Health Care Delivery Models

Question 1

groups of providers come together voluntarily to provide coordinated high-quality care to Medicare patients. Shares in savings it achieves for Medicare program when they succeed in delivering high-quality care and spending health care dollars wisely.

Answer 1

Accountable Care Organization (ACO)

Question 2

payment model where patients are assigned per-member, per-month payment based on age/sex/race/lifestyle/medical history/benefit design

Answer 2

Capitation (partial or full)

Question 3

fixed dollar amount paid annual for all care

Answer 3

Global Budget

Question 4

contracts with medical center/group of providers to provide preventative/acute care for insured person. generally require referrals

Answer 4

Health Maintenance Organization (HMO)

Question 5

PCP coordinates treatment to make sure patients receive required care when/where needed, and in a way they can understant

Answer 5

Patient-Centered Medical Home (PCMH)

Question 6

reimbursement model that compensates providers only if they meet certain measures for quality and efficiency.

Answer 6

Pay for performance

Question 7

more flexibility than HMO. insured person doesn’t need a PCP, but can go directly to specialist without referral. can see in or out of network providers (in-network costs less)

Answer 7

Preferred Provider Organization (PPO)