Glossary
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- Balanced Budget Act of 1997
- The Balanced Budget Act, Pub. Law No. 105-33 (1997) included provisions designed to control the growth of Medicare spending through various payment reforms. The Act also expanded private health plan coverage options for Medicare beneficiaries by introducing Medicare Advantage.
- Balanced Budget Refinement Act of 1999
- The Balanced Budget Refinement Act, Pub. Law No. 106-113 (1999) modified the payment reductions of the Balanced Budget Act of 1997 by increasing payments for some Medicare providers, reducing or freezing payment rates for other Medicare services, and increasing payments to Medicare Advantage plans.
- Barrier to entry
- In an industry, any economic and/or technical factor or industry characteristic that creates a cost advantage for existing firms in the industry over new rivals.
- Behavioral Risk Factor Surveillance System
- A state-based system of health surveys established in 1984 by the Centers for Disease Control and Prevention (CDC), BRFSS collects information on health risk behaviors, preventive health practices, and health care access, primarily related to chronic disease and injury.
- Beneficiary
- An individual who receives, or may become eligible to receive, benefits under a health insurance policy.
- Benefit Based Co-payment
- A mechanism that sets cost-sharing levels according to patient health benefit rather than price. It is a way of achieving more appropriate clinical and financial outcomes by providing incentives for individuals to base their out-of-pocket drug expenditures on the clinical value of their medications. (See also value-based benefit).
- Beta-blocker
- A group of drugs that combine with and block the activity of a beta-receptor to decrease the heart rate and lower high blood pressure.
- Blue Cross and Blue Shield of Michigan (BCBSM)'s Participating Hospital Agreement (PHA) Incentive Program
- An incentive-based contract between BCBSM and a hospital that rewards hospitals that demonstrate achievement in three major categories: clinical quality, patient safety, and health of the community.
- Budget neutral
- With respect to government programs like Medicare and Medicaid, budget neutrality means that a change to the government program should not increase costs over the costs of the existing program. For example, payment rates under new rules should be adjusted to ensure that total spending remains constant, within a certain spending threshold.
- Bundled payment
- Use of a single payment for all services related to a treatment or condition, possibly spanning multiple providers in multiple settings. For example, a single payment could be made for coronary artery bypass graft (CABG) surgery, including pre-surgical services, facility and physician fees, and follow-up care. (Also referred to as case rates or episode-based payment).