Lets get organized!
Organized approach to deliver comprehensive health care services to enrolled members.
What is managed care?
Refers to paying a fixed monthly fee per member.
What is captiation?
S Shortly after World War I, the US government began to provide services to veterans.
What is the Department of Veterans Affairs?
The federal government provides a program for the elderly and certain disabled individuals.
What is Medicare?
Reduces fragmented care when transitioning between different settings?
What is: "
Patient treatment is managed through the primary care provider.
What is Patient-Centered Medical Home?
Providers bill after services are rendered, but will be paid based on a fee schedule.
What is discounted fee?
An attempt to save some of the very small rural hospitals, the Balanced Budget Act of 1997 created the Medicare Rural Hospital Flexibility Program. Rural hospitals could apply to Medicare.
What is a Critical Access Hospital (CAH)?
The federal and state governments jointly administer a program for the indigent.
What is Medicaid?
Enrollees require a primary care provider (PCP) to coordinate all healthcare services.
What is: "Gatekeeping"
A group of doctors, hospitals, and other healthcare providers come together to provide high-quality, coordinated care to patients.
What is an Accountable Care Organization (ACO)?
Physicians are employed by a MCO.
What is fixed salary?
A hospital must have one or more graduate residency programs approved by the American Medical Association.
What is a Teaching Hospital?
Employers purchase health insurance through a Managed Care Organization for employees and their families.
What is employee-based insurance?
Focused on coordinating the care of high-risk patients with multiple or complex medical conditions.
What is: Disease Management
Retainer based medicine.
What is concierge practice?
In a managed care organization that pays a provider a salary - they may pay a bonus for managing healthcare and costs.
What is higher performance?
Designated by the American Nurses Credentialling Center if recognized for quality patient care, nursing excellence, and innovations in professional nursing practice in hospitals.
What is a Magnet Hospital?
Those without private or public insurance.
Who are the uninsured?
In order to manage and control rising prescription drug costs this is used by managed care organizations.
What is Pharmaceutical Managment
Community health clinics or walk-in clinics
What is Pay-As-You-go Clinic?
A payer model that results in higher costs, uncontrolled utilization, and focuses on illness?
What is Fee-for-Service Model?
Specializes in therapeutic services to restore the maximum level of functioning in individuals who have suffered recent disability due to an illness or accident.
What is rehabilitation hospital?
The federal program provides comprehensive health care services directly to members of federally recognized American Indian and Alaska Native tribes and their descendants.
What is Indian Health Services (IHS)?
Client-centered approach to evaluate and coordinate care.
What is: Case Management