Under a payment arrangement in which physicians are paid a fixed salary and performance-based bonuses, risk is shifted from the MCO to the physicians .4pt;=”” white;=””>Under a payment arrangement in which physicians are paid a fixed salary and performance-based bonuses, risk is shifted from the MCO to the physicians .4pt;=”” white;=””>The percentage of premium spent on administration, marketing, and profits is the medical loss ratio .4pt;=”” white;=””>The HMO Act of 1973 had failed to achieve its objective of creating 1,700 HMOs .4pt;=”” white;=””>All MCOs are now required to be accredited by the National Committee for Quality Assurance. .4pt;=”” white;=””>Utilization is better controlled under a closed-panel plan than under an open-panel plan. .4pt;=”” white;=””>Case management is mainly recommended for patients who need secondary and tertiary care more often than primary care. .4pt;=”” white;=””>Disease management is highly individualized. .4pt;=”” white;=””>One distinguishing feature of HMOs is that they use discounted fees as the primary method of paying providers. .4pt;=”” white;=””>By law, an HMO is prohibited from having an exclusive contract with a group practice. .4pt;=”” white;=””>In the IPA model, the IPA rather than the HMO contracts with the physicians. .4pt;=”” white;=””>The majority of Medicaid beneficiaries are enrolled in managed care. .4pt;=”” white;=””>In the 1990s, managed care was widely credited for enabling small employers to offer health insurance coverage to their employees. .4pt;=”” white;=””>Research shows that quality of care has declined as managed care has continued to grow. .4pt;=”” white;=””>The objective of horizontal integration is to control the geographic distribution of a service. .4pt;=”” white;=”” 10pt;=””>Diversification is not achieved through horizontal integration.
