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Stanford: AI in HC: Introduction to Healtchare > AI in HC - Introduction to Healthcare > Flashcards

AI in HC - Introduction to Healthcare Flashcards

1
Q

Independent Facilities

A

Healthcare providers and facilities outside of traditional hospitals, including dental practices, optometry practices, independent labs, and diagnostic facilities.

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2
Q

Fee-for-Service (FFS)

A

A payment model where providers are paid for each individual service provided to a patient.

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3
Q

Charge Master

A

A comprehensive list of services and their corresponding charges maintained by hospitals for billing purposes.

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4
Q

Per Diem Payment

A

A hospital payment system where a fixed daily rate is paid for patient care, regardless of the services rendered.

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5
Q

Diagnosis-Related Group (DRG)

A

A system for categorizing hospital services into groups for payment purposes based on diagnoses and procedures.

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6
Q

Electronic Medical Record (EMR)

A

A digital version of a patient’s medical history maintained within a single provider’s facility.

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7
Q

Electronic Health Record (EHR)

A

A broader digital record of a patient’s medical history that can include data from multiple providers.

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8
Q

Physician-Hospital Organization (PHO)

A

An integrated organization combining hospitals and physicians to deliver coordinated care.

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9
Q

Integrated Delivery Network (IDN)

A

A healthcare system where a network of providers delivers a full spectrum of care within a unified system.

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10
Q

Global Budget

A

A payment model where a fixed total budget is allocated to a hospital or healthcare system for a defined period.

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11
Q

Outlier Payment

A

Additional payments made under DRG systems for cases that require significantly more resources than average.

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12
Q

Personal Health Record (PHR)

A

An electronic application enabling patients to manage and share their personal health data.

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13
Q

Shared Savings Model

A

A payment approach where providers are rewarded for reducing healthcare costs while maintaining quality.

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14
Q

Pay-for-Performance (P4P)

A

A payment model providing financial incentives to providers for meeting specific performance measures.

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15
Q

Teaching Hospital

A

A hospital that provides medical training in addition to patient care, often associated with a medical school.

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16
Q

Admitting Privileges

A

The rights granted to physicians to admit and treat patients in a specific hospital.

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17
Q

Intermediary

A

Entities such as insurance companies or health plans that facilitate payments between providers and patients.

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18
Q

Global Capitation

A

A payment system where providers are paid a fixed amount per patient for all services over a specific time period.

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19
Q

Health Maintenance Organization (HMO)

A

A healthcare system that provides care through a network of providers under a capitated payment system.

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20
Q

Hospital System

A

A network of hospitals operating under a single organization, often sharing resources and administration.

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21
Q

Independent Facilities

A

Healthcare providers and facilities outside of traditional hospitals, including dental practices, optometry practices, independent labs, and diagnostic facilities.

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22
Q

Fee-for-Service (FFS)

A

A payment model where providers are paid for each individual service provided to a patient.

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23
Q

Charge Master

A

A comprehensive list of services and their corresponding charges maintained by hospitals for billing purposes.

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24
Q

Per Diem Payment

A

A hospital payment system where a fixed daily rate is paid for patient care, regardless of the services rendered.

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25
Q

Diagnosis-Related Group (DRG)

A

A system for categorizing hospital services into groups for payment purposes based on diagnoses and procedures.

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26
Q

Electronic Medical Record (EMR)

A

A digital version of a patient’s medical history maintained within a single provider’s facility.

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27
Q

Electronic Health Record (EHR)

A

A broader digital record of a patient’s medical history that can include data from multiple providers.

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28
Q

Physician-Hospital Organization (PHO)

A

An integrated organization combining hospitals and physicians to deliver coordinated care.

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29
Q

Integrated Delivery Network (IDN)

A

A healthcare system where a network of providers delivers a full spectrum of care within a unified system.

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30
Q

Global Budget

A

A payment model where a fixed total budget is allocated to a hospital or healthcare system for a defined period.

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31
Q

Outlier Payment

A

Additional payments made under DRG systems for cases that require significantly more resources than average.

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32
Q

Personal Health Record (PHR)

A

An electronic application enabling patients to manage and share their personal health data.

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33
Q

Shared Savings Model

A

A payment approach where providers are rewarded for reducing healthcare costs while maintaining quality.

How well did you know this?
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5
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34
Q

Pay-for-Performance (P4P)

A

A payment model providing financial incentives to providers for meeting specific performance measures.

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35
Q

Teaching Hospital

A

A hospital that provides medical training in addition to patient care, often associated with a medical school.

How well did you know this?
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4
5
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36
Q

Admitting Privileges

A

The rights granted to physicians to admit and treat patients in a specific hospital.

How well did you know this?
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2
3
4
5
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37
Q

Intermediary

A

Entities such as insurance companies or health plans that facilitate payments between providers and patients.

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38
Q

Global Capitation

A

A payment system where providers are paid a fixed amount per patient for all services over a specific time period.

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39
Q

Health Maintenance Organization (HMO)

A

A healthcare system that provides care through a network of providers under a capitated payment system.

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40
Q

Hospital System

A

A network of hospitals operating under a single organization, often sharing resources and administration.

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41
Q

Independent Facilities

A

Healthcare providers and facilities outside of traditional hospitals, including dental practices, optometry practices, independent labs, and diagnostic facilities.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Fee-for-Service (FFS)

A

A payment model where providers are paid for each individual service provided to a patient.

How well did you know this?
1
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2
3
4
5
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43
Q

Charge Master

A

A comprehensive list of services and their corresponding charges maintained by hospitals for billing purposes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Per Diem Payment

A

A hospital payment system where a fixed daily rate is paid for patient care, regardless of the services rendered.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Diagnosis-Related Group (DRG)

A

A system for categorizing hospital services into groups for payment purposes based on diagnoses and procedures.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Electronic Medical Record (EMR)

A

A digital version of a patient’s medical history maintained within a single provider’s facility.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Electronic Health Record (EHR)

A

A broader digital record of a patient’s medical history that can include data from multiple providers.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Physician-Hospital Organization (PHO)

A

An integrated organization combining hospitals and physicians to deliver coordinated care.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Integrated Delivery Network (IDN)

A

A healthcare system where a network of providers delivers a full spectrum of care within a unified system.

How well did you know this?
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2
3
4
5
Perfectly
50
Q

Global Budget

A

A payment model where a fixed total budget is allocated to a hospital or healthcare system for a defined period.

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51
Q

Traditional Indemnity Insurance

A

Classic health insurance model with open panel and fee-for-service payments.

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52
Q

HMO (Health Maintenance Organization)

A

Health plans focused on preventive care with a closed provider panel and capitation payment model.

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53
Q

PPO (Preferred Provider Organization)

A

Plans with semi-open networks allowing in-network and out-of-network care with differing cost-sharing.

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54
Q

High Deductible Health Plan

A

Plans with high deductibles, encouraging patients to manage care costs more directly.

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55
Q

Narrow Network Plan

A

Plans with a small, carefully chosen provider network to control costs and maintain quality.

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56
Q

Fee-for-Service (FFS)

A

Payment model where providers are paid for each individual service delivered.

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57
Q

Capitation

A

Payment model providing a fixed amount per patient per time period for care.

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58
Q

Utilization Review

A

A process to monitor and approve care usage, including pre-authorization, concurrent review, and retrospective review.

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59
Q

Gatekeeper Requirement

A

Requirement for a primary care physician to coordinate all care and provide specialist referrals.

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60
Q

Deductible

A

Amount a patient pays out-of-pocket before insurance begins covering costs.

61
Q

Copayment

A

Fixed amount a patient pays for specific services, such as a doctor’s visit.

62
Q

Coinsurance

A

Percentage of service costs a patient pays after meeting the deductible.

63
Q

Out-of-Pocket Maximum

A

The maximum amount a patient pays for covered services in a year before insurance covers 100% of costs.

64
Q

Selective Contracting

A

Process by which insurers create a provider network by contracting with specific providers.

65
Q

Medicare Advantage

A

Private insurance plans contracted by Medicare to provide Part A and Part B benefits.

66
Q

Managed Care

A

Health plan designs where intermediaries manage utilization through tools like networks and cost-sharing.

67
Q

Episode-Based Payment

A

Payment model providing a single payment for all services related to a care episode.

68
Q

Salary Payment Model

A

Physicians are paid a fixed salary regardless of the volume of care provided.

69
Q

RVU (Relative Value Unit)

A

A measure used in fee schedules to value the work, expense, and risk of a service.

70
Q

DRG (Diagnosis-Related Group)

A

A system for categorizing hospital cases for payment purposes.

71
Q

Panel

A

The population of patients assigned to a provider or practice.

72
Q

HCPCS (Healthcare Common Procedure Coding System)

A

Coding system used in the US for billing medical services and procedures.

73
Q

ICD-10

A

International Classification of Diseases, used for coding diagnoses.

74
Q

CPT (Current Procedural Terminology)

A

A standardized coding system for medical procedures and services.

75
Q

IPA (Independent Practice Association)

A

An organization that contracts with physicians to provide care for insurers.

76
Q

Medigap

A

Supplemental insurance for covering gaps in Medicare, like cost-sharing.

77
Q

Global Capitation

A

Capitation payment covering all medical care for a population over a set time.

78
Q

Tiered Networks

A

Network structure where providers are grouped by cost and quality, with differing patient cost-sharing.

79
Q

Network Organizer

A

Entities that facilitate insurer-practice relationships, e.g., IPAs.

80
Q

Primary Care Gatekeeper

A

Physician who manages a patient’s overall care within a plan.

81
Q

Bundled Payment

A

Payment model for multiple services in a single episode of care.

82
Q

PMPM (Per Member Per Month)

A

Payment metric in capitation models.

83
Q

Patient Cost Sharing

A

Financial responsibility shared by patients through deductibles, copayments, or coinsurance.

84
Q

Out-of-Network Care

A

Services received outside an insurer’s network, often with higher patient costs.

85
Q

Medicaid Managed Care

A

Medicaid services provided through private plans under state contracts.

86
Q

Risk Adjustment

A

Adjusting payments to insurers based on the health status of enrollees.

87
Q

ACO (Accountable Care Organization)

A

Groups of providers that share responsibility for patient care to improve quality and reduce costs.

88
Q

Shared Savings Program

A

Program rewarding providers for reducing healthcare costs while meeting quality benchmarks.

89
Q

Tiered Cost Sharing

A

Cost-sharing model with different levels for various services or provider tiers.

90
Q

Premium Subsidies

A

Government payments to reduce the cost of insurance premiums for individuals.

91
Q

Integrated Care

A

Coordinated healthcare services to improve quality and efficiency.

92
Q

Preventive Care

A

Services aimed at preventing illnesses or detecting them early.

93
Q

Prior Authorization

A

Requirement for approval before certain services are covered by insurance.

94
Q

Concurrent Review

A

Ongoing evaluation of care during treatment.

95
Q

Retrospective Review

A

Evaluation of care after treatment has been delivered.

96
Q

Practice Ownership Models

A

Structures of practice ownership, e.g., private, corporate, or governmental.

97
Q

Self-Insured Plans

A

Employer-sponsored health plans where employers bear the financial risk.

98
Q

Community Rating

A

Setting insurance premiums based on the community’s overall health risk.

99
Q

Adverse Selection

A

When higher-risk individuals are more likely to enroll in health insurance, raising costs.

100
Q

MCO (Managed Care Organization)

A

Entity that integrates the financing and delivery of healthcare services.

101
Q

Artificial Intelligence (AI)

A

Technology that simulates human intelligence to assist in decision-making, predictions, and problem-solving in healthcare.

102
Q

Risk Pooling

A

A method used in healthcare systems to combine financial risks across a group to make costs more predictable.

103
Q

Intermediaries

A

Organizations like insurance companies that collect funds, pool risks, and pay for healthcare services.

104
Q

Electronic Health Records (EHRs)

A

Digital versions of patients’ paper charts, containing medical history, treatment plans, and test results.

105
Q

Branded Drugs

A

Drugs marketed under a specific brand name, often patented and sold at higher prices.

106
Q

Generic Drugs

A

Chemically equivalent to branded drugs but sold without branding after patent expiration.

107
Q

Formulary

A

A list of prescription drugs covered by a health insurance plan.

108
Q

Prescription Drug Pricing

A

The cost structure of prescription drugs, often negotiated by intermediaries and pharmacy benefit managers.

109
Q

Quality Measures

A

Metrics used to evaluate the quality of healthcare services, including structural, process, and outcome measures.

110
Q

Outcomes Measurement

A

Assessing the results of medical care, such as patient health improvements and complication rates.

111
Q

Pay-for-Performance

A

Payment model that rewards healthcare providers for meeting specific quality and efficiency benchmarks.

112
Q

Health Disparities

A

Differences in healthcare access and outcomes among different populations, often due to socioeconomic factors.

113
Q

Medicare

A

A U.S. government program providing health insurance for individuals aged 65 and older or with certain disabilities.

114
Q

Medicaid

A

A U.S. government program providing health coverage for low-income individuals and families.

115
Q

Preventive Care

A

Healthcare services aimed at preventing illnesses or detecting issues early.

116
Q

Patient-Centered Care

A

Healthcare approach focused on respecting and addressing individual patient preferences, needs, and values.

117
Q

Structural Measures

A

Metrics evaluating the infrastructure of healthcare systems, such as availability of qualified personnel and up-to-date equipment.

118
Q

Process Measures

A

Metrics assessing the specific actions or steps taken to deliver healthcare, such as adherence to clinical guidelines.

119
Q

Health Maintenance Organization (HMO)

A

A health insurance plan that provides care through a network of physicians and hospitals.

120
Q

Preferred Provider Organization (PPO)

A

A health insurance plan offering more flexibility in choosing healthcare providers, both in-network and out-of-network.

121
Q

Telemedicine

A

The use of telecommunications technology to deliver healthcare services remotely.

122
Q

Patient Advocacy

A

Efforts by individuals or organizations to support and promote patient rights and access to care.

123
Q

Pharmacy Benefit Manager (PBM)

A

Companies that manage prescription drug benefits on behalf of health insurers, negotiating prices and coverage.

124
Q

Cost Sharing

A

The division of healthcare costs between insurance and patients, including copayments and deductibles.

125
Q

Healthcare Access

A

The ability of individuals to obtain needed medical services.

126
Q

Healthcare Equity

A

Ensuring that all individuals have access to necessary healthcare services regardless of socioeconomic status.

127
Q

Regulatory Approval

A

The process by which healthcare products, including drugs and devices, are reviewed for safety and efficacy before use.

128
Q

FDA (Food and Drug Administration)

A

U.S. agency responsible for regulating food, drugs, medical devices, and other health-related products.

129
Q

Clinical Trials

A

Research studies performed on humans to evaluate the safety and effectiveness of medical treatments.

130
Q

Health Insurance Premium

A

The amount paid, often monthly, to maintain health insurance coverage.

131
Q

Health Information Privacy

A

Protecting patients’ medical information from unauthorized access or disclosure.

132
Q

Bias in AI

A

Systematic errors in AI models that lead to unfair outcomes, often due to unrepresentative training data.

133
Q

Accountable Care Organization (ACO)

A

A group of healthcare providers who voluntarily coordinate care to improve quality and reduce costs.

134
Q

Managed Care

A

Healthcare delivery system designed to manage costs, utilization, and quality of care.

135
Q

Patient Safety

A

Preventing harm to patients during the delivery of healthcare.

136
Q

Social Determinants of Health

A

Conditions in which people are born, live, work, and age that affect health outcomes.

137
Q

AI Transparency

A

The ability to understand and interpret how AI models make decisions.

138
Q

Out-of-Pocket Expenses

A

Healthcare costs directly paid by patients that are not covered by insurance.

139
Q

Health Technology Assessment (HTA)

A

Evaluation of medical technologies for their effectiveness and cost-efficiency.

140
Q

Health Literacy

A

The ability of individuals to understand health information and make informed decisions.

141
Q

Digital Health Tools

A

Technologies such as mobile apps and wearables used to monitor and improve health.

142
Q

Healthcare Innovation

A

The development of new methods, technologies, or processes to improve healthcare delivery.

143
Q

Ethical AI

A

Developing and using AI in a way that is fair, just, and prioritizes patient welfare.

144
Q

Financial Risk in Healthcare

A

The potential for economic losses associated with healthcare costs.

145
Q

Public Health

A

Efforts to prevent disease and promote health at a population level.

146
Q

Utilization Review

A

Process of evaluating the necessity, efficiency, and appropriateness of healthcare services.

147
Q

Evidence-Based Medicine

A

Healthcare practices based on scientific research to achieve the best outcomes.

148
Q

Healthcare Sustainability

A

Creating systems that deliver quality care efficiently and can be maintained over time.

149
Q

Healthcare Workforce

A

All individuals engaged in providing healthcare services, including physicians, nurses, and support staff.

Stanford: AI in HC: Introduction to Healtchare (1 decks)

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