The broad range of activities that a managed care organization and its employees undertake to support the delivery of the promised benefits to members and to keep them satisfied with the company.

A combination of at least two managed care organizational models that are melded into a single health plan. Since its features do not uniformly fit one model, it is called a hybrid.

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The basis for Health Maintenance Organization (HMO) or Competitive Medical Plan (CMP) reimbursement under Medicare-risk contracts. The average monthly amount received per enrollee is currently calculated as 95 percent of the average costs to deliver medical care in the fee-for-service sector. It is the Centers for Medicare & Medicaid Services’ [..]

The leading national association of preferred provider organizations (PPOs) and affiliate organizations, and was established in 1983 to advance awareness of the benefits — greater access, choice and flexibility — that PPOs bring to American health care. 

A patient’s ability to obtain medical care determined by the availability of medical services, their acceptability to the patient, the location of health care facilities, transportation, hours of operation, and cost of care.

The balance of money owed to a client by others. 

The process by which an organization recognizes a program of study or an institution as meeting predetermined standards. Three organizations that accredit managed care plans are the National Committee for Quality Assurance (NCQA), URAC and the Joint Commission.

See Rating, Adjusted Community Rating

A person trained in statistics, accounting and mathematics who conducts statistical studies such as determining insurance policy rates, dividend reserves and dividends, as well as conducts various other statistical studies.