Consumer Driven Care Learning Center
The Consumer Driven Care Learning Center and newsletter, brought to you by MCOL, have been developed to provide a resource for health care professionals interested in Consumer Driven Care and related programs.
| Term | Definition |
|---|---|
| Account Administrator | The organization responsible for the administration of an applicable spending or savings account. Such organizations could include a health plan, third party administrator, or financial institution. |
| Account Integration | The processes in place in a consumer driven health plan that attempt to make the consumer and other interfaces between the applicable spending or savings account, and the high deductible health plan, as seamless as possible. |
| Benefits Cycle | The concept that in the consumer choice environment, future marketplace competition between health plans will not cause major fluctuations in premium increases that have historically occurred over periods of time (see Premium Cycle) and instead will cause periods of increased or decreased cost sharing and benefit coverage based upon economic conditions. |
| Concierge Care | Physician or other provider services that typically involve an upscale packaging of services to a patient population in a non-managed care environment. |
| Consumer Choice Health Care | See Consumerism |
| Consumer Driven Health Plan | Involves a combination of an tax advantaged and funded spending or savings account with a high deductible insurance policy |
| Consumerism | The delivery of health care services, information or benefits that is rendered in a more consumer-oriented fashion, with the focus on engaging and empowering consumers more in clinical decision making, in the financing of the care, and in enhancing consumer knowledge about their health care. |
| Convenient Care | See Retail Clinics |
| Customized Health Plans | A Customized Health Plan offers a variable plan of benefits, and or participating provider networks, which a consumer may select from within the plan, during an open enrollment period, so that the plan premium price is determined by the variable options selected by the consumer. |
| Debit Card | A health care debit card involves issuance of card to participants in a qualified health care spending or savings account (such as HRAs, MSAs or FSAs) that can be presented to providers to transfer funds from the applicable account to the provider for payment of health care services rendered to the participant. In order for such accounts to properly qualify for tax advantaged treatment, the administration of the debit card payments must meet various IRS provisions. |
| Decision Tools | Decision support provided by plans, administrators or third parties, typically web-enabled, that assist consumers in providing information under different options and scenarios for such functions as provider selection, provider pricing, clinical treatment options, out of pocket expense calculation, benefit option selection and various other items. |
| Defined Contribution Health Plan | A health plan funding arrangement whereby an employee is given a specified dollar amount each period from an employer or union to purchase health plan coverage or health care services from various available option |
| Design Your Own Plan | A Customized Health Plan offers a variable plan of benefits, and or participating provider networks, which a consumer may select from within the plan, during an open enrollment period, so that the plan premium price is determined by the variable options selected by the consumer. |
| Flexible Spending Account | A plan which provides employees a choice between taxable cash and non-taxable benefits for un-reimbursed health care expenses or dependent care expenses that can not roll over from year to year |
| FSA | A plan which provides employees a choice between taxable cash and non-taxable benefits for un-reimbursed health care expenses or dependent care expenses that can not roll over from year to year , and has qualified under Section 125 of the IRS code. |
