COMMUNITY CARE ALLIANCE
Managed Service Organizations

Managed Services is a health care delivery system organized to manage cost, utilization, and quality. Medicaid managed service provides for the delivery of Medicaid health benefits and additional services through contracted arrangements between state Medicaid agencies and managed services organizations (MSOs) that accept a set per member per month (capitation) payment for these services. By contracting with various types of MSOs to deliver Medicaid program health care services to their beneficiaries, states can reduce Medicaid program costs and better manage utilization of health services. Improvement in health plan performance, health care quality, and outcomes are key objectives of Medicaid managed care.
Some states are implementing a range of initiatives to coordinate and integrate care beyond traditional managed care. These initiatives are focused on improving care for populations with chronic and complex conditions, aligning payment incentives with performance goals, and building in accountability for high quality care.
Managed Health  plans typically include a network of health care providers. Although there are different types of managed care health insurance plans that operate slightly differently, most plans have a network or preferred providers that patients can use. Using a provider outside this network may mean that the individual must pay more for medical services because he or she will not be reimbursed by the insurance company. For this reason, the network will usually determine, in part, what doctors an individual can see without paying additional costs, and because of the rising costs of healthcare, most patients will not want to see a health care provider who is not covered by the network.


Managed Health plans come in different types. The Health Maintenance Organization (HMO) is the most popular. With this health insurance plan, individuals can only go to doctors within the organization's network. Outside of the network, the HMO will not pay for care. A Preferred Provider Organization (PPO) is a type of health insurance that allows individuals to seek care outside of the network.



MSOs are working to meet the three-part aim:
  • Improve health care
  • Improve health
  • Lower growth in expenditures through continuous improvement.


MSOs also create incentives for health care providers to work together to treat an individual patient across care settings – including doctor’s offices, hospitals, and long-term care facilities. The Medicare Shared Savings Program (Shared Savings Program) will reward MSOs that lower their growth in health care costs while meeting performance standards on quality of care. Provider participation in an MSO is purely voluntary, and Medicare beneficiaries retain their current ability to seek treatment from any provider they wish.
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Please visit www.medicare.gov/acos.html or call 1-800-MEDICARE (1-800-633-4227) (TTY users should call1-877-486-2048) for general questions or additional information about Managed Care Organizations. For Physician Compare http://www.medicare.gov/find-a-doctor/provider-search.aspx.
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