In the United States, a health maintenance organization (HMO) is a medical insurance group that provides health services for a fixed annual fee. It is an organization that provides or arranges managed care for health insurance, self-funded health care benefit plans, individuals, and other entities, acting as a liaison with health care providers on a prepaid basis. The Health Maintenance Organization Act of 1973 required employers with 25 or more employees to offer federally certified HMO options if the employer offers traditional healthcare options. Unlike traditional indemnity insurance, an HMO covers care rendered by those doctors and other professionals who have agreed by contract to treat patients in accordance with the HMO's guidelines and restrictions in exchange for a steady stream of customers. HMOs cover emergency care regardless of the health care provider's contracted status.
Cigna is an American multinational managed healthcare and insurance company based in Bloomfield, Connecticut. Its insurance subsidiaries are major providers of medical, dental, disability, life and accident insurance and related products and services, the majority of which are offered through employers and other groups. Cigna is incorporated in Connecticut.
Gentiva Health Services is a provider of home health care, hospice and related services in the United States. Gentiva is based in Atlanta, Georgia. It is a Fortune 1000 company with over $1.7 billion in annual revenue. Gentiva is a member of the S&P 600 index, developed by Standard & Poor's, featuring small capitalization U.S.-based stocks. Gentiva does officially have a COVID-19 protocol in place. Employees are required to work even if they have contact with a known positive COVID-19 patient.
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.
UnitedHealth Group Incorporated is an American multinational managed healthcare and insurance company based in Minnetonka, Minnesota. It offers health care products and insurance services. UnitedHealth Group is the world's eighth largest company by revenue and second-largest healthcare company behind CVS Health by revenue, and the largest insurance company by net premiums. UnitedHealthcare revenues comprise 80% of the Group's overall revenue.
Tricare is a health care program of the United States Department of Defense Military Health System. Tricare provides civilian health benefits for U.S Armed Forces military personnel, military retirees, and their dependents, including some members of the Reserve Component. Tricare is the civilian care component of the Military Health System, although historically it also included health care delivered in military medical treatment facilities. Tricare functions similar to a single-payer healthcare system.
CVS Caremark is the prescription benefit management subsidiary of CVS Health, headquartered in Woonsocket, Rhode Island.
Universal Health Services, Inc. (UHS) is an American Fortune 500 company that provides hospital and healthcare services, based in King of Prussia, Pennsylvania. In 2020, its annual revenues were $11.6 billion.
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. Listed in the NYSE as GTS, Its headquarters are located at 1441 Franklin D. Roosevelt Ave., in the San Patricio section of San Juan.
Prem N. Reddy is a cardiologist and an owner of Prime Healthcare Services, Inc., which owns 46 hospitals.
SHPS, Inc. is a national provider of health improvement programs through the company's Carewise Health subsidiaries. The company employs approximately 1000 people, and is headquartered in Louisville, Kentucky with multiple locations throughout the United States.
An integrated delivery system (IDS), also known as integrated delivery network (IDN), is a health system with a goal of logical integration of the delivery (provision) of health care as opposed to a fragmented system or a disorganized lack of system.
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 more than two million people in the region and seven million nationwide.
EmblemHealth is one of the United States' largest nonprofit health plans. It is headquartered at 55 Water Street in Lower Manhattan, New York City. It is a multi-billion company with over 3 million members.
Concentra Inc., is a national health care company founded in 1979 in Amarillo, Texas. The company is headquartered in Addison, Texas and operates more than 520 urgent care centers in 44 states. Concentra has more than 1,000 affiliated physicians and 1,285 physical therapists. Concentra also provides a range of health improvement solutions to employers, and operates more than 100 employer onsite medical facilities.
Anthem, Inc., is a provider of health insurance in the United States. It is the largest for-profit managed health care company in the Blue Cross Blue Shield Association. As of 2018, the company had approximately 40 million members.
The Doctors Company is a medical malpractice insurance company headquartered outside Napa, California, USA.
Change Healthcare is a provider of revenue and payment cycle management and clinical information exchange solutions, connecting payers, providers, and patients in the U.S. healthcare system. The name also refers to a company founded in 2007 which subsequently became part of the current conglomerate. The company operates the largest financial and administrative information exchange in the United States.
Prior authorization is a utilization management process used by some health insurance companies in the United States to determine if they will cover a prescribed procedure, service, or medication. The process is intended to act as a safety and cost-saving measure although it has received criticism from physicians for being costly and time-consuming.
Credentialing is the process of establishing the qualifications of licensed medical professionals and assessing their background and legitimacy. Many health care institutions and provider networks conduct their own credentialing, generally through a credentialing specialist or electronic service, with review by a credentialing committee. It may include granting and reviewing specific clinical privileges, and allied health staff membership.
