A provision in a contract in which a health care provider is restricted in speaking about an insurer or their financial arrangement.
Healthcare providers that are able to reduce costs while still meeting quality standards are allowed to share in the savings.
A colloquial term for a primary care physician who is responsible for coordinating patient care and referring the patient to specialists. Many insurance programs, particularly HMOs, require a referral from a "gatekeeper" before covering visits to specialists.
Also known as primary care providers or family doctors, these doctors do not have specialist training and offer a wide range of basic health care services.
Prescription drugs with the same chemical make-up as a drug that went through the full FDA approval process that are sold under a different name and usually by a different company than the maker of the original drug.
A method of constraining costs wherein multiple providers are expected not to exceed a certain spending target (for example, the SGR), or where a provider is given a “global budget” to provide care for a certain population.
The second highest actuarial level health plans available through the insurance exchanges, equal to an 80 percent actuarial value. Bronze, Silver, and Platinum plans offer varying actuarial values.
Government Accountability Office (GAO)
The audit, evaluation and investigation arm of the U.S. Government.
Government Performance Results Act
A federal law that targets waste and fraud in federal programs.
Graduate Medical Education (GME)
Residency training programs that are often supported, at least partially, by Medicare.