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In these patients, intravenous therapy, for example, is administered at the patients residence, usually by a health care professional. Prospective per-case payment rates are set at a level intended to cover operating costs in an efficient hospital for treating a typical inpatient in a given diagnosis-related group. Cautionary Statement This news release includes forwardlooking statements within the meaning of the Private Securities Litigation Reform Act of 1995.

It sets minimum standards for regulation of the small group insurance market and for a set group in the individual insurance market in the area of portability and availability of health insurance. Group Model In the group-model HMO, the HMO contracts with a physician group, which is paid a fixed amount per patient to provide specific services. See also Vertical Integration.

Step Therapy The practice of beginning drug therapy for a medical condition with the most cost-effective and safest drug, and stepping up through a sequence of alternative drug therapies as a preceding treatment option fails. . A tendency for utilization of health services in a population group to be higher than average or the tendency for a person who is in poor health to be enrolled in a health plan where. If a beneficiary receives service from an out of network provider, the health plan (other than Medicare) may pay for the service at a reduced rate or may not pay at all.