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P Mylin Study Stack

Additional for Chapter 3 - HI

Involves the development of patient care plans for the coordination and provision of care for complicated cases in a cost-effective manner Case Management
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
Includes activities that assess the quality of care provided in a health care setting quality assurance program
HEDIS Health Plan Employer Data and Information Set
EQRO external quality review organization
QISMC Quality Improvement System for Managed Care
NCQA National Committee for Quality Assurance
Medicare and many states prohibit managed care contracts from containing ______________ gag clauses
MSO Management Service Organization
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
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
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
The first known managed care program Ross-Loos Medical Group 1929Los Angeles Dept. of Water & Power
Which act of ligislation permitted large employers to self-insure employee health care benefits? (ERISA) of 1974: Employee Retirement Income Security Act
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
Created by: pmylin