What is the primary goal of a managed care program?

The primary goal of a managed care program is to contain costs by controlling participant behavior. Managed care organizations, such as Health Maintenance Organizations (HMOs) or Preferred Provider Organizations (PPOs), implement various strategies to manage the quality and cost of healthcare. One common strategy is to encourage participants to use a network of providers, which helps to negotiate lower rates and optimize the delivery of services. Additionally, managed care often includes practices such as prior authorization for certain treatments and a focus on preventive care, all designed to reduce unnecessary expenditures while ensuring that patients receive appropriate care.

This approach aims to create a more efficient healthcare system, which benefits both insurance providers and patients by keeping overall costs down. Thus, the focus on controlling participant behavior directly addresses the overarching goal of cost containment in the managed care structure.