Managed care is a term that describes:

Managed care is a term that describes:

• A. An established system of healthcare delivery that is mandated by the federal government
• B. A network of providers who contract to provide services for a specific group of enrollees
• C. A system that does not recognize APRN as a primary provider
• D. A network of hospitals and nursing homes that provide care to chronically ill people

Answer: (B)

Managed care centers on a network of providers who contract to deliver services for a defined group of enrollees. This arrangement uses negotiated rates, capitation or other payment methods, and often includes gatekeeping, preauthorization, and utilization review to coordinate care and control costs for the enrolled population. The key idea is the contractual network linked to an enrolled group, not a system mandated by the federal government or a focus on a specific facility type. Some plans may designate primary care physicians (often gatekeepers) but that role can be filled by different providers depending on the contract, and the model isn’t limited to hospitals and nursing homes or to care for chronically ill patients alone.

Managed care centers on a network of providers who contract to deliver services for a defined group of enrollees. This arrangement uses negotiated rates, capitation or other payment methods, and often includes gatekeeping, preauthorization, and utilization review to coordinate care and control costs for the enrolled population. The key idea is the contractual network linked to an enrolled group, not a system mandated by the federal government or a focus on a specific facility type. Some plans may designate primary care physicians (often gatekeepers) but that role can be filled by different providers depending on the contract, and the model isn’t limited to hospitals and nursing homes or to care for chronically ill patients alone.