Youth Health Enters Age of Managed Care: Definitions

Heather Szerlag
November 1, 1995

Capitation — a managed care reimbursement mechanism, when a provider receives a fixed per capita payment in exchange for providing services to each person in the health plan.

Fee for service — payment made to the provider at the time each service is provided. Fee-for-service payment is the opposite of capitation; it is generally not a managed care concept.

Forms of managed care —in the alphabet soup of managed care providers, acronyms include:

HIO -- health insurance organization.

HMO — health maintenance organization.

Network — the group of identified health service providers to which a managed care plan directs patients/clients.

Outcome Measurement — system of determining the efficacy of treatment and client satisfaction.

PCCM — primary care case management.

Privileging — a form of treatment allows counselors to continuously manage patient progress, moving with the patient from program to program.

Risk — in managed care, the chance of not being fully reimbursed for services provided.

Single point of entry — a key characteristic of managed care; individuals gain access to services through a primary health care provider who decides what additional services are needed.

Utilization management — a system of reviewing and approving care that is characteristic of managed care, of care, or will they succumb to the system's negatives: too great a focus on profits and an economy of scale that tends toward the monolithic. That is the 64 billion dollar question.

*most of the definitions were taken from Managed Care: An Agency Guide to Surviving and Thriving

Szerlag, Heather. "Youth Health Enters Age of Managed Care: Definitions." Youth Today, November/December 1995, p. 34.

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