Managed Care Terms

Question 1

Who or What is:

AHRQ

Answer 1

Agency for Healthcare Research and Quality (AHRQ): The lead federal agency (one of 12 within the Dept. of Health & Human Services) charged with improving the quality, safety, efficiency, and effectiveness of healthcare for all Americans

Question 2

Define:

Adjusted Per Capita Cost

Answer 2

(APCC) - Medicare benefits estimation for a person in a given county using sex, age, institutional status, Medicaid disability, and end stage renal disease status as a basis.

Question 3

What is the . . .

Agency for Health Care Policy and Research

Answer 3

(AHCPR) - The agency of the Public Health Service responsible for enhancing the quality, appropriateness and effectiveness of health care services

Question 4

Define:

Cost Minimization Analysis

Answer 4

(CMA) - An assessment of the least costly interventions among available alternatives that produce equivalent outcomes.

Question 5

Define:

Quality-adjusted life year

Answer 5

(QUALY): A universal health outcome measure applicable to all individuals and all diseases that allows for comparisons across diseases and interventions

Question 7

Define:

Managed Behavioral Health Organization

Answer 7

(MBHO) An organization that provides behavioral health services by implementing managed care techniques.

Question 8

Define:

PCORI

Answer 8

Patient-Centered Outcomes Research Institute (PCORI): An independent organization created to help patients, clinicians, purchasers and policymakers make better informed health decisions

Question 9

Define:

Shadow Pricing

Answer 9

Within a given employer group, pricing of premiums by HMO based upon the cost of indemnity insurance coverage, rather than strict adherence to community rating or experience rating criteria.

Question 10

Define:

TRICARE Prime

Answer 10

An enrollment-based managed care option designed to provide coordinated care managed by a primary care manager, who is similar to a primary care provider in a commercial HMO

Question 11

Who are the eligible benficiaries of TRICARE Prime?

Answer 11

Eligible Beneficiaries

• Active duty service members and their families Retired service members and their families*
• Activated National Guard/Reserve members and their families
• Non-activated National Guard/Reserve members and their families who qualify for care under the Transitional Assistance Management Program
• Retired National Guard/Reserve members (age 60 and receiving retired pay) and their families*
• Survivors Medal of Honor recipients and their families Qualified former spouses