Managed Care

[ABC]

I just got a glimpse of the new managed care or referral management plan design of future.

It's looks like an HMO.

Primary care Doctor is the gate keeper to all medical care. No referral no coverage, out of network claims have no coverage. Except ER.

The plan I looked at, went as far at to list the PC doc. on the insurance card.

I think this might be a plan of the future, inside and outside the exchange. Individual, small group, large group, & ASO.

 

[somarco]

Exchange plans will definitely follow the "HMO model" with PCP's, referrals, and possibly no coverage if you wander out of network (except for medical emergency).

Non-exchange plans might have tighter reins, but I don't see them being as strict on network size or the mechanics of operation.

 

[brandeeno]

I wonder if this is similar to the Patient Centered Medical Homes I keep hearing about....

 

[ABC]

I wonder if this is similar to the Patient Centered Medical Homes I keep hearing about....

I don't think so...........

 

[brandeeno]

Seems very similar to me. I need a few more posts to be able to post links or I would post one linking to what I'm talking about. Oh well, maybe one day.

 

[leevena]

type the link into a reply.

 

[brandeeno]

You can Google Patient-Centered Medical Home to get an idea of what I'm talking about. I was at a meeting last week with all the leadership of one of the Blues and this is all they could talk about. They are setting up to move in this direction. Very similar to the HMO-type/captitation models that ABC was talking about I think. Those models actually worked.... Guess nobody likes a narrow network, however.

 

[leevena]

Abc...was it part of a aco?

 

[somarco]

I believe Brandeeno is referring to ABC, a forum participant.

 

[brandeeno]

I think ABC is talking about ACO's above....