Percentages
What percentage of current US GDP is spent on healthcare?
17%
What is Medicaid called in Massachusetts?
MassHealth
inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care
What is a "fee for service" payment model?
Payment model where a provider bills for each service they provide. Incentivizes quantity over quality.
What is an Accountable Care Organization?
ACOs are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high-quality care to their Medicare patients. - CMS website
What percentage of US healthcare spending is considered waste?
20%
What does the insurance say in Epic if a patient has Medicaid ACO insurance?
WELLSENSE ALLI ACO
What does Medicare Part B cover?
Outpatient care, Home health care, Durable medical equipment, Many preventive services
What is a "capitated" payment model?
What is "Wellsense"?
Formerly BMC HealthNet - this is the BMCHS health plan (aka an insurance company). It is non-profit and part of its mission is to serve the BMCHS population.
How many Americans are in healthcare debt?
60%
What insurance do patients in Massachusetts have if they are not US citizens or residents?
Medicaid Limited
What is Medicare Part D?
Prescription Drug coverage.
What is risk adjustment?
Idea that you need to increase payment for higher risk patients within a capitated payment model, in order to prevent cherry picking.
What is "SCO"?
Senior care options = Special insurance product in MA for dual eligible seniors. Includes case management for all patients.
What percentage of healthcare spending is on primary care?
5%
How many Massachusetts residents have Medicaid insurance?
25-30%
What is Medicare Part C?
This is Medicare Advantage - includes all benefits and services covered under Part A and Part B — prescription drugs and additional benefits such as vision, hearing, and dental.
Who decides what healthcare costs?
The RVS Update Committee (RUQ), which is multispecialty committee of AMA, makes recommendations on how much Medicare will pay for each healthcare code. CMS makes final decision but usually accepts these recommendations.
What is the "HARP" Program?
Hospital Admissions Reduction Program - program for patients discharging from BMC who get wrap around home based care for 60 days to help prevent readmissions.
How many IM residents choose to go into primary care?
20%
What is a 1115 Waiver?
Legislation that states write to ask CMS for an "exception" on the way they can use their Medicaid funds. These vary dramatically in scope.
Over 65, disability, ESRD, ALS
What is "value-based care"?
Catch all phrase for saying you are trying to incentivize high value in a health care system. Many use it to mean a capitated payment model.
What is CCM?
Complex case management - RN led case management program available for patients with MassHealth ACO insurance. Accepting patients!