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Foundations ch 8

Term Definition
accountable care organization (ACO) care model offering incentives to provide integrated, well-coordinated care to patients. ACOs are made up of several types of organizations that deliver care
ambulatory care health care settings located in areas that are con-venient for people to walk into and receive care; may be provided in hospitals, clinics, or centers
capitation gives providers a fixed amount per enrollee of health plan.
care coordination is the deliberate organization of patient care activities between two or more participants (including the patient) involved in a patient’s care to facilitate the appropriate delivery o? healthcare services.
community health center regionalized services for vulnerable geographic populations with an emphasis on primary care and education.
consumer person who uses health care services (the patient)
diagnosis-related group (DRG) classification of patients by major medical diagnosis for the purpose of standardizing health care costs
entitlement reform proposed legislation making changes in enti-tlement benefits, such as Medicare and Medicaid, paid by the government to citizens, with the goal of improving the nation’s budget
extended-care services provide medical and nonmedi-cal care ?or people with chronic illnesses or disabilities
fee-for-service system in which a bill is generated and a fee is paid every time a provider does something for a patient
Health Insurance Marketplace federal and state system designed to help people more easily find health insurance that fits their budget and needs with a plan offering comprehensive coverage
health maintenance organization (HMO) Prepaid, group-managed care plan that allows subscribers to receive all the medical services they require through a group of affiliated providers; subscribers may pay only a small fee, called a copayment
hospice a type of end-of-life care for persons who are terminally ill, characterized by the following: (1) free of pain as possible; (2) continuity of care (3) patients retain as much control as possible (4) viewed as individuals
inpatient person who enters a health care setting for a stay ranging from 24 hours to many years
managed care an organized, high-quality, cost-effective system of health care that influences the selection and use of health care services of a population
Medicaid Title XIX (Social Security Act, 1965) to make health care available to those people with less than the minimum income who do not qualify for Medicare
medical home an enhanced model of primary care that provides whole-person, accessible, comprehensive, ongoing, and coordinated patient-centered care
medical neighborhood patient-centered medical home and the constellation of other clinicians providing health care services to patients within it, along with community and social service organi-zations and state and local public health agencies
Medicare Title XVIII (Social Security Act, 1965) to provide a mea-sure of health coverage to all Social Security recipients
multipayer system a health care system in which care is paid for by both private insurance companies and the government
multispecialty group practice organization of physicians from different specialties joined to share income, expenses, facilities, equipment, and support staff; the group practice can better provide comprehensive care
outpatient person who requires health care services but does not need to stay in an institution for those services
palliative care hospice care; taking care of the whole person—body, mind, spirit, heart and soul—with the goal of giving patients with life-threatening illnesses the best quality of life they can have through the aggressive management of symptoms
Patient Protection and Affordable Care Act (PPACA) 2010 fed-eral legislation designed for comprehensive health reform, with an intent to expand coverage, control health care costs, and improve the health care delivery system
pay for performance a strategy using financial incentives to reward providers for achieving a range of payer objectives, including deliv-ery efficiencies, submission of data and measures to the payer, and improved quality and patient safety
preferred provider organization (PPO) a prepaid group practice that allows a third-party payer (such as an insurance company) to contract with a group of health care providers to administer services at a lower fee in return for prompt payment and a guaranteed volume of patients and services
respite care a type of care provided for caregivers of homebound ill, disabled, or elderly patients
single-payer system one entity such as a government run the organization, collect all health care ?ees, and pay out all health care costs.