Spurred by voter outcry, state and federal governments have begun to mandate reform in managed care. Unfortunately, the horror stories and mandates have caused many people to equate managed care with less care. Through careful planning and investigation by employers, managed care can and does provide quick access, quality of care and competitive cost. It's not an HMO or any other kind of specific plan. The concept can best be described as a broad spectrum of cost controlling options designed to coordinate the financing and provision of healthcare to produce high-quality healthcare for the lowest possible cost.
Utilization review serves to screen against medical tests and treatments that are unnecessary.
To accomplish this, techniques such as preapproval of hospital admissions and surgeries, review of treatment received, and case management for patients needing high-cost care are employed. Utilization review techniques arc widely used today in varying degrees in most insurance plans. Managed care networks represent a variety of arrangements with healthcare provider groups which enable insurance providers to have more control over costs. These plans are basically contracted arrangements which establish alliances between insurance companies and a select group of doctors and hospitals who agree to provide services at a discounted or fixed cost. HMO, PPO, and POS plans all offer employers the ability to control their healthcare expenditures.