Additional for Chapter 3 - HI
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| Involves the development of patient care plans for the coordination and provision of care for complicated cases in a cost-effective manner | Case Management
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| Responsible for the health of a group of enrollees and can be a health plan, hospital, physician group, or health system | (MCO) Managed Care Organization
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| Includes activities that assess the quality of care provided in a health care setting | quality assurance program
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| HEDIS | Health Plan Employer Data and Information Set
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| EQRO | external quality review organization
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| QISMC | Quality Improvement System for Managed Care
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| NCQA | National Committee for Quality Assurance
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| Medicare and many states prohibit managed care contracts from containing ______________ | gag clauses
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| MSO | Management Service Organization
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| An organization of affiliated providers' sites (hospital, ambulatory surgical centers, or physician groups) that offer joint health care services to subscribers | (IDS) Integrated Delivery System
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| An alternative to traditional group health insurance coverage and provides comprehensive health care services to voluntarily enrolled members on a prepaid basis | (HMO) Health Maintenance Organization
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| Is usually offered either by a single insurance plan or as a joint venture among two or more insurance carriers, provides subscribers or employees with a choice of HMO, PPO, or traditional health insurance plans | triple option plan
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| The first known managed care program | Ross-Loos Medical Group 1929Los Angeles Dept. of Water & Power
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| Which act of ligislation permitted large employers to self-insure employee health care benefits? | (ERISA) of 1974: Employee Retirement Income Security Act
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| Allows individuals to withdraw tax-free funds for health care expenses that are not covered by a qualifying high-deductible health plan | MSA - Medical Savings Account
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