Key Terms- Chapter 8

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1

Accountable care organization (ACO)

are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients

2

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

3

capitation

the payment of a fee or grant to a doctor, school, or other person or body providing services to a number of people, such that the amount paid is determined by the number of patients, students, or customers

4

care coordination

the deliberate organization of patient careactivities between two or more participants involved in a patient's care to facilitate the appropriate delivery of health care services

5

community health center

are private, nonprofit organizations that directly or indirectly (through contracts and cooperative agreements) provide primary health services and related services to residents of a defined geographic area that is medically underserved.

6

consumer

the person who uses health care services

the patient

7

diagnosis-related group

DRG

classification of patients by major medical diagnosis for the purpose of standardizing health care costs

8

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 nations budget

9

extended-care services

includes residential care and intermediate or skilled long-term care facility

10

fee-for-service

system in which a bill is generated and a fee is paid every time a provider does something for a patient

11

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 medications to hospital visits; insurance options can be compared based on price, benefits, quality, and other features described in plain language

12

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; there may be no additional out-of-pocket costs, or subscribers may pay only a small fee called a copayment

13

hospice

a type of end of life care for persons who are terminally ill

14

inpatient

person who enters a health care setting for a stay ranging from 24 hours to many years

15

managed care

an organized, high quality, cost effective system if health care that influences the selection and use of health care services of a population

16

Medicaid

title xix to make health care available to those people with less than the minimum income who do not qualify for medicare

17

medical home

an enhanced model of primary care that provides whole person, accessible, comprehensive, ongoing, and coordinated patient centered care

18

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 service organizations and state and local public health agencies

19

medicare

title xviii to provide a measure of health coverage to all SS recipients

20

multipayer system

a health care system in which care is paid for by both private insurance companies and the government

21

mutispecialty 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

22

outpatient

person who requires health care services but does not need to stay in an institution for those services

23

palliative care

hospice care; taking care of the while person- body, mind, spirit, heart, and soul- with the goal ofgiving patients with life-threatening illnesses the best quality of life they can have through the aggressive management of symtoms

24

patient protection and affordable care act

PPACA

2010 federal legislation designed for comprehensive health reform, with an intent to expand coverage, control healthcare costs, and improve the health care delivery system

25

pay for performance

a strategy using financial incentives to reward providers for acheiving a range of payer objectives, including delivery efficiencies, submission of data and measures of the payer, and improved quality and patient safety

26

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

27

respite care

a type of care provided for caregivers of homebound ill, disabled, or elderly patients