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In theses managed –care contractual relationships, sponsors such as employers, negotiate contracts with insurers to obtain medical coverage fro the individuals they represent. Insurers negotiate contracts with health-care service providers, such as hospitals, to establish terms of payment for services rendered for covered individuals...
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In addition to insurers, payor’s include government programs, such as Medicare ad Medicaid, that provide coverage for the elderly and disabled, and low-income groups. Payment flows directly or indirectly from individuals to sponsors to insurers to providers.
Risk traditionally was an area of focus for the insurers...
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