Question: In what year were the pioneers of managed care in the United States established?
Context: Medicaid managed care Medicaid and additional services in the United States through an arrangement between a state Medicaid agency and managed care organizations (MCOs) that accept a set payment – “capitation” – for these services.  The State pays the MCO a monthly premium to cover the services provided to a beneficiary.  As of 2014, 26 states have contracts with MCOs to deliver long-term care for the elderly and individuals with disabilities.  There are two main forms of Medicaid managed care, “risk-based MCOs” and “primary care case management (PCCM).”  In a PCCM system, the State pays for services on a fee-for-service basis as well as a monthly fee to a contracted primary care provider to coordinate care for the beneficiary. Abrazo Community Health Network (Abrazo Health) is one of the largest health care delivery system in Arizona, United States.  Abrazo Community Health Network is located in Phoenix, Arizona and was established in 2003.  The Abrazo system comprises six acute care hospitals including one cardiovascular-specialty hospital.  The health care system offers a broad range of medical services, including cardiology, internal medicine, general surgery, orthopedics, neurology, obstetrics, bariatrics, women’s health, diagnostic imaging, outpatient services, and emergency care.  In addition to the hospitals, Abrazo Community Health Network includes primary and specialty care physician offices, urgent care offices, emergency centers and managed care health plans (under the name Phoenix Health Plans). Group Health Cooperative, (formerly known as Group Health Cooperative of Puget Sound), later more commonly known as Group Health, was a Seattle, Washington based nonprofit healthcare organization.  Established in 1945, it provided coverage and care for about 600,000 people in Washington and Idaho and was one of the largest private employers in Washington. The term managed care or managed healthcare is used in the United States to describe a group of activities ostensibly intended to reduce the cost of providing health care while improving the quality of that care ("managed care techniques").  It has become the essentially exclusive 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. 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 (hospitals, doctors, etc.) 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. This is the main article on the medical facilities of Seattle, Washington.  Seattle, USA is well served medically.  The University of Washington is consistently ranked among the country's dozen leading institutions in medical research; Group Health Cooperative was one of the pioneers of managed care in the United States; and Seattle was a pioneer in the development of modern paramedic services with the establishment of Medic One in 1970. Medicare Advantage is a type of United States health insurance program within of Medicare.  Medicare Advantage plans provide a managed health care plan (typically a health maintenance organization (HMO) but also often a preferred provider organization (PPO) or another type of managed care arrangement) that is paid based on a monthly capitated fee.  This Part of Medicare provides beneficiaries an alternative to "Original Medicare" Parts A and B Medicare, which provides insurance for the same medical services but pays providers a fee for service (FFS) directly rather than through managed care plans.  However a Medicare Advantage beneficiary must first sign up for both Parts A and B of Medicare.  All three of these Parts of Medicare—A, B and C—are administered by private insurance companies (often the same insurance companies). Aetna Health Inc. v. Davila, 542 U.S. 200 (2004) , was a United States Supreme Court case in which the Court limited the scope of the Texas Healthcare Liability Act (THCLA).  The effective result of this decision was that the THCLA, which held Case Management and Utilization Review decisions by Managed Care entities like CIGNA and Aetna to a legal duty of care according to the laws of The State of Texas could not be enforced in the case of Health Benefit plans provided through private employers, because the Texas statute allowed compensatory or punitive damages to redress losses or deter future transgressions, which were not available under ERISA § 1132.  The ruling still allows the State of Texas to enforce the THCLA in the case of Government-sponsored (Medicare, Medicaid, Federal, State, Municipal Employee, etc., Church-sponsored, or Individual Health Plan Policies (High-deductible individual policies, self-pay, any insurance not subsidised by a Private Employer), which are saved from preemption by ERISA.  The history that allows these Private and Self-Pay Insurance to be saved dates to the "Interstate Commerce" power that was given the federal Government by the Supreme Court.  ERISA, enacted in 1974, relied on the "Interstate Commerce" rule to allow federal jurisdiction over private employers, based on the need of private employers to follow a single set of paperwork and rules for pensions and other employee benefit plans where employers had employees in multiple states.  Except for private employer plans, insurance can be regulated by the individual states, and Managed Care entities making medical decisions can be held accountable for those decisions if negligence is involved, as allowed by the Texas Healthcare Liability Act. Primary Care Case Management (PCCM), is a program of the United States government healthcare service Medicaid.  It oversees the United States system of managed care used by state Medicaid agencies in which a primary care provider is responsible for approving and monitoring the care of enrolled Medicaid beneficiaries, typically for a small monthly case management fee in addition to fee-for-service reimbursement for treatment.  In the mid-1980s, states began enrolling beneficiaries in their PCCM programs in an attempt to increase access and reduce inappropriate emergency room and other high cost care.  Use increased steadily through the 1990s. Kaiser Permanente ( ; KP) is an 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 2014, Kaiser Permanente operates in eight states and the District of Columbia, and is the largest managed care organization in the United States.
Answer: 1945