In managed care, which role does a gatekeeper primarily serve?

The role of a gatekeeper in managed care primarily serves as a care coordinator. In this context, the gatekeeper is usually a primary care physician (PCP) responsible for overseeing and managing a patient's healthcare needs. This includes directing patients to specialists, coordinating referrals, and ensuring that the necessary tests or services are provided. By doing so, the gatekeeper plays a vital role in managing healthcare costs and ensuring that patients receive appropriate and timely care.

The gatekeeper's involvement helps in maintaining a streamlined approach to health services, which is essential in managed care programs. The coordinated care provided by a gatekeeper helps prevent unnecessary procedures and reduces the potential for fragmented treatment, which can lead to increased healthcare costs. By taking on the responsibility of coordinating care, the gatekeeper ensures that patients receive holistic treatment that aligns with their healthcare plan.

The other roles, such as payment processor, insurance underwriter, and patient advocate, do not align with the primary responsibilities of a gatekeeper. Payment processors focus on the financial aspects of claims and billing; insurance underwriters assess risk and determine coverage terms; and patient advocates support patients in navigating the healthcare system, but do not typically manage care directly.