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HEALTH Market - Managed Care
Managed Care: Managed care refers to a model of health care in which services are provided to members of a health care plan in a coordinated manner designed to promote increased quality of care, disease management, and cost control. Managed care has come to replace traditional fee-for-service programs as the dominant way of providing health care services. In Hawai'i, as in the rest of the nation, the two dominant types of managed care organizations are health maintenance organizations and preferred provider organizations.

Health Maintenance Organizations (HMOs): Health maintenance organizations are health plans that contract with medical groups to provide a full range of health services for their enrollees for a fixed pre-paid, per-member fee. Nearly 35 percent of Hawai'i residents with insurance were enrolled in an HMO in 2007. Of these HMO enrollees, one out of three participates with one of the QUEST plans.

Preferred Provider Organizations (PPOs): Preferred provider organizations are health plans that arrange for health care through a network of preferred providers--health professionals who agree to provide medical services to plan members for contracted reimbursement. Plan members may obtain "out of network" medical services from nonparticipating medical professionals, but are charged higher co-payments for this option. Almost forty percent of Hawai'i's residents were enrolled in a PPO in 2007.

Traditional Fee-for-Service: Traditional fee-for-service insurance is a health insurance plan that reimburses physicians and hospitals for each individual service provided. These plans allow consumers to choose any physician or hospital. Traditional fee-for-service coverage declined by 63 percent between 1992 and 2007, and currently makes up 11 percent of covered lives. All of the fee-for-service covered lives were covered by either Medicare or Medicaid. Both the federal and state governments are in the process of changing coverage for these populations to managed care options.


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Summary
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> Health Plans, by Type, Hawai`i
> Government Coverage, by County
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> Coverage Type, by Age Group, Hawai`i
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  Managed Care
Continuum Table
Source: AlohaCare.; Hawaii Management Alliance Association.; Hawaii Medical Service Association.; Kaiser Permanente.; MDX Hawaii.; University Health Alliance.; Hawai`i State Department of Human Services, MedQUEST Division.; Health Trends in Hawai`i, eds. 1-6.; Centers for Medicare and Medicaid Services.
Note: Covered lives are the individuals "covered" by a health plan. 2003 Medicare and Medicare (FFS) covered lives are assumed for 2004. Under managed care, the health plan is accountable for its ability to support the health status of its covered lives, as well as for treating its members who are sick.
Source: AlohaCare.; Hawaii Medical Service Association.; Kaiser Permanente.; Hawai`i State Department of Human Services, MedQUEST Division.; Health Trends in Hawai`i, eds. 1-6.; Centers for Medicare and Medicaid Services.
Note: Covered lives are the individuals "covered" by a health plan. Government coverage includes any plan funded by the government. Coverage by county available beginning 2005. (Previous years not available.)
Source: Hawaii Management Alliance Association.; Hawaii Medical Service Association.; Kaiser Permanente.; University Health Alliance.
Note: Coverage by county available beginning 2005. (Previous years not available.) Covered lives are the individuals "covered" by a health plan.
Source: AlohaCare.; Hawaii Management Alliance Association.; Hawaii Medical Service Association.; Kaiser Permanente.; University Health Alliance.; Hawai`i State Department of Human Services, MedQUEST Division.; Health Trends in Hawai`i, eds. 1-6.; Centers for Medicare and Medicaid Services.
Note: Government coverage for age group available beginning 2005, previous years not available. Government coverage includes any plan funded by the government.