Chapter 2 Flashcards
National Priorities Partnership
28 joined organization that will transform healthcare
6 priorities of NPP
(PaPoSCaPo )
- Patient and family engagement
- Population Health
- Safety
- Care of coordination
- Palliative CAre
- Overuse
PSRO ( professional std review org )
review the quality, quantity, and docket of hospital case
Utilization Review
done by Md’s to review admissions and eliminate overuse dx
DRG’s
adjusted by : severity, regional/urban/rural cost, and teaching cost
Capitation
aims to build a payment plan consists of best standards at lower cost
Managed care…
receives a predetermined captained payment
Managed care focuses on….
prevention, early intervention and outpatient care
Goals of Public Law 111-148
healthcare services for all reducing healthcare costs improving healthcare quality reduction in mortality rate advancement in sanitation prevention on infectious disease patient teaching injury prevention program
Tertiary Care
intensive care
subacute care
Secondary Care
acute care
emergency care
acute medical-surgical care
radiological procedures
Primary Care
prenatal and well-baby care
nutrition counseling
family planing
exercise class
Preventative Care
BP and CA screening
immunizations
mental health counseling
community legislation
Restorative Care
cardiopulmonary rehab sports medicine home care continuing care ALF adult day care
8 dimensions of patient centered care
CRIP ATIE coordination of care respect of values information physical comfort access to care transition and continuity involvement of family emotional support
5 components of review Magnet model
transformational leadership structural empowerment new knowledge exemplary professional practice empirical quality results
Managed Care Organization MCO
Provides comprehensive preventative and treatment services to a specific group of voluntarily enrolled people.
Preferred Provider Organization PPO
Type of managed care plan that limits an enrollee’s choice to a list of “preferred” caregivers.
Focus is on primary care
Medicare
Federally administrated program by the Commonwealth Fund of the CMS; for people 65+
Medicare Part A
provides basic protection for medical, surgical, and psychiatric care costs based on DRGs; limited skilled nursing facility care, hospice, and home health care
Medicare Part B
a voluntary medical insurance; covers physician, certain other health professional services, and certain outpatient services
Medicare Part C
managed care provision that provides a choice of the three insurance plans
Medicare Part D
voluntary prescription drug improvement
Medicaid
Federally funded, state-operated program that provides
- health insurance to low-income families
- health assistance to low income people
- supplemental coverage and LTC assistance to older adults in nursing homes
