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Part I: Terminology
 > Types of Managed Care

Common Definitions for Types of Managed Care

Managed Care defines certain types of care in order to better "manage" or control the provision and payment of care.

Primary Care includes the diagnosis, treatment and management of general medical conditions. Emphasis is on prevention through immunizations, wellness check-ups, screening services and education of patients. It is usually provided by family practice doctors, internists or general practitioners. The primary care physician focuses on wellness and providing routine care.

Primary Care Physician (PCP) serves as a gatekeeper controlling access to more expensive care or specialty services. This physician is often charged by the managed care plan with making referrals to specialists for plan members who need access to specialty care. Managed care organization enrollees are assigned or choose a primary care physician who coordinates and manages their medical care.

Specialty Care is care focused on dealing with the diagnosis and treatment of specific, nonroutine conditions. Medical services are received from specialists or physicians with additional training and education in a particular field of medicine such as cardiology, surgery, oncology or orthopedics.

Acute Care refers to the intensive services provided in a hospital setting or outpatient care facility, for serious or complex conditions.

Emergency Care refers to intensive services given in an emergency room or emergency care center. Care is administered to stabilize a patient’s medical condition and/or prevent loss of life or worsening the condition.

Chronic Care refers to non-acute care usually delivered in a nursing home, or out patient setting such as clinics, or by a home care organization. Care needed is for long-term duration for chronic, recurring conditions. An example would be skin ulcer therapy in a diabetic patient administered in the home by a licensed nurse.