a variety of settings, such as Health Maintenance Organizations and Preferred Provider Organizations.
David Matthew Cutler is an American economist who is the Otto Eckstein Professor of Applied Economics at Harvard University. He was given a five-year term appointment of Harvard College Professor, which recognizes excellence in undergraduate teaching. He holds a joint appointment in the economics department and at Harvard Kennedy School and the Harvard School of Public Health, is a faculty member for the Harvard Center for Population and Development Studies, and serves as commissioner on the Massachusetts Health Policy Commission.
Highmark is an American non-profit healthcare company and Integrated Delivery Network based in Pittsburgh, Pennsylvania, United States. It is a large individual not-for-profit health insurer in the United States, which operates several for-profit subsidiaries.
Blue Cross Blue Shield Association, also known as BCBS, BCBSA, or The Blues, is a United States–based federation with 33 independent and locally operated BCBSA companies that provide health insurance in the United States to more than 115 million people as of 2022.
Blue Shield of California is a mutual benefit corporation and health plan founded in 1939 by the California Medical Association. It is based in Oakland, California, and serves 4.5 million health plan members and more than 65,000 physicians across the state. Blue Shield of California was founded as a not-for-profit organization. As of 2014, it is no longer tax-exempt in California and has been paying federal taxes for several years before that.
WellCare Health Plans, Inc. is an American health insurance company that provides managed care services primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug plans for members across the United States.
The Triple-S Management Corporation (TSM) —commonly known as Triple-S, or SSS— is an insurance holding company based in San Juan, Puerto Rico, which offers a wide range of insurance products and services in Puerto Rico through its wholly owned subsidiaries. Its headquarters are located at 1441 Franklin D. Roosevelt Ave., in the San Patricio section of San Juan.
Independence Blue Cross (Independence) is a health insurer based in Philadelphia, Pennsylvania, in the United States. Independence is the largest health insurer in the Philadelphia area, serving people in the region and seven million nationwide.
In the United States, health insurance marketplaces, also called health exchanges, are organizations in each state through which people can purchase health insurance. People can purchase health insurance that complies with the Patient Protection and Affordable Care Act at ACA health exchanges, where they can choose from a range of government-regulated and standardized health care plans offered by the insurers participating in the exchange.
Medical Mutual of Ohio (MMOH) is an American mutual health insurance company. It is the oldest and largest health insurance company based in Cleveland, Ohio, and serves more than 1.6 million customers. Employing 2,500 people, Medical Mutual is one of the biggest employers in downtown Cleveland.
Molina Healthcare, Inc. is a managed care company headquartered in Long Beach, California, United States. The company provides health insurance to individuals through government programs such as Medicaid and Medicare.
Blue Cross and Blue Shield of Alabama (BCBSAL) is a nonprofit health insurance company headquartered in Birmingham, Alabama. The company was founded in 1936, provides coverage to more than 3 million people and is a member of the Blue Cross and Blue Shield Association (BCBS). BCBSAL employs nearly 5,000 people, which includes almost 3,500 people at its corporate headquarters in Birmingham. The company also operates Cahaba Government Benefit Administrators and Cahaba Safeguard Administrators, both headquartered in Birmingham. It commands over 90 percent of the health insurance market in Alabama, a state with half a million uninsured people, one of the highest uninsured rates in the nation at 10 percent of the population.
Blue Cross Blue Shield of Michigan (BCBSM) is an independent licensee of Blue Cross Blue Shield Association.
Elevance Health, Inc. is an American health insurance provider. Prior to June 2022, Elevance Health was named Anthem, Inc. The company's services include medical, pharmaceutical, dental, behavioral health, long-term care, and disability plans through affiliated companies such as Anthem Blue Cross and Blue Shield, Anthem Blue Cross in California, Wellpoint, and Carelon. It is the largest for-profit managed health care company in the Blue Cross Blue Shield Association. As of 2022, the company had 46.8 million members within its affiliated companies' health plans.
Jerrold Jacob Hercenberg, JD, MPA, is a subject-matter expert for the healthcare and health insurance industry and has been on the cutting edge of numerous innovations over the last 30 years.
Wellmark Blue Cross Blue Shield is a mutual insurance in the United States with more than two million members in Iowa and South Dakota. It is the dominant health insurance in Iowa. It is an independent licensee of the Blue Cross Blue Shield Association. Founded in 1939, Wellmark offers dental and health insurance as well as life insurance. It began participating in the health care exchange for 2017.
This article summarizes healthcare in California.
Value-based insurance design is a demand-side approach to health policy reform. V-BID generally refers to health insurers' efforts to structure enrollee cost-sharing and other health plan design elements to encourage enrollees to consume high-value clinical services – those that have the greatest potential to positively impact enrollee health. V-BID also discourages the use of low-value clinical services – when benefits do not justify the cost. V-BID aims to increase health care quality and decrease costs by using financial incentives to promote cost efficient health care services and consumer choices. V-BID health insurance plans are designed with the tenets of "clinical nuance" in mind. These tenets recognize that medical services differ in the amount of health produced, and the clinical benefit derived from a specific service depends on the consumer using it, as well as when and where the service is provided.
ZoomCare is a Portland, Oregon-based chain of health care clinics. The company has 37 clinics in the U.S. states of Oregon and Washington, as of December 2018.
CareFirst BlueCross BlueShield is a health insurance provider serving 3.5 million individuals and groups in Maryland and the Washington metropolitan area. It has dual headquarters in Baltimore, Maryland and Washington, D.C. It is a nonprofit organization and an independent licensee of the Blue Cross Blue Shield Association.
