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.
Aetna Inc. is an American managed health care company that sells traditional and consumer directed health care insurance and related services, such as medical, pharmaceutical, dental, behavioral health, long-term care, and disability plans, primarily through employer-paid insurance and benefit programs, and through Medicare. Since November 28, 2018, the company has been a subsidiary of CVS Health.
Kaiser Permanente is an American integrated managed care consortium, based in Oakland, California, United States, founded in 1945 by industrialist Henry J. Kaiser and physician Sidney Garfield. Kaiser Permanente is made up of three distinct but interdependent groups of entities: the Kaiser Foundation Health Plan, Inc. (KFHP) and its regional operating subsidiaries; Kaiser Foundation Hospitals; and the regional Permanente Medical Groups. As of 2023, Kaiser Permanente operates in eight states and the District of Columbia, and is the largest managed care organization in the United States.
Humana Inc. is a for-profit American health insurance company based in Louisville, Kentucky. In 2023, the company ranked 42 on the Fortune 500 list, which made it the highest ranked company based in Kentucky. It is the fourth largest health insurance provider in the U.S.
HCA Healthcare is an American for-profit operator of health care facilities that was founded in 1968. It is based in Nashville, Tennessee, and, as of May 2020, owns and operates 186 hospitals and approximately 2,000 sites of care, including surgery centers, freestanding emergency rooms, urgent care centers and physician clinics in 21 states and the United Kingdom. As of 2023, HCA Healthcare is ranked #66 on the Fortune 500 rankings of the largest United States corporations by total revenue.
The American multinational retail chain Walmart has been criticized by many groups and individuals, such as labor unions and small-town advocates, for its policies and business practices, and their effects. Criticisms include charges of racial and gender discrimination, foreign product sourcing, anti-competitive practices, treatment of product suppliers, environmental practices, the use of public subsidies, and its surveillance of its employees. The company has denied any wrongdoing and said that low prices are the result of efficiency.
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.
In U.S. health insurance, a preferred provider organization (PPO), sometimes referred to as a participating provider organization or preferred provider option, is a managed care organization of medical doctors, hospitals, and other health care providers who have agreed with an insurer or a third-party administrator to provide health care at reduced rates to the insurer's or administrator's clients.
Kindred Healthcare was a post-acute healthcare services company that operated long-term acute-care hospitals and provides rehabilitation services across the United States.
UnitedHealth Group Incorporated is an American multinational managed healthcare and insurance company based in Minnetonka, Minnesota. Offering insurance services under UnitedHealthcare and healthcare products under Optum, it is the world's eleventh-largest company by revenue and the largest healthcare company by revenue, and the largest insurance company by net premiums. Optum and UnitedHealthcare had roughly equal earnings from operations in 2022.
The University of Pittsburgh Medical Center (UPMC) is an American integrated global nonprofit health enterprise that has 92,000 employees, 40 hospitals with more than 8,000 licensed beds, 800 clinical locations including outpatient sites and doctors' offices, a 3.8 million-member health insurance division, as well as commercial and international ventures. It is closely affiliated with its academic partner, the University of Pittsburgh. It is considered a leading American health care provider, as its flagship facilities have ranked in U.S. News & World Report "Honor Roll" of the approximately 15 to 20 best hospitals in America for over 15 years. As of 2016, its flagship hospital UPMC Presbyterian was ranked 12th nationally among the best hospitals by U.S. News & World Report and ranked in 15 of 16 specialty areas when including UPMC Magee-Womens Hospital. This does not include UPMC Children's Hospital of Pittsburgh which ranked in the top 10 of pediatric centers in a separate US News ranking.
Arkansas Children's Hospital (ACH) is a pediatric hospital with a Level I trauma center in Little Rock, Arkansas. It is among the largest in the United States, serving infants, children, teens, and young adults from birth to age 21. ACH is affiliated with the University of Arkansas for Medical Sciences and serves as a teaching hospital with the UAMS College of Medicine's Department of Pediatrics. ACH staff consists of more than 505 physicians, 200 residents, and 4,400 support staff. The hospital includes 336 licensed beds, and offers three intensive care units. The campus spans 36 city blocks and has a floor space of over 1,200,000 square feet (110,000 m2).
Tenet Healthcare Corporation is a for-profit multinational healthcare services company based in Dallas, Texas, United States. Through its brands, subsidiaries, joint ventures, and partnerships, including United Surgical Partners International (USPI), the company operates 65 hospitals and over 450 healthcare facilities. Tenet also operates Conifer Health Solutions, which provides healthcare support services to health systems and other clients.
Walmart Watch, formed in the spring of 2005, was a joint project of the Center for Community and Corporate Ethics, a nonprofit organization studying the impact of large corporations on society, and its advocacy arm, Five Stones. The Walmart Watch group was based in Washington with the claimed goal to challenge Walmart to become a better employer, neighbor, and corporate citizen in order to improve the wages, health benefits, and treatment of workers.
A health professional, healthcare professional, or healthcare worker is a provider of health care treatment and advice based on formal training and experience. The field includes those who work as a nurse, physician, physician assistant, registered dietitian, veterinarian, veterinary technician, optometrist, pharmacist, pharmacy technician, medical assistant, physical therapist, occupational therapist, dentist, midwife, psychologist, audiologist, healthcare scientist, or who perform services in allied health professions. Experts in public health and community health are also health professionals.
Mauldin v. Wal-Mart Stores, Inc. was a sexual discrimination class action lawsuit filed on October 16, 2001, in the United States District Court for the Northern District of Georgia, seeking back pay and an injunction. The suit challenged Walmart's denial of health insurance coverage for prescription contraceptives. The case was granted class action status with an estimated 400,000 women eligible for participation in the lawsuit.
Sutter Health is a not-for-profit integrated health delivery system headquartered in Sacramento, California. It operates 24 acute care hospitals and over 200 clinics in Northern California.
The Mount Sinai Health System is a hospital network in New York City. It was formed in September 2013 by merging the operations of Continuum Health Partners and the Mount Sinai Medical Center.
U.S. HealthWorks, Inc. was an American healthcare provider network with headquarters in Valencia, California. It offered:
United States v. GlaxoSmithKline was a case before the United States District Court for the Eastern District of Pennsylvania. Robert J. Merena was one of the first who filed claims against SmithKline Beecham Clinical Laboratories on November 12, 1993. The complaints alleged that GlaxoSmithKline, which operated a system of clinical laboratories, adopted myriad complicated procedures for the purpose of defrauding state and federal healthcare programs, in particular Medicare and Medicaid. The U.S. Justice Department publicly praised Robert Merena for his "cooperation and support" in helping the government collect the largest settlement ever involving a whistle-blower lawsuit. The SmithKline settlement is considered to be one of the largest whistleblower assisted recoveries in the history of the United States.
