Intro to Nursing CH 8, Ameritech College

Accountable care organization (ACO)
are made up of several types of organizations that deliver care: hospitals, primary care settings, and specialty care of practices. Together, the organization in an ACO come together to deliver the most efficient and high-quality care for the population served; only one bill is generated that covers all care delivered across the various settings
Ambulatory care
health care settings located in areas that are convenient 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 of healthcare services
Community health center
are regionalized services for vulnerable geographic populations with an emphasis on primary care and education
Consumer
the person who uses health care services (the patient)
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Diagnosis-related groups (DRGs)
classification of patients by major medical diagnosis for the purpose of standardizing health care costs
Entitlement reform
proposed legislation making changes in entitlement benefits, such as Medicare and Medicaid, paid by the government to citizens, with the goal of improving the nation’s budget
Extended-care services
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, from doctors to medication to hospitals visits; insurance options can be compared based on price, benefits, quality, and other features described in plain language
Health maintenance organization (HMO)
Prepaid, group-managed car plan that allows subscribers to receive all the medical services they required through a group of affiliated providers, there may be no additional out-of-pocket costs, or subscribers may pay only a small fee, called a co-payment
Hospice
a type of end-of-life care for persons who are terminally ill, characterized by the following: (1) patients are kept as free of pain as possible so that they may die comfortably and with dignity; (2) patients receive continuity of care, are not abandoned, and do not lose personal identity; (3) patients retain as much control as possible over decisions regarding their care and are allowed to refuse further life-prolonging techno-logic interventions; and (4) patients are viewed as individuals with personal fears, thoughts, feelings, values, and hopes
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 that 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
a patient-centered medical home and the constellation of other clinicians providing health care services to patients within it, along with community and social services organizations and state and local public health agencies
Medicare
Title XVIII (Social Security Act, 1965) to provide a measure of health coverage to all Social-Security recipients
Multiplayer 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 lie-threatening illnesses the best quality of life they can have through the aggressive management of symptoms
Patient Protection and Affordable Care Act (PPACA)
2010 federal 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 delivery efficiencies, submission of data and measures to the payer, and improved quality and patients 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
Single-payer system
one entity such as a government run the organization, collect all health care fees, and pay out all health care costs