19 Terms
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Managed care
A health care practice intended to streamline services and provide high quality, cost-effective care.
Industry: Health care
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Managed care
cost of risk (COR)
Health care; Managed care
A measurement of the total costs associated with providing health or managed medical care insurance, for the payer or underwriter.
bed days
Health care; Managed care
A measurement used by managed care plans to indicate the total number of days of hospital care provided to a member of a health or managed care plan.
age/sex factor
Health care; Managed care
A measurement used in underwriting. It represents the age and sex risk of medical costs of one population relative to another. A group with an age or sex factor of 1.00 is average. A group with an ...
volume performance standards (VPS)
Health care; Managed care
A mechanism to adjust updates to fee-for-service payment rates based on how actual aggregate.
primary care case management (PCCM)
Health care; Managed care
A Medicaid managed care program in which an eligible individual may use services only with authorization from his or her assigned primary care provider. That provider is responsible for locating, ...
qualifying individuals
Health care; Managed care
A Medicaid-sponsored program for those who need assistance paying Part B Medicare health insurance premiums.
cost outlier
Health care; Managed care
A medical case that is more costly to treat compared with other patients in a particular diagnosis-related group. Outliers also refer to any unusual occurrence of cost, cases that skew average costs, ...
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