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Managing Managed Care Quality Improvement in Behavioral Health (1997) / Chapter Skim
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GLOSSARY
Pages 255-260

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From page 255...
... Accreditation An official decision made by a recognized organization that a health care plan, network, or other delivery system complies with applicable stan' cards. Adverse selection Individuals enrolling in health plans tend to select plans that will best suit their expected health care needs, and individuals with a greater chance of needing particular kinds of care will select health care plans with generous benefits for those services.
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From page 256...
... Credentialing The process of assessing and validating the qualifications of a licensed independent practitioner to provide member services in a health care network or its components. The determination is based on an evaluation of the individual's current license, education, training, experience, current competence, and ability to perform privileges requested.
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From page 257...
... Deemed status A method of quality assurance in which public agencies hold an organization accountable to standards developed by, for example, a nonprofit accreditation organization. For example, Health Care Financing Administration requires hospitals to conform to the Joint Commission on Accreditation of Healthcare Organizations standards to receive Medicare reimbursement.
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From page 258...
... Privileging The process of authorizing by an appropriate authority (e.g., a governing body, where one exists) in a component of a health care network or by the network itself a practitioner to provide specific patient care services in the component or the network, as appropriate, within defined limits, on the basis of an individual practitioner's license, education, training, experience, competence, ability to perform assigned tasks, and judgment (ICAHO, 1996, p.
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From page 259...
... Recovery A term used by some individuals and groups to refer to the process of making a commitment to change personal behaviors in order to overcome addiction. Thus, an individual who has chosen to make changes is "in re' covery." Report card on health care An emerging tool that can be used by policy makers and health health care purchasers, such as employers, government bodies, employer coalitions, and consumers, to compare and understand the actual performance of health plans.
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From page 260...
... 1994. The Managed Care Resource: The Language of Managed Health Care and Organized Health Care Systems.
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Key Terms

  • united healthcare
  • healthcare corporation
  • health plans
  • joint commission
  • healthcare organizations

  • national committee
  • care services
  • care network
  • substance abuse
  • assistance professional

  • review criteria
  • maintenance organization
  • health plan
  • standards manual
  • practice guidelines

  • care delivery
  • health maintenance
  • patient care
  • licensed independent
  • care standards

  • employee assistance
  • professional association
  • interpersonal aspects
  • enrolled population
  • standalone basis

  • organized health
  • care financing
  • care practitioner
  • care term
  • desired health


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