Feb 5, 2025 · The HHS-OIG Strategic Plan for Oversight of Managed Care for Medicare and Medicaid has three goals: Promote access to care for people enrolled in managed care; Provide comprehensive financial oversight; Promote data accuracy and encourage data-driven decisions; OIG developed the managed care life cycle to guide oversight and enforcement work.

Close collaboration between states and managed care plans can help ensure eligible enrollees retain coverage in Medicaid and CHIP and ease transitions for individuals eligible for coverage through the Marketplace. Facilitating transitions from …

Jan 22, 2024 · Together, these oversight strategies help Medicaid agencies ensure that their managed care organizations are delivering high-quality care to their members. HOW IS MEDICAID MANAGED CARE CONTINUING TO EVOLVE? Medicaid managed care has grown dramatically over the past two decades, with over 70 percent of Medicaid members currently enrolled in MCOs ...

Sep 6, 2023 · Managed care is a healthcare delivery system that aims to provide efficient, cost-effective, and coordinated care while maintaining high-quality standards. This comprehensive article delves into the concept of managed care, highlighting its key …

Oct 24, 2022 · In essence, managed care was designed to help centralize health care, contain patient costs, improve resource utilization, and improve patient quality of care. Over time, managed care seems to achieve these goals but still has …

Apr 28, 2023 · In an increasingly volatile marketplace, managed care contracting is quickly becoming a strategic priority for many healthcare organizations nationwide. As such, providers have begun to ask these and other difficult questions: Do we want to enable in-market payer growth or restrict it?

As the dominant delivery system for Medicaid and the Children’s Health Insurance Program (CHIP), managed care has enormous potential to improve health care quality and outcomes. State Medicaid and CHIP agencies that MCP performance.

Mar 6, 2023 · Managed care organizations are essential for providers to understand as their policies can dictate many aspects of healthcare delivery; provider networks, medication formularies, utilization management, and financial incentives influence how and where a patient receives their medical care.

Managed care plans and strategies proliferated and quickly became nearly ubiquitous in the U.S. However, this rapid growth led to a consumer backlash. Because many managed care health plans are provided by for-profit companies, their cost-control efforts are driven by the need to generate profits and not providing health care. [ 5 ]

This chapter discusses some of the major trends in managed care and their implications for behavioral health care: (1) the increasing rate of growth of managed care, (2) the rapid expansion in the use of managed care systems by public-sector populations, (3) the role of purchasers in managing costs, and (4) the recognition of quality assurance ...