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 best practices and 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?
Bio-psycho-social 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 outlined 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 factors 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)
Name 2 of Picker's Principles for patient-centered care.
Fast access to reliable health information
Effective treatment delivered by trusted professionals
Continuity of care, smooth transition during care
Involvement of patients in decisions, respect for patient preferences
Clear, comprehensible health information and support
Involvement, and support for, family and caregivers
Emotional support, empathy and respect for patients and families
Attention to physical environment and needs
Name 2 specific professionals that work in each of the following 'layers' of a healthcare system:
-Clinical
-Non-clinical
-Ancillary/Support
Clinical: Providers
Non-clinical: Registration, Medical Billing, Office Management, Laboratory Services
Ancillary/Support: Supply Chain management, Environmental Services, Dietary Services
Name the steps of the third party reimbursement process in the correct order.
1. Patient registration
2. Care is provided and documented by the healthcare organization/provider
3. Documentation is used to general medical codes
4. Healthcare organization/provider submits a claim to the patient's insurance company
5. Insurance company processes the claim
6. EOB is generated + Payment is made to the provider
7. Care provider sends bill to the patient for remaining balance
Define health informatics.
The systematic collection, analysis and use of health data to improve health outcomes and improve the delivery of healthcare services.