1.7 Models of Care

Question 1

providers in _____ _____ _____ (ACOs) are held jointly accountable for delivering care more efficiently by _____ ______ _______ ______ and reductions in the rate of spending growth.

Answer 1

Accountable Care Organizations, achieving measured quality improvements

Question 2

in ACOs, unlike _____s, patients are free to select which medical services they receive and from whom.

Answer 2

HMO

Question 3

Core Components of ACO model of care:
1. 
2. 
3. 
4.

Answer 3

1. provider led, strong base in primary care
2. all providers, across the full continuum of care, are accountable for quality and cost related to a population of patients
3. Payments are linked to quality improvements that reduce overall costs
4. performance is measured

Question 4

Medicare ACO is formed by a group of _____, _____, and other healthcare providers who come together voluntarily to give coordinated, high quality care to the Medicare Fee-for-service beneficiaries they serve.

Answer 4

Doctors, Hospitalists

Question 5

To evaluate the healthcare quality performance of an ACO, CMS has established ACO _____ ______.

Answer 5

Quality measures

Question 6

CMS has established ACO Quality Measures. There are 33 quality measures in 4 domains:
1. 
2.
3.
4.

Answer 6

1. patient/caregiver experience
2. care coordination/patient safety
3. preventative health
4. At-Risk population

Question 7

provides comprehensive care for children, youth, and adults. This healthcare setting facilitates long-term partnerships between patients, their personal physicians, and when appropriate, patient’s families.

Answer 7

Patient-Centered medical Home

Question 8

Unlike the _____ , ______ is a single practice.

Answer 8

ACO, Patient Centered Medical Home (PCMH)

Question 9

Principles of the Patient-Centered Medical Home (there are 9)

Answer 9

1. personal physician- coordinates all the care
2. physician directed medical practice- personal dr leads a team of practicing healthcare providers
3. whole person orientation- dr. provides for the patients entire healthcare needs
4. Care is coordinated/integrated across all elements
5. Enhanced access to care (open scheduling, expanded hours, etc)
6. Evidence based medicine
7. Physician accepts accountability for quality improvements
8. Patient participation in decision making
9. information technology utilized appropriately

Question 10

state medicaid option for service delivery specifically for enrollees with chronic conditions.

Answer 10

Health Home

Question 11

Medicaid health home offers coordinated care to individuals with multiple chronic health conditions including:
1.
2.

Answer 11

1. mental health

2. substance abuse

Question 12

These build linkages to community supports and resources, as well as enhances coordination and integration of primary and behavioral healthcare to better meet the needs of people with multiple chronic illnesses.

Answer 12

Health Homes

Question 13

are a type of Medicare Advantage Plan (like an HMO or PPO) available to some participants with Medicare Parts A and B. Limit membership to people with specific diseases or characteristics, and tailor their benefits, provider choices, and drug formularies to best meet the specific needs of the group.

Answer 13

Special Needs Plans (SNPs)

Question 14

Medicare SNPs are approved by Medicare and run by?

Answer 14

Private Companies

Question 15

Is a method of caring for people with chronic disease in the primary care setting. It encourages practical, supportive, and evidence-based chronic disease management using a proactive approach.

Answer 15

Chronic Care Model

Question 16

Includes HMOs and PPOs and provide healthcare to members using contracted providers (providers agree to give care at a discounted rate).

Answer 16

Managed Care

Question 17

Is a variety of providers and/or organizations that come together to provide a coordinated continuum of services to a defined population. (ex. an insurance company with physicians and hospitals)

Answer 17

Integrated Delivery System