ERM-512-13: Economics and Financing


Reading Source: ERM-512-13 Study Note

Topics Covered in this Reading:

  • Managed Care Plans
    • Why Managed Care?
    • Management: The Distinctive Feature of Managed Care
    • Contractual Reforms to Reduce Costs
    • A Fourth Way: Reforming the Organization to Reduce Costs
    • Medical Loss Ratios
  • The Range of Managed Care
    • Provider Networks
    • Gatekeeping
    • Capitation
    • Withholds
    • Utilization Review