Certified Revenue Cycle Representative (CRCR) Practice Exam

Why do managed care plans have agreements with healthcare providers?

1. To limit patient numbers in practices

2. To improve access to quality healthcare

3. To enhance provider incomes

4. To increase administrative efficiencies

The correct answer is: To improve access to quality healthcare

Managed care plans establish agreements with healthcare providers primarily to improve access to quality healthcare for their members. By forming these partnerships, managed care organizations can create networks of providers that ensure patients receive coordinated, efficient care. These agreements typically involve setting forth standards for care quality, accessibility, and preventive services, which leads to comprehensive health management. Managed care plans focus on delivering value-driven healthcare, emphasizing health outcomes and patient satisfaction. This is achieved through a network of providers who agree to provide care at negotiated rates, making it easier for patients to receive necessary treatments and preventive services without facing excessive costs. The focus on improving overall healthcare access is not only beneficial for patients but also aids in managing costs effectively for the healthcare system as a whole. Though there are other considerations such as enhancing provider incomes, increasing administrative efficiencies, and managing patient volumes, the core purpose of these agreements is centered on enhancing the quality and accessibility of healthcare services for plan members.