test review Flashcards
12 hours
how many people were uninsured in 2010?2016?
almost 50 million people were uninsured in 2010, and then in 2016 after the passage of the ACA the number decreased to 28.1 million people
what has happened to the cost of healthcare in this country? GDP?
Health spending in the US is increasing: 2010: 17.4% and 2016: 17.9%…Total amounted to $2.6 trillion in 2010 – $3.3 trillion in 2016.
what is the per capital basis?
in 2010: $8,412 in 2016: $10,348
how many people does the healthcare system kill every year?
250,000 people
where is the health care dollar being spent?
physicians and hospitals (52%), important in healthcare policy development
why does health care cost so much?
because we have an increase in elderly people with multiple chronic medical conditions and so this drives healthcare costs, 15 of most expensive conditions account for 44% of spending
who pays the bill?
Private insurers & medicare/medicaid (mostly),tricare, employers, individuals
describe the uninsured and the impact of not being insured?
whites account for the highest uninsured individuals with hispanics and blacks more likely to be uninsured, more likely to be single/unmarried, lack of an education (no high school diploma), adults ages 19-64 of working age
Less likely to get preventative care
More likely to postpone care
Will go to the ER for care- high volumes of patients, long waits, expensive
Less likely to fill RX or get follow up/recommended care
Avoidable mortality
Generally they are in poorer health than the general population
what is medicare part A?
also known as the Hospital Insurance (HI) program, covers inpatient hospital, skilled nursing facility, some home health visits, and hospice care. Part A is funded by a tax of 2.9 percent of earnings paid by employers and workers (1.45 percent each), along with an additional 0.9 percent paid by higher-income taxpayers (wages above $200,000/individual and $250,000/couple). An estimated 55 million people are enrolled in Part A in 2015.
what is medicare part B?
the Supplementary Medical Insurance (SMI) program, helps pay for physician, outpatient, some home health, and preventive services. Part B is funded by general revenues and beneficiary premiums. Beneficiaries who have higher annual incomes (more than $85,000/single person, $170,000/married couple) pay a higher, income-related monthly Part B premium; the Affordable Care Act (ACA) froze the income thresholds at 2010 levels from 2011 through 2019. An estimated 51 million people are enrolled in Part B in 2015.
what is medicare part C?
also known as the Medicare Advantage program, allows beneficiaries to enroll in a private plan, such as a health maintenance organization (HMO) or preferred provider organization (PPO), as an alternative to traditional Medicare. These plans receive payments from Medicare to provide all Medicare-covered benefits, including hospital and physician services, and in most cases, prescription drug benefits. In 2014, 15.7 million beneficiaries were enrolled in Medicare Advantage plans.
what is medicare part D?
Provides drug coverage if the beneficiary joins a Medicare Prescription Drug Plan that are available through private companies.
what are services not covered by Part A and Part B?
Most dental care; Eye exams related to prescribing glasses; Dentures; Cosmetic surgery; Acupuncture; Hearing aids and exams for fitting them
what are the ways managed care manages care?
Selection of providers based on quality, cost, location and services; Focus on population health; Use of care management tools; Quality assessment; Cost controls
what are the types of MCO’s?
Health Maintenance Organizations (HMO);
Exclusive Provider Organizations (EPO);
Point-of-Service Plans (POS);
Preferred Provider Organizations (PPO)
what are the major payment methodologies?
capitation, global payment, fee-for service, and episodic payments
define patient-centered medical homes (PMCH)?
refers to health care that establishes a partnership among practitioners, patients, and their families (when appropriate) to ensure that decisions respect patients’ wants, needs, and preferences and that patients have the education and support they require to make decisions and participate in their own care” -IOM
what are the seven core components of PCMH?
1) personal physician
2) physician directed medical practice
3) whole person orientation
4) coordinated/integrated care
5) focus on quality and safety
6) increased access
7) payment reform
how the seven core components of PCMH address the six domains of healthcare quality?
A growing body of scientific evidence shows that PCMHs are saving money by reducing hospital and emergency department visits, mitigating health disparities, and improving patient outcomes. The evidence we present here outlines how the medical home inspires quality in care, cultivates more engaging patient relationships, and captures savings through expanded access and delivery options that align patient preferences with payer and provider capabilities; in addition the five year cohort study in terms of quality measures indicated PCMH showed modest improvements in two areas compared to control group
define personal physician of the seven core components of PCMH
Patients value relationships, continuous care= better outcomes +lower cost
define physician directed medical practice of the seven core components of PCMH
Physicians organizes and clarifies each team members role
define whole person orientation of the seven core components of PCMH
Care for all stages of life. Body, mind, spirit cultural approach
define coordinated/integrated care of the seven core components of PCMH
coordinated care across all healthcare settings and efficient transfer of info= better outcomes
define the focus on quality and safety of the seven core components of PCMH
evidence based medicine, performance measuring tools
define increased access of the seven core components of PCMH?
expanded hours, patient access to electronic records
define payment reform of the seven core components of PCMH
PCMH more primary care visits and fewer specialists visits
Fewer diagnostic tests
