Which term identifies a healthcare plan with established cost controls designed to improve quality of care?

• A. FPL
• B. Dual Eligibles
• C. MCOs
• D. HRRP

Answer: (C)

Managed care is a healthcare plan model that uses established cost controls to improve quality of care. In a managed care organization, costs are controlled through negotiated rates with a network of providers, capitation or bundled payments, and utilization management such as preapprovals and referrals. Care is coordinated by primary care gatekeepers, with an emphasis on preventive services, care coordination, and case or disease management. Quality is pursued through ongoing performance measurement and quality-improvement programs, tying incentives to better outcomes and value.

That combination—cost controls plus a structured approach to care coordination and quality improvement—defines a plan designed to manage overall value in health care. The other options refer to different concepts: one is a poverty guideline, another describes people eligible for both Medicare and Medicaid, and the last is a program aimed at reducing hospital readmissions, not a care plan.