Each primary care physician of a managed care plan receives a specific amount each month for each member who selects that physician as his or her primary care physician. See capitation (cap or CAP).

Managed care option under Section 1915(b) of the Social Security Act. In the Medicaid program, this lets states contract directly with primary care providers who agree to provide medical services to Medicaid recipients and authorize specialty care. In this system the state pays the primary care physician a monthly case management fee, as well as fee-for-service (FFS).

Usually a physician, physician group practice, or an entity employing or having other arrangements with such physicians, but sometimes also including nurse practitioners, nurse midwives, or physician assistants who contract to locate, coordinate, and monitor covered primary care and sometimes additional services.

1. In a managed care plan, individual who gives and coordinates members’ health care and makes referrals to specialists when necessary. 2. In TRICARE, physician who is responsible for coordinating and managing all the beneficiary’s health care unless there is an emergency.

Panel of providers focused on giving primary care services to patients of a managed care plan.

Physician (e.g., family practitioner, general practitioner, pediatrician, obstetrician/gynecologist, general internist) who sees patients first for most health problems, who oversees the care of patients in a managed health care plan (HMO or PPO), and who refers patients to specialists (e.g., cardiologist, oncologists, surgeons) for services as needed. Also known as a gatekeeper, primary care doctor, or primary care practitioner.