PCC Lecture 1

Question 1

The estimated time that it took medical knowledge to double in 2010 was _____ in 2020 it was _____

Answer 1

The estimated time that it took medical knowledge to double in 2010 was every 3.5 years in 2020 it was every 73 days

Question 2

What are the five characteristics of a good team

Answer 2

honesty, discipline, creativity, humility, curiosity.

Question 3

What are the 4 fundamental teamwork CONCEPTS

Question 4

What are the 4 fundamental teamwork CONCEPTS
1. unity of purpose
2. knowledge of limitations
3. maximizing contribution of individual skills
4. resource efficiency

Answer 4

What are the 4 fundamental teamwork CONCEPTS
1. ________ of ______
2. knowledge of ________
3. maximizing ________ of individual skills
4. resource ___________

Question 5

Describe the fundamental teamwork concept “unity of purpose”

Answer 5

team works to establish shared goals

Question 6

Describe the fundamental teamwork concept “knowledge of limitations”

Answer 6

a clear delination of each persons skill set and abilities

Question 7

Describe the fundamental teamwork concept “maximizing contribution of individual skills”

Answer 7

clear expectations of each members functions, responsibilities, and accountabilities

Question 8

Describe the fundamental teamwork concept “resource efficiency”

Answer 8

choosing methods of providing care to allow the maximal quality of care with minimal wasting of resources

Question 9

Describe Fee for service
pros
cons

Answer 9

-services to a patients are unbundled and paid for seperatly
pros
1. simplicity
2. productivity
3. flexibility

1. quantity over quality
2. Inflationary
3. thwarts “free” activities (come into office instead of call on phone because phone calls arent paid as much.)
4. efficiency? Who needs it

Question 10

describe value-based care
pros
1. _____
2. ________
3. improve __________ between providers
4. emphasis on ________
5. favored by __________

cons
1. _________… and ____
2. “______ bad patients”
3. focused on some ________ outcomes while _______ others
4. significant ________ work
5. _______ goals = ________ goals?

Answer 10

Payment or Incentive for achieving defined and measurable goals related to patient care

pros
1. quality
2. efficiency
3. improve collaboration between providers
4. emphasis on outcomes
5. favored by medicare/medicaid

cons
1. what do we measure…. and how
2. “firing bad parents”
3. focused on some specific outcomes while ignoring others
4. significant administrative work
5. payer goals = patient goals?

Question 11

describe episodic/bundle payments
pros
1. _________
2. improve ______________ between providers
3. __________

cons
1. boundaries of an “episode” (
2. what if _________________?
3. Avoiding __________

Answer 11

pros
1. efficiency
2. improve collaboration between providers
3. simple billing

cons
1. boundaries of an “episode” (how long does their sickness/disease last and what if it waxes and wanes)
2. what if everyone isn’t on board? (PCP not on board Hospitcal on board)
3. Avoiding “bad” or complex patients

Question 12

Capitation / comprehensive care

cons:
how much _______ exactly?
is my doctor __________ because there is no extra pay
can promote _______________

Answer 12

A risk adjusted payment for a full range of healthcare services needed by a specific group for a fixed period of time (an insurance company gives an office 2m$ for the year to cover all services needed by the 100 patients under that insurance)

cons:
how much risk exactly?
is my doctor withholding care to increase risk
can promote quantity over quality.

Question 13

Accountable care organization description

cons:
1. what is he patients needs or wants a provider that is not in this organization
2. is my doctor withholding care
3. monopolies of care especially in rural and underserved areas.

Answer 13

Providers of varying specialties enroll as a group to provide comprehensive care

cons:
1. what is he patients needs or wants a provider that is not in this organization
2. is my doctor withholding care
3. monopolies of care especially in rural and underserved areas.

Question 14

Managed care models were implemented by many health insurance companies to _________________.

This is not a reimbursement method directly but affects _________ and ____________ for the patient

this includes ________, ________, and _______.

Answer 14

Managed care models were implemented by many health insurance companies to help reduce overall healthcare costs.

This is now a reimbursement method directly but affects cost of care and availability of care for the patient

this includes HMOs, PPOs, and POS.

Question 15

__________ - single entity that encompasses patients insurance and medical providers

• insurance chooses what entities that they want to work with.

________

Answer 15

Health maintenance organization (HMO) - single entity that encompasses patients insurance and medical providers

• insurance chooses what entities that they want to work with.

cheapest

Question 16

Health maintenance organization (HMO) - single entity that encompasses ____________ and __________

• insurance chooses _________________.

Answer 16

Health maintenance organization (HMO) - single entity that encompasses patients insurance and medical providers

• insurance chooses what entities that they want to work with.

Question 17

________________ - network of third party providers contracted with a patients insurance or health coverage
1. providers accept regulations from the insurance
2. patients receive financial incentives to stay “in network”

__________

Answer 17

Preferred provider organization - network of third party providers contracted with a patients insurance or health coverage
1. providers accept regulations from the insurance
2. patients receive financial incentives to stay “in network”

in the middle cost

Question 18

Point of service - patient only has to pay a copay or coinsurance when in-network
- combines ________ and __________
-_____________-

Answer 18

Point of service - patient only has to pay a copay or coinsurance when in-network
- combines HMO and PPO principles
-most expensive.

Question 19

Patient Centered Medical Homes (describe)

Answer 19

a medical facility that is responsible for coordinating a patients care including spiritual support, medical services, financial assistance, educational services ect.