Foundations, Key Orgs and Documents
What organization seeks to be the global leader in public health?
World Health Organization (WHO)
Define patient-centered care.
'Providing care that is respectful of, and responsive to, individual patient preferences, needs and values, and ensuring that patient values guide all medical decisions' (IOM/NAM)
Caring for patients in ways that are meaningful and valuable to them.
'Meeting the patient where they are'
How is value calculated?
Quality divided by cost
Who is responsible for submitting the claim to the insurance company?
The provider (billing department)
What term relates to the non-clinical factors that impact the health of individuals and communities?
What document outlines the guidelines for quality and safety of healthcare services in the US?
Joint Commission Standards (produced by Joint Commission on the Accreditation of Healthcare Organizations, JCAHO
What disablement model conceptualizes multidirectional interactions between biological, psychological and social factors?
Biopsychosocial Model
True or False: The most common payment model in the US is based on reimbursement for the quality of care provided.
False
Who is responsible for sending the bill to a patient?
The provider (billing department)
Improved communication amongst healthcare team
Improved translation of research to clinical practice
Assistance with decision making at the point of care
Reduction in malpractice claims
Which document outlines the need for improvements in quality and patient safety in healthcare?
Crossing the Quality Chasm (Produced by NAM/IOM in 2001)
Name one challenge of interprofessional collaborative practice.
Schedule issues/conflicts between providers/professionals
Resource allocation/sharing amongst providers/professionals
Need for institutional support
Buy in from the professionals/providers
Cultural differences/barriers amongst the providers/professionals
False
What term describes the percentage of cost the patient is responsible for after the deductible has been met?
Co-insurance
Which domain of SDOH relates to financial assets vs. debts, employment status, and financial support?
Economic stability
What organization is responsible for monitoring and responding to health emergencies in the US?
Centers for Disease Control and Prevention (CDC)
What QI tool is used to explore steps involved in a sequence of events from start to finish?
What is the best predictor of financial viability of a healthcare system?
Explain the steps of claims processing.
Verification of medical codes (ICD-11 + CPT/HCPCS)
Evaluation of medical necessity
Verification of patient's coverage/policy
Determination of payment
Which non-clinical factor has the largest impact on an individual's health?
Socioeconomic status (approx. 40%)
What framework seeks to integrate and optimize the health of people, animals and the environment?
One Health (produced by the CDC)
Describe the ICF model, including the 2 main categories of items included in the model.
Developed by the WHO to provide a comprehensive view of health by considering interplay between personal and environmental factors
Functioning and Disability (Impairments, Activity Limitations, Participation Restrictions)
Contextual Factors (Personal and Environmental)
Name 2 specific professionals that work in each of the following 'layers' of a healthcare system:
-Clinical
-Non-clinical/Administrative
-Ancillary/Support/Operations
Clinical: Providers
Non-clinical/Administrative: Registration, Medical Billing, Office Management, Laboratory Services
Ancillary/Support/Operations: Supply Chain management, Environmental Services, Dietary Services
What do HMO and PPO stand for? Identify 1 difference between an PPO and an HMO insurance plan.
HMO = Health Maintenance Organization
PPO= Preferred Provider Organization
HMO uses a gatekeeper, PPO has tiers of providers to choose from.
HMOs are typically less expensive than PPOs.
PPOs provide more flexibility to choose your provider.
Define health informatics.
The systematic collection, analysis and use of health data to improve health outcomes and improve the delivery of healthcare services.