Managed Care
In the 1990’s managed care made significant headway and achieved success in slowing h.c. expenditures by introducing this specific type of managed care plan
HMO
Provide 3 reasons why the U.S. has high healthcare costs.
3rd party payment, growth of technology, increase in elderly pop, medical model of care delivery, multipayer system and administrative costs, defensive medicine, waste and abuse, practice variations
There are five components of in a policy cycle (formation and implementation of policies) that are often undertaken by Congress and interest groups– list 2
Issue raising, policy design, building of public support, legislative decision-making and building of policy support, policy implementation
Provide 3 examples of outpatient care settings and/or methods of care delivery
Private practice, hospital outpatient clinics, mobile facilities, home care, hospice care, telephone triage, LTC, public health dept, comm. Health center, free clinics, CAM
American h.c. will be significantly affected by this trending change in the population
Aging population
What was consumers' main complaint against managed care during the 1990s?
Lack of choice of providers
What three domains best predict access and access disparities?
Race, income, and occupation
Which historical policy is credited with having the greatest impact on the expansion of hospital beds in the United States?
Hill-Burton Act
The rapid growth of the aging population will require an increase in this specialty of medicine
Geriatrics
As a result of decreasing public/private insurance reimbursement for hospitalizations, this type of health care service has increased over the past 20 years
Outpatient care
Managed care is a mechanism of providing health care services in which a single organization takes on the management of these main functions. (Provide 2 of 4)
Financing, delivery, insurance, and payment
When analyzing health care quality, what three topics are evaluated?
Structure, process, outcome
There are 3 main challenges related to fully implementing the ACA - explain 2 of these.
What is the largest source of financing for nursing home care?
Medicaid
A patient safety incident that results in death, severe harm, or permanent harm to a patient is known as this.
A sentinel event
The ACA authorized formation of these to serve Medicare beneficiaries enrolled in traditional fee-for-service program.
Accountable Care Organizations (ACOs) were designed to help increase cooperation between providers across various health care settings to improve Medicare patient outcomes.
List 2 strategies of cost containment the U.S. health care system has implemented
Health planning, price controls, peer review, competitive approaches, chronic disease management and prevention
This type of medicine includes consideration of individual, environmental, and lifestyle factors
Precision medicine
Public health programs are evaluated for effectiveness through this mechanism.
National surveillance systems
This method determines the appropriateness for utilization after services have already been delivered
Retrospective Utilization Review
What are the three main distinguishing factors that differentiate HMOs, PPOs, and POS plans.
Choice of providers, delivery of services, payment and risk sharing
i.e. In-network/out of network; gatekeeping; limited specialty services; capitation and fee for service; risk sharing, etc.
List 2 developments in process improvements that have been utilized in U.S. healthcare
Clinical Practice Guidelines, Cost-Efficiency, Critical Pathways, Risk Management
Explain what factors rural Americans face with the U.S. health care system that predisposes them to vulnerability?
Poverty, lack of public health infrastructure, poorer access to health care, increased burden of disease (heart disease, stroke, diabetes, mental health, substance use), geographic maldistribution of health care professionals
List 2 characteristics of the medical home model
Patient-centered access, team-based care, population health mgmt., care mgmt., care coordination/transitions, and performance measure/quality improvement
Provide 3 strategies to improve health and reduce disparities
Nutrition programs, Work/environment safety efforts, Primary care and prevention-oriented efforts, Coordinated care for chronically ill persons, community-based partnerships, culturally appropriate care, patient safety/medical error reduction