Managed Care
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| Capitation | Method of payment for health services in which an individual or institutional provider is paid a fixed, per capita amount for each person enrolled without regard to the actual number or nature of services provided or number of persons served.
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| Carve-out | Contracts that separate out services or populations of patients or clients to decrease risk and costs.
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| Case Management | Coordination of individuals' care over time and across multiple sites and providers, especially in complex and high-cost cases. Goals include continuity of care, cost-effectiveness, quality, and appropriate utilization
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| Cherry-picking | Targeting the enrollment of healthy patients to minimize healthcare costs.
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| Closed panel | Type of health maintenance organization that provides hospitalization and physicians' services through its own staff and facilities (staff or group model)
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| Community rating | Method of determining healthcare premium rates by geographic area rather than by age, health status, or company size.
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| Cost sharing | Provision of a healthcare insurance policy that requires policyholders to pay for a portion of their healthcare services; a cost-control mechanism.
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| Disease management |
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| Dual eligivle |
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| Enrollee |
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| Episode-of-care reimbursement |
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| Evidence-based clinical practice guidelines |
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| Exclusive provider organization (EPO) |
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| Fee-for-service reimbursement |
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| Formulary |
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| Gatekeeper |
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| Global payment |
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| Group practice model |
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Created by:
Lyn Slough
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