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Thursday, July 31

Minimum Medical Loss Ratio for Insurers

Ratio of insurance expenditures used on care as opposed to administrative or other costs. Under ACA insurance companies are required to issue rebates to consumers if too large a share of the expenditures are allocated to costs not directly associated with care (max of 15% for large group plans, max of 20% for individual or small group plans).

Wednesday, July 30

Payment Error Rate Measurement (PERM)

The measure of the improper payments of Medicaid and CHIP, which results in an error rate for each program. These rates are based on multiple factors; fee-for-service (FFS), managed care and eligibility sections of Medicaid and CHIP in the fiscal year under review.

Tuesday, July 29

Aligning Incentives

Aligning incentives refers to an effort to pay for the actions that provide value (such as good quality care, care coordination, and the like) and thus incentivize medical providers to make decisions toward that aim. Currently, the fee-for-service system incentivizes providers to provide services whether they are beneficial or not.

Monday, July 28

Primary Care

Care given at the initial point of contact with the health care system - usually a general practitioner or family physician. This provider may then coordinate with other professionals (surgeons, specialists, etc.).

Friday, July 25

High-Risk Pool

State programs aimed at offering health insurance to individuals considered uninsurable and unable to buy coverage on the individual market.

Center for Disease Control (CDC)

A federal agency under HHS that focuses on prevention and control of diseases, both communicable and chronic.