A fixed payment to provide health care services to an individual for a set period of time, regardless of the actual number or nature of services provided.
A payer strategy in which an insurerisolates (“carves out”) a benefit and hires another organization to provide this service. Common carve-outs include behavioral health and prescription drugs. The technique is intended to allow the insurer to better...
A process in which a health plan identifies covered persons with specific health care needs, then devises and carries out a plan to achieve the best patient outcome in the most cost-effective manner.
The mix of patients treated within a particular institutional setting, such as a hospital or within a particular health plan. Case mix may be measured by the severity of patients’ illnesses or the prospective use of care resources.