Managed Care: Is it right for you?

Managed care is a system designed to help people get the healthcare they need while keeping costs under control. It works like a guide, helping you to find the right providers, specialists, and services to keep you healthy.

Defining managed care

Managed care encompasses several tiers of solutions, including:

Health insurance with extra help: Managed care is often part of your health insurance plan. It connects you with providers, hospitals, and other healthcare providers working together to provide the necessary care.

Covered services: These are the healthcare services your insurance will pay for, like provider and specialist visits, hospital stays, and medications. Managed care helps ensure you receive services without spending too much money.

Access to care: Managed care helps you get appointments with providers and specialists when needed, so you don't have to wait too long for care.

Managed Care Organization benefits

A managed care organization, or MCO, assists in coordinating your healthcare by working with your insurance provider. There are many benefits offered by an MCO:

Coordinated care: MCOs can facilitate your healthcare team to ensure all your providers and specialists are in sync, for seamless care without missed information.

Delivery systems: MCOs ensure the delivery of high-quality and efficient care to improve your overall health.

Managed costs: MCOs ensure you receive high-quality care at the lowest cost, preventing your medical expenses from escalating.

Primary care: MCOs usually ask you to select a primary care provider who will coordinate all of your care and make referrals to specialists as needed.

PACE: How it fits into managed care

PACE, which stands for Program of All-Inclusive Care for the Elderly, is a particular type of managed care. It's designed to help older adults who need extra support to stay healthy and live independently. Here's what makes PACE unique:

Comprehensive care: PACE provides all the healthcare services a person needs, including provider visits, medications, therapy, and even transportation to medical appointments. It's like a one-stop shop for healthcare.

Quality of care: PACE focuses on keeping older adults healthy and living at home rather than in a nursing home. The program is known for its high quality of care and personal attention.

Manage cost: PACE helps manage the cost of healthcare by coordinating all the services a person needs. This prevents surprise bills.

Health plan: PACE works as both a health plan and a healthcare provider. It offers a complete package of services under one umbrella.

Making a decision whether managed care or PACE is right for you

Managed care can be an excellent option because it helps keep healthcare costs down and makes getting the care you need easier. Here's why it might be a good fit for you:

Better access to care: Managed care helps you see providers and specialists more easily.

Coordinated healthcare: Your primary care provider and other providers work together to give you the best care.

Lower costs: Managed care helps control costs, so you don't incur high medical bills.

If you're an older adult with special health needs, PACE, or managed care, could be perfect. It offers comprehensive, high-quality care and helps you stay independent. If you're interested in managed care or PACE, talk to your provider or a healthcare professional to see if it's right for you.

If you have more questions about whether managed care or PACE is right for you, contact us at Reid Health's PACE Center.