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Show J Joint Commission on Accreditation of Healthcare Organizations (JCAHO) A national private, nonprofit organization whose purpose is to encourage the attainment of uniformly high standards of institutional medical care. Establishes guidelines for the operation of hospitals and other health facilities and conducts survey and accreditation programs. M Managed Care The body of clinical, financial and organizational activities designed to ensure the provision of appropriate health care services in a cost-efficient manner. Managed care techniques are most often practices by organizations and professionals that assume risk for a defined population. Medical Savings Account (MSA) An account in which individuals can accumulate contributions to pay for medical care or insurance. Medicare Risk Contract An agreement by an HMO or competitive medical plan to accept a fixed dollar reimbursement per Medicare enrollee, derived from costs in the fee-for-service sector, for delivery of a full range of prepaid health services. Morbidity The extend of illness, injury, or disability in a defined population. It is usually expressed in general or specific rates of incidence or prevalence. Mortality Death. Used to describe the relation of deaths to the population in which they occur. N National Committee for Quality Assurance (NCQA) A national organization founded in 1979 composed of 14 directors representing consumers, purchasers, and providers of managed health care. It accredits quality assurance programs in prepaid managed health care organizations, develops and coordinates programs for assessing the quality of care and service in the managed care industry. O Outcomes Research Research on measures of changes in patient outcomes, that is, patient health status and satisfaction, resulting from specific medical and health interventions. P Physician-Hospital Organization (PHO) A legal entity formed by a hospital and a group of physicians to further mutual interests and to achieve market objectives. A PHO generally combines physicians and a hospital into a single organization for the purpose of obtaining payer contracts. Doctors maintain ownership of their practices and agree to accept managed care patients according to the terms of professional services agreement with the PHO. The PHO serves as a collective negotiating and contracting unit. Point of Service A health insurance benefits program in which subscribers can select between different delivery systems (HMO, PPO, and fee-for-service) when in need of health care services, rather than making the selection between delivery systems at time of open enrollment at place of employment. Portability Requirement that health plans guarantee continuous coverage without waiting periods for persons moving between plans. Preferred Provider Arrangement (PPA) Selective contracting with a limited number of health care providers, often at reduced or pre-negotiated rates of payment. Preferred Provider Organization (PPO) Formally organized entity generally consisting of hospital and physician providers. The PPO provides health care services to purchasers usually at discounted rates in return for expedited claims payment and somewhat predictable market share. 124 Glossary |