Provider Organization Flashcards
Independent Practice Association
Type of physician group in which individual practices are owned and operated independently, but the IPA negotiates on behalf of practices with the health plan.
Integrated Health Practice
Practices are owned and operated together,
Physician Hospital Organization
Organization which houses a physician organization and a hospital
Integrated Delivery System
Organization which houses a physician organization, hospital, and imaging centers and laboratories.
“Acute” care
Hospital visit
“Post-acute” care
Care provided after the patient leaves the hospital
> home health
> skilled nursing facility
> inpatient rehab sites
> hospice facilities
> long-term acute care facilities
Staff-Model HMO
Describes an organization that operates both as a health plan and an integrated delivery system
Physicians are increasingly operating in ___.
Physicians are increasingly operating in larger groups.
BCBSMA ACO
The Blue Cross-Blue Shield-Massachussetts Affordable Care Organization
The BCBSMA ACO contract pays provider organizations who sign up for the program a risk-adjusted prospective payment (a global payment or budget) for all care provided to a pre-defined population of enrollees in health maintenance organization (HMO) plans based on primary care physician assignment. If the costs of caring for the organization’s patients exceed the budget, provider organizations must bear (at least a portion of) those excess costs. However, if the costs are lower than expected, then the organization receives a share of the savings.
What are the goals of an ACO contract?
To create incentives to slow health care spending growth while improving the quality of care
ACO contracts are similar to ___ in the incentives they create
ACO contracts are similar to capitation in the incentives they create
The BCBSMA ACO contract passes a portion of the financial risk for the cost of care onto . . .
The BCBSMA ACO contract passes a portion of the financial risk for the cost of care onto the provider organization.
In the Medicare Shared Savings program, the large majority of provider groups . . .
In the Medicare Shared Savings program, the large majority of provider groups bear no financial risk
Partners Healthcare
A merger of MGH and Brigham and Women’s which took place in 1994. It has continued to expand since, and competitors complain that it is approaching a monopoly and has undue influence over the market.
