| O |
| Open
Enrollment |
Top |
The
annual period during which people in a
"dual choice" health benefits program
can choose among the two (or more) plans being
offered. Also the period during which a
federally qualified HMO must make its plan
available without restrictions to individuals
who is not part of a group. |
| Organized
Care System |
Top |
Often
used to discuss a more evolved form of IDSs and
CCNs, this relatively new term describes the
result of mergers and alliances between and
among physicians, health systems, and managed
care organizations. These systems often have the
same performance imperatives as IDSs and CCNs:
improve health status, integrate delivery,
demonstrate value, improve efficiency of care
delivery and prevention, and meet patient and
community needs. |
| Outcome |
Top |
This
term has been used to mean different things to
different people. It can refer to the following:
Changes in birth and death rates for a global
population, for example, residents of a state.
The "outcome" or finding of a given
diagnostic procedure.
The results for a patient after care, for
example, how long it took to restore the
patient's ability to walk or to work. |
| Outcome
Management |
Top |
A
clinical outcome is the result of medical or
surgical intervention or nonintervention. It is
thought that through a database of outcome
experience, caregivers will know better which
treatment modalities result in consistently
better outcomes for patients. Outcome management
may lead to the development of clinical
protocols. |
| Outlier |
Top |
A
patient whose length of stay or treatment cost
differs substantially from the stays or costs of
most other patients in a diagnosis related
group. |
| Outlier
thresholds |
Top |
The
day and cost cutoff points that separate inlier
patients from outlier patients. |
| Out-of-Area |
Top |
Refers
to the treatment given an HMO member outside the
geographical limits of his own HMO. The coverage
generally is restricted to emergency services. |
| Outpatient
Care |
Top |
Care
given a person who is not bedridden. |
