# Managed Care **Managed care** is the dominant model of U.S. health insurance, in which an insurer (a managed-care organization, or MCO) actively manages the cost and utilization of care rather than simply paying bills. The levers are provider **networks**, **[[Prior Authorization]]**, formularies, and risk-based payment that puts the insurer at financial risk for a defined population. The big MCOs — [[UnitedHealth Group]], [[Elevance Health]], [[Humana]], [[Centene]], [[CVS Health]], [[Cigna]], and the nonprofit [[Kaiser Permanente]] — now sit between patients, providers, and drugmakers in nearly every coverage segment. ## The Loaded Core The defining tension is that **cost control and care denial are the same mechanism viewed from two sides**. Tools meant to curb waste — prior authorization, network restrictions, [[Claim Denial]] — also function as profit levers, since money not spent on care ("medical loss ratio") flows to margin. That tension exploded into public rage after the [[UnitedHealthcare CEO Shooting]] and underlies the entire payer-side critique in the [[Healthcare Industry Ecosystem]]. In public programs, the model is implemented as Medicaid managed care and [[Medicare Advantage]].