Managed Care Glossary of Terms

(HPSA) Health Professional Shortage Area
A geographic area, population group, or medical facility that HHS determines to be served by too few health professionals of particular specialties. Physicians who provide services in HPSAs qualify for the Medicare bonus payments. This may also include re-payment of medical school loans or other incentives. These reports are published annually by HHS and can be of assistance to providers or groups wishing to recruit physicians to particular areas.

Health Resources and Services Administration
HRSA is a component of the U.S. Department of Health and Human Services. Included in HRSA responsibilities is administration of the Ryan White Care funds with a budget of about $1 billion/year to support a continuum of care services for persons with HIV infection.

(HSA) Health Service Agreement
Detailed explanation of procedures and benefits provided to an employer by a health plan.

HIPAA
See Health Insurance Portability and Accountability Act of 1996, above.

HL7
Health Level 7: An accredited Standards Developing Organization that produces standards for various healthcare domains (i.e. Pharmacies, medical devices, claims processing, etc.)

Hold Harmless Clause
A clause frequently found in managed care contracts whereby the HMO and the physician hold each other not liable for malpractice or corporate malfeasance if either of the parties is found to be liable. Many insurance carriers exclude this type of liability from coverage. It may also refer to language that prohibits the provider from billing patients if their managed care company becomes insolvent. State and federal regulations may require this language.

Home Health Care
Full range of medical and other health related services such as physical therapy, nursing, counseling, and social services that are delivered in the home of a patient, by a provider.

Horizontal Integration
Merging of two or more firms at the same level of production in some formal, legal relationship. In hospital networks, this may refer to the grouping of several hospital, the grouping of outpatient clinics with the hospital or a geographic network of various health care services. Integrated systems seek to integrate both vertically with some organizations and horizontally with others. See vertical integration.

Hospice
Facility or program providing care for the terminally ill.

Hospital
Any institution duly licensed, certified, and operated as a Hospital. In no event shall the term "Hospital" include a convalescent facility, nursing home, or any institution or part thereof which is used principally as a convalescence facility, rest facility, nursing facility, or facility for the aged.

Hospital Affiliation
A contractual agreement between an health plan and one or more hospitals whereby the hospital provides the inpatient services offered by the health plan.

Hospital Alliances
Groups of hospitals joined together to share services and develop group purchasing programs to reduce costs. May also refer to a spectrum of contracts, agreements or handshake arrangements for hospitals to work together in developing programs, serving covered lives or contracting with payers or health plans. See also Network, Integrated Delivery System, PHO, or Provider Health Plan.

Hospital Audit Companies
Retrospective audit providers that typically achieve a 15-20 percent savings of billed claims

Hospital Days (per 1,000)
A measurement of the number of days of hospital care HMO members use in a year. It is calculated as follows: Total Number Of Days Spent In A Hospital By Members divided by Total Members. This information is available through HHS, OHMO and a variety of sources.