What is the Knox-Keene Act, and what are Knox-Keene plans?
The Knox-Keene Act is the California law that regulates and licenses managed care plans. It is designed to promote the delivery and quality of health and medical care to the people of California. It is the first and most extensive state law regulating HMOs and other health plans in the United States. All CAHP member plans have achieved Knox-Keene licensure. The California Department of Managed Health Care has the responsibility to oversee licensure and plans' compliance with state regulations.
What are managed care plans, and how do they benefit consumers?
Managed care plans provide the public with better and more cost-effective health care services by coordinating care among providers and focusing on tools that help prevent or manage debilitating conditions. These plans strive to keep costs down for all their members by spreading the coverage risk among a broader pool of consumers. Managed care plans employ various tools to provide better health care, including encouraging the use of evidence-based medicine, coordinating care through a primary physician and offering consumer support. Managed care plans use other mechanisms to reduce unnecessary health care costs, including cost controls, economic incentives and management of high-cost health care cases. Nearly 90 percent of insured Americans are enrolled in some form of managed care program, according to the America's Health Insurance Plans. Managed care is sometimes used as a general term for the activity of organizing doctors, hospitals and other providers into groups, such as Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs).