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15 Cards in this Set

  • Front
  • Back
Group model HMO
HMO contracts with one more than one medical practice
Gag Rule
Clause in managed care contract that prohibits provider from discussing coverage the plan
Joint venture
Multiple Organizations share resources to create a new organization to pursue a commom purpose
Addition of new services that the organization has not offered before.
Any willing provider
Law preventing the exclusion of an MD from a managed care plan when he meets the criteria
Vertical Integration
Growth stragedy linking of services that are in different stages in the production process of health care
Federal and State laws that make it illegal to forma system that stifles competition
Type of MCO that has a panel of preferred providers paid acording to their discounting fee schedule
Virtual Integration
Type of intergrated based on contractual aggreements rather than actual merging inot one company
Joint agreement between organizations to share resources without joint ownership of resources
Quasi- MCO where the risk is borne by MD's & Hospitals to compare with MCO's
Horganizational integration
Growth stredegy in which core product or services are extended, often geographically
Unification of two or more organizations into one through mutual agreement
IPA Model
HMO contracts with more than one medical group practice
Purchase of one organization by another