PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Preferred Provider Organizations”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 91 records · Page 5Linked to original sources
PubMed2001

The case for dental preferred provider organizations.

The dental PPO market is the fastest growing segment of the dental benefits business. As with traditional indemnity plans, dentists are reimbursed on a fee-for-service basis. Members can refer themselves to dentists of choice, including specialists, inside and outside the network. Employers' interest in DPPOs is expected to continue as they seek to control or reduce expenses associated with dental benefits plans. Dentist participation in managed care programs significantly lags medical, and fewer than half of practicing dentists participate in DPPOs. Negotiated discounts vary across carriers and geographic regions, generally ranging 15% to 30% off average fees. The American Dental Association predicts that dentists' participation in DPPOs will continue to increase, indicating further growth for these dental plans. There are financial incentives for members to stay in network.

Health Benefit Plans, Employee↗
PubMed2001

Risk transfer and accountability in managed care organizations' carve-out contracts.

OBJECTIVE: This study examined characteristics of contracts between managed care organizations (MCOs) and managed behavioral health organizations (MBHOs) in terms of delegation of functions, financial arrangements between the MCO and the MBHO, and the use of performance standards. METHODS: Nationally representative administrative and clinical information about the three largest types of commercial products offered by 434 MCOs in 60 market areas was gathered by telephone survey. These products comprised services provided by health maintenance organizations, preferred provider organizations, and point-of-service plans. Chi square tests were performed between pairings of all three types of products to ascertain differences in the degree to which claims processing, maintenance of provider networks, utilization management, case management, and quality improvement were delegated to MBHOs through specialty contracts among the various types of products. Contractual specifications about capitation arrangements, risk sharing, the use of performance standards, and final utilization review decisions were also compared. RESULTS: For all types of products, almost all the major functions were contracted by the MCO to the MBHO. Although most contracts assigned some risk for the costs of services to the MBHO, the degree of this risk varied by product type. Except in the case of preferred-provider organizations, a large number of performance standards were identified in MCOs' contracts with MBHOs, although financial incentives were rarely tied to such standards. CONCLUSIONS: MCOs that contract with MBHOs place major responsibility, both financial and administrative, on the vendors.

Contract Services↗