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Susan FranczykPhase 3 Individual ProjectProfessor Kristy TaylorHCM632-1604A-01October 16, 2016
Managed care has been around for many years and has had a major impact on the health care industry. In order to understand the impact that managed care had on the health care industry, it is important to understand the meaning of managed care. What is managed care? Managed care is “a system of healthcare where patients only visit certain physicians and hospitals, and where treatment is overseen by a managing company” [Lie08]. Managed care is also known as the “gatekeeper”. With all the advancements in medical technology and the requirements set by the federal, state, and local government health care costs were rising. In order to try to reduce the health carecosts, changes were made by the government. The government and health insurance companies worked together to devise a plan to reduce the overall cost of health care. One way that the government and health insurance companies determined would help reduce costs by creating managed care. Managed care is the overseer of health care services utilizing a coordinated path. The coordinated path includes a wide array of health care services that could be needed by the insured individuals at a stipulated price, including discounts, as set up by the primary care physicians. Before managed care, individual with insurance were allowed to see any physician, primary care or a specialist and incur the cost without limits. The individuals were held liable for the remaining balance after their insurance paid their portion. Once managed care was established, one primary care physician was responsible for overseeing the care of the individual.With managed care, individuals are able to see their primary care physician, have any testing (blood work, x-rays, or any other ancillary services) ordered [Lie08], and be referred to specialists to have these services covered under their insurance plans. Individuals did not have toworry if the services were covered and they were reassured that they would not incur a bill,