Healthcare Administration Evolution, Systems,
and Leadership - D545 Questions and Correct
Answers
Patient Protection and Affordable Care Act (ACA)
also known as the Affordable Care Act and Obamacare; a U.S. federal statute enacted in 2010
aimed at expanding health insurance coverage, reducing healthcare costs, and improving
healthcare system efficiency and quality
uninsured
individuals who do not have health insurance coverage through private companies, government
programs, or other means, and therefore, may face difficulties in accessing healthcare services
health insurance marketplace
system established to facilitate the purchase of health insurance in organized markets (also
referred to as health insurance exchanges)
health care
an act or deed between the healthcare provider and the patient to maintain or improve the
patient's healthcare status
biomedical model
a theoretical framework in healthcare that views illness and disease as primarily resulting from
biological factors
holistic health
,an approach to wellness that simultaneously addresses the physical, mental, emotional, social,
and spiritual components of health
holistic medicine
the practice of healthcare professionals using a diverse range of disciplines, religious
philosophies, and cultural practices to heal individuals, communities, and the environment
accountable care organization (ACO)
a network of doctors, hospitals, and other healthcare providers that voluntarily come together to
provide coordinated, high-quality care to their patients
structure
how specific activities are performed to ensure the mission and vision of the organization are
achieved
functional organization structure
splits the organization into departments based on the expertise of employees (also referred to as
bureaucratic organizational structure)
matrix organizational structure
a type of organizational design that combines two or more types of organizational structures,
typically functional and project-based
financing
premiums established through negotiations between employers and the MCO
insurance
,a financial arrangement that protects against financial loss or liability, typically by allowing
individuals or entities to pool the risk of potential losses in exchange for regular payments
known as premiums
managed care organization (MCO)
a type of healthcare delivery system that aims to manage the cost, quality, and accessibility of
healthcare services; MCOs are commonly associated with HMOs, PPOs, and POS plans
delivery
the provision of healthcare services by various providers in exchange for payment for services
rendered
payment function
to determine fees for services, how much a provider should be paid for services rendered, and the
actual payment to the provider after services have been rendered
health maintenance organization (HMO)
a type of managed care organization that provides health insurance coverage through a network
of healthcare providers who offer services to members for a fixed fee
preferred provider organization (PPO)
a type of managed care organization that provides health insurance coverage where members can
receive care from both in-network and out-of-network providers, with greater flexibility and
higher coverage for in-network services
integrated delivery system (IDS)
, a network of organizations that provides or arranges to provide an organized variety of services
to specific populations and is held accountable for the outcomes and health status of those
populations
payer-provider integration
a system comprising a merger between the payers of healthcare and the providers of healthcare
to control healthcare costs and improve the delivery of healthcare services
consumer-driven health plan (CDHP)
(also known as a high-deductible health plan) a type of health insurance plan that encourages
individuals to manage their healthcare costs
point-of-service plan
a type of managed care health insurance that combines features of HMOs and PPOs; it offers a
blend of flexibility and cost-efficiency, with an emphasis on coordinated care
fee-for-service
a system wherein healthcare is provided as individual units of service, such as magnetic
resonance imaging (MRI) or other X-ray, medical examination, flu shot, or other service
preferred provider
a type of organization that provides services based on contracts with groups
magnetic resonance imaging (MRI)
A medical imaging technique used to visualize internal structures of the body.
preferred provider
and Leadership - D545 Questions and Correct
Answers
Patient Protection and Affordable Care Act (ACA)
also known as the Affordable Care Act and Obamacare; a U.S. federal statute enacted in 2010
aimed at expanding health insurance coverage, reducing healthcare costs, and improving
healthcare system efficiency and quality
uninsured
individuals who do not have health insurance coverage through private companies, government
programs, or other means, and therefore, may face difficulties in accessing healthcare services
health insurance marketplace
system established to facilitate the purchase of health insurance in organized markets (also
referred to as health insurance exchanges)
health care
an act or deed between the healthcare provider and the patient to maintain or improve the
patient's healthcare status
biomedical model
a theoretical framework in healthcare that views illness and disease as primarily resulting from
biological factors
holistic health
,an approach to wellness that simultaneously addresses the physical, mental, emotional, social,
and spiritual components of health
holistic medicine
the practice of healthcare professionals using a diverse range of disciplines, religious
philosophies, and cultural practices to heal individuals, communities, and the environment
accountable care organization (ACO)
a network of doctors, hospitals, and other healthcare providers that voluntarily come together to
provide coordinated, high-quality care to their patients
structure
how specific activities are performed to ensure the mission and vision of the organization are
achieved
functional organization structure
splits the organization into departments based on the expertise of employees (also referred to as
bureaucratic organizational structure)
matrix organizational structure
a type of organizational design that combines two or more types of organizational structures,
typically functional and project-based
financing
premiums established through negotiations between employers and the MCO
insurance
,a financial arrangement that protects against financial loss or liability, typically by allowing
individuals or entities to pool the risk of potential losses in exchange for regular payments
known as premiums
managed care organization (MCO)
a type of healthcare delivery system that aims to manage the cost, quality, and accessibility of
healthcare services; MCOs are commonly associated with HMOs, PPOs, and POS plans
delivery
the provision of healthcare services by various providers in exchange for payment for services
rendered
payment function
to determine fees for services, how much a provider should be paid for services rendered, and the
actual payment to the provider after services have been rendered
health maintenance organization (HMO)
a type of managed care organization that provides health insurance coverage through a network
of healthcare providers who offer services to members for a fixed fee
preferred provider organization (PPO)
a type of managed care organization that provides health insurance coverage where members can
receive care from both in-network and out-of-network providers, with greater flexibility and
higher coverage for in-network services
integrated delivery system (IDS)
, a network of organizations that provides or arranges to provide an organized variety of services
to specific populations and is held accountable for the outcomes and health status of those
populations
payer-provider integration
a system comprising a merger between the payers of healthcare and the providers of healthcare
to control healthcare costs and improve the delivery of healthcare services
consumer-driven health plan (CDHP)
(also known as a high-deductible health plan) a type of health insurance plan that encourages
individuals to manage their healthcare costs
point-of-service plan
a type of managed care health insurance that combines features of HMOs and PPOs; it offers a
blend of flexibility and cost-efficiency, with an emphasis on coordinated care
fee-for-service
a system wherein healthcare is provided as individual units of service, such as magnetic
resonance imaging (MRI) or other X-ray, medical examination, flu shot, or other service
preferred provider
a type of organization that provides services based on contracts with groups
magnetic resonance imaging (MRI)
A medical imaging technique used to visualize internal structures of the body.
preferred provider
