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PPOs grow with trend toward managed care
The health care industry has learned to compete on price by giving discounts to major buyers, offering multiple products and mastering the art of marketing. Now in the 1990s comes the era of managed care, or as some are now calling it, "coordinated care" because it is a "kinder and gentler" term.
Managed-care strategies are increasingly being implemented by insurance carriers, third-party administrators, benefits consultants, health maintenance organizations (HMOs), preferred provider organizations (PPOs) and employers. These strategies include working with health care providers to obtain the proper care at the proper price through cost containment.
Prior approval for non-emergency or non-maternity hospital stays are common. Most plans include guidelines for second surgical opinions, outpatient surgery and home health care. These managed-care components have a strong track record in eliminating duplicate testing and …