Provider whose opinion or advice regarding evaluation and/or management of a specific problem is requested by another physician. This may involve either examining the patient or the patient’s medical record.

In the area of health care, an individual who may receive medical services, such as a patient or a member of a managed care plan. Also called health care consumer.

Annual national survey that releases information on Medicare beneficiaries’ experiences and satisfaction with receiving care in managed care plans.

Regional, private, nonprofit components of managed care systems that purchase health care benefit packages for small employers and individuals. They act as cooperatives between government and the public so that health plans in a region conform to federal benefits and quality standards and keep costs within a mandated budget. They enroll individuals, collect premiums, purchase enrollee’s insurance from participating health plans, and enforce rules that manage health plan competition. Also referred to as alliances, health insurance purchasing cooperatives (HIPCs), health insurance purchasing corporations, health alliances, regional health alliances, health plan purchasing cooperatives (HPPC), or purchasing group.

Economic barometer used by the Department of Labor Statistics to measure the average change in prices over time in a fixed group of goods and services. In this report, all references to the CPI relate to the CPI for urban wage earners and clerical workers (CPI-W).

Communication of information that pertains to a consumer’s credit standing, credit capacity, general reputation, or personal characteristics.

Organization that prepares consumer reports and provides them either for profit or on a nonprofit basis to other persons or organizations. Also called a credit reporting agency.

Information collected through survey or focus groups. Surveys may include Medicaid beneficiaries currently or previously enrolled in a managed care organization (MCO) or prepaid health plan (PHP). The survey may be conducted by the state or a contractor to the state.

Information collected through a survey of those Medicaid beneficiaries who are enrolled in the program and have used the services. The survey may be conducted by the state or managed care entity (if the managed care entity reports the results to the state).

Type of health insurance plan that places more control of health care into the consumer’s hands. These plans have high deductibles that the patient must pay; thus it is important that the provider collect the deductible and coinsurance amounts. Also see health reimbursement account (HRA) and health savings account (HSA).