Managed Care Initiatives

HEHS-96-153R: Published: Sep 25, 1996. Publicly Released: Oct 28, 1996.

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Pursuant to a congressional request, GAO provided information on: (1) tools that managed care plans use to control costs; and (2) state initiatives that address concerns associated with managed care. GAO noted that managed care plans use a variety of tools to control costs, including: (1) shifting some financial risk to providers; (2) requiring plan permission to refer a patient to a specialist; and (3) providing for preventive care. GAO also noted that several states have enacted laws and regulations governing the operation of managed care plans in such areas as: (1) banning the practice of withholding a portion of doctors' fees as an incentive to control services; and (2) requiring that only licensed physicians make the final decision to deny care to managed care enrollees.

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