| D |
| Day
Outlier |
Top |
A
patient with an atypically long length of stay
compared with other patients in a particular
diagnosis related group. |
| Days
(Or Visits) Per 1,000 |
Top |
An
indicator calculated by taking the total number
of days (for inpatient, residential, or partial
hospitalization) or visits (for outpatient)
received by a specific group for a specific
period of time (usually one year). This number
is then divided by the average number of covered
members or lives in that group during the same
period and multiplied by 1,000. A measure used
to evaluate utilization management performance. |
| Deductibles |
Top |
Amounts
required to be paid by the insured under a
health insurance contract, before benefits
become payable. |
| Dependent |
Top |
In
a payer's policy of insurance, a person other
than the subscriber eligible to receive care
because of a subscriber's contract. |
| Diagnosis
related groups (DRGs) |
Top |
A
patient classification scheme used by Medicare
that clusters patients into 468 categories on
the basis of patients' illnesses, diseases and
medical problems. |
| Direct
Contracting |
Top |
Providing
health services to members of a health plan by a
group of providers contracting directly with an
employer, thereby butting out the middleman or
third party insurance carrier. This can be
provider heaven, since middleman-MCO-is cut out
and provider gets some portion of the money
usually made by it. Key is to price services
correctly, since provider is usually at full
risk in this situation. Takes a strong IDS or
AHP to pull this off. |
| Direct
Payment Subscriber |
Top |
A
person enrolled in a prepayment plan that makes
individual premium payments directly to the plan
rather than through a group. Rates of payment
are generally higher, and benefits may not be as
extensive as for the subscriber enrolled and
paying as a member of the group may. |
| Discounted
Fee-For-Service |
Top |
An
agreed upon rate for service between the
provider and payer that is usually less than the
provider's full fee. This may be a fixed amount
per service, or a percentage discount. Providers
generally accept such contracts because they
represent a means to increase their volume or
reduce their chances of losing volume. |
| Disease
Management |
Top |
A
type of product or service now being offered by
many large pharmaceutical companies to get them
into broader healthcare services. Bundle use of
prescription drugs with physician and allied
professionals, linked to large databases created
by the pharmaceutical companies, to treat people
with specific diseases. The claim is that this
type of service provides higher quality of care
at more reasonable price than alternative,
presumably more fragmented, care. The
development of such products by hugely
capitalized companies should be the entire
indicator necessary to convince a provider of
how the healthcare market is changing.
Competition is coming from every
direction--other providers of all types, payers,
employers (who are developing their own in-house
service systems), the drug companies. |
| Dual
Choice (Multiple Choice, Dual Option) |
Top |
The
opportunity for an individual within an employed
group to choose from two or more types of health
care coverage such as an HMO and a traditional
insurance plan. Section 1310 of the HMO Act
provides for dual choice. |
| Durable
Medical Equipment (DME) |
Top |
Equipment
which meets the following criteria:
A) Can withstand repeated use.
B) Is primarily and customarily used to serve a
medical purpose.
C) Generally, is not useful to a person in the
absence of illness/injury.
D) Is appropriate for home use. |
