Chapter 11 Flashcards
(ACO) Accountable care organization
group of health care entities organized via incentives to deliver the most efficient and high quality care for the population served
APRN Advanced practice registered nurse
a registered nurse educated at the masters or post masters level in a specific role and for a specific population. Examples include, nurse practitioners, clinical nurse specialist, CRNA, and midwives
Ambulatory care
health care settings located in area that are convenient for people to walk into and receive care; may be provided in hospitals, clinics or centers
Capitation
a fixed amount per patient for a specified time period to a health care service provider for the delivery of health care services
care coordination
deliberate coordination of patient care activites between 2 or more participants, to facilitate the appropriate delivery of health care services.
*Make sure patient gets right care at right time at right place
care coordination
Deliberate coordination of patient care activities between 2 or more participants, to facilitate the appropriate delivery of health care services.
*Make sure the patient gets the right care at right time at the right place
Community health center
Regionalized service for vulnerable geographic populations w/ emphasis on primary care and education; est to ensure everyone who needs care gets it regardless of ability to pay
Consumer
Person who uses the health care (patient)
DRG - Diagnosis related group
classifications of patient by major medical diagnosis for purpose of standardizing health care costs
entitlement reform
proposed legislation making changes in entitlement benefits, such as medicare and Medicaid, paid by the government to citizens with goal in improving the nations budget
Extended care services
Organizations, family members and other caregivers that provide medical and nonmedical care for people with chronic illnesses or disabilities who are physically or mentally unable to care for themselves
Fee for service
system for when a bill is generated and a fee is paid everytime a provider does something for a patient
Health insurance marketplace
Federal and state system designed to help people more easily find health insurance that fits their budget and needs
HMO Health maintenance organization
prepaid, group-managed care plan that allows subscribers to receive all medical services they require through a group of affiliated providers
High reliability organization
organization that operates in a complex, high hazard domain for an extended period without serious accidents
Hospice
end of life care for persons who are terminally ill
- Patients kept free of pain
- Recieve continuing care
- Remain in control of their decisions
- Viewed as individuals
Inpatient
person who enters healthcare setting for 24 hour to years
Managed care
An organized system of health care that influences the selection and use of health care services of a population
Medicaid
To make health care available to people with less than the minimum income who do not qualify for medicare
Medical home
an advanced model of primary care that provides whole person, accessible, comphrensive, ongoing patient centered care
Medical neighborhood
a patient centered
other clinicians providing health care to patients in it along with other social services, state and local health facilites
Medicare
provide health coverage to all social security reciepents
multipayer system
a health care system in which care is paid for by both private insurance and governement
multispeciality group practice
organziation of physicians of different specialties joined to share income, expenses, facilities, equipment, and support staff
Outpatient
Person who requires health care services but does not need to stay
Palliative care
hospice care, taking care of the whole person - body, mind, spirit, heart and soul. with the goal of giving terminally ill patients the best quality of life
Patient protection and afforable care act
2010 federal legislation designed for comprehensive health reform, w/ intent to expand coverage, control health care costs, and improve health care delivery system
Pay for performance
a stragety using financial incentives to reward providers for achieving a range of payer objectives, including delivery efficiencies, submission of data and measures to the payer, and improved quality and patient safety
PPO Perferred provider organization
a prepaid group / 3rd party payer / contract group health care providers /services at lower fee for prompt payment and guarantee volume of patients
respite care
type of care provided for caregivers of homebound ill, disabled or older adult patients
Single payer system
health care system in which government collects all health care fees via taxes and pays out all health care costs
value based purchasing
program that measures, reports and rewards excellence in health care delivery, taking into consideration access, price, quality, efficiency and alignment of incentives
What are the 8 domain areas that were aligned with key quality priorities for the system
- Mortality
- readmissions
- Length of stay
- Hospital consumer assessment of hc providers and systems
- Hand hygiene
- Prevention of C diff
- Prevention of surgical site infections
- PRevention of catheter site UTI
What is the primary care
GOAL
PRACTIONER
PRACTICE SITE
ACTIVIES
Goal: Common health problems & Preventative measures
Practioner: Family doc, NP, Midwife
Practice site: Primary & Urgent care, employee health center
Activites: Prenatal, immunizations, screenings, tests, education, medication
What is the secondary care
GOAL
PRACTIONER
PRACTICE SITE
ACTIVITIES
Goal: Problems that require more specialized care (hospital)
Practioner: Physicians, APRN
Practice site: ER, hospital, same-day surgery, physiatric
Activities: Disease ID and Managemtn
What is the TERTIARY care
GOAL
PRACTIONER
PRACTICE SITE
ACTIVITIES
GOAL: Management of rare and complex disorders. Pituitary tumors, congenial defects
PRACTIONER: Subspecialist physicians & APRN
PRACTICE SITE: tertiary care medical centers
ACTIVITIES: Rare and complex disease management
DIfference between HMO and PPO
HMO - provide care as independant practioners, patients no choice, primary care to reduce costs by preventing illness, popular with large employers
PPO- services at lower fee for prompt payment and guaranteed patients
What are the 4 modes of paying for health care
Out of pocket
individual private insurance
employer based group private insurance
gov financing
