Statements (50)
| Predicate | Object |
|---|---|
| gptkbp:instanceOf |
gptkb:insurance
|
| gptkbp:accreditation |
gptkb:URAC
gptkb:National_Committee_for_Quality_Assurance |
| gptkbp:alsoKnownAs |
gptkb:MCOs
|
| gptkbp:canBe |
disease management programs
case management provider networks utilization review |
| gptkbp:canBePossessedBy |
insurance companies
hospital systems independent organizations |
| gptkbp:criticizedFor |
denying coverage for some services
restricting patient choice |
| gptkbp:emergedIn |
1970s
|
| gptkbp:focusesOn |
preventive care
|
| gptkbp:goal |
reduce healthcare costs
coordinate patient care improve healthcare quality |
| gptkbp:hasType |
gptkb:Exclusive_Provider_Organization
gptkb:Point_of_Service_Plan gptkb:Preferred_Provider_Organization Health Maintenance Organization |
| https://www.w3.org/2000/01/rdf-schema#label |
Managed Care Organizations
|
| gptkbp:limitation |
coverage for out-of-network providers
|
| gptkbp:mayImplement |
value-based payment models
|
| gptkbp:mayIncentivize |
preventive health behaviors
|
| gptkbp:mayReceive |
quality metrics
|
| gptkbp:mayReport |
gptkb:Healthcare_Effectiveness_Data_and_Information_Set_(HEDIS)_measures
|
| gptkbp:mayRestrict |
out-of-network care
|
| gptkbp:negotiatedBy |
payment rates with providers
|
| gptkbp:offers |
Medicaid managed care plans
Medicare Advantage plans commercial health insurance plans |
| gptkbp:operatesIn |
healthcare industry
|
| gptkbp:originatedIn |
gptkb:United_States
|
| gptkbp:participatedIn |
public and private insurance markets
|
| gptkbp:provides |
health insurance plans
|
| gptkbp:purpose |
manage cost, utilization, and quality of healthcare
|
| gptkbp:regulates |
gptkb:government
state governments healthcare services |
| gptkbp:requires |
referrals for specialists
primary care physician selection prior authorization for certain services |
| gptkbp:subject |
Affordable Care Act regulations
Medicaid regulations Medicare regulations |
| gptkbp:targetUser |
healthcare providers
|
| gptkbp:bfsParent |
gptkb:Provider_Service_Networks
|
| gptkbp:bfsLayer |
7
|