D391 Healthcare Ecosystems Guaranteed Success

D391 Healthcare Ecosystems Guaranteed Success Healthcare Ecosystem and System 1. What is the entire structure that supports healthcare provision to individuals? Answer: The healthcare ecosystem. 2. Who are the key stakeholders in the healthcare ecosystem? Answer: Patients, providers, professional administrators, policymakers, and payers. Stakeholders and Clients 3. What group of people have a common interest in a business, especially in healthcare? Answer: Stakeholders. 4. Which type of disparity is experienced by a client who has received nutritional counseling but is on a fixed income and shops at a food pantry with limited food selection? Answer: Access to social needs. 5. What is one of the social determinants of health that can affect a client's health outcomes? Answer: Financial restrictions and inability to afford proper dietary food choices. Quadruple Aim 6. What is one of the components of the Quadruple Aim of healthcare? Answer: Improving population health (preventive care). 7. What are the four main aims of the Quadruple Aim in healthcare? Answer: Enhancing patient experience, improving population health, reducing costs, and improving work-life balance. Healthcare Providers 8. What role do healthcare providers play in the healthcare ecosystem? Answer: Providers perform services such as doctors, mid-level providers, nurses, occupational therapists, physical therapists, and mental health providers. 9. Which type of provider is responsible for performing medical procedures, designing treatment plans, and coordinating with a client's entire medical team? Answer: Hospitalists. 10. What type of provider serves as a client's main point of contact throughout their stay in an inpatient facility? Answer: Hospitalists. Government Organizations 11. Which government organization monitors payers' organizations and accredits health insurance companies? Answer: National Commission on Quality Assurance. 12. Which agency under the Department of Health can help clients locate resources to assist with out of-pocket expenses? Answer: Social Security Office. Payers 13. What type of insurance covers more than half of the U.S. population under 65 years old? Answer: Employer-sponsored insurance plans. 14. Which type of insurance will be a better fit for a 30-year-old client who is currently receiving dialysis for permanent kidney failure? Answer: Medicare. Quality Improvement 15. What act aimed to promote a culture of safety and encouraged the development of quality improvement strategies? Answer: Patient Safety and Quality Improvement Act of 2005 (PSQIA). 16. What act aimed to move the US system to universal coverage and expanded Medicaid and CHIP? Answer: Affordable Care Act of 2010 (ACA). Funding Models 17. What are the five main funding models in the US healthcare system? Answer: Self-funded, Bismarck, Beveridge, National Health Insurance, and Bis-Bev. 18. Which model is a social health insurance model that reimburses for social needs in the plan of care? Answer: The Bismarck Model. 19. Which model is a single-payer national health service that is provided and financed by the government? Answer: The Beveridge Model. Relies on an insurance system known as sickness funds Providers are mostly private! Which is an example of fraud by a provider? ️Kickbacks.Providers are not allowed to take funds from vendors for referrals. Which health plan is regulated under the Employee Retirement Income Security Act (ERISA)? ️Self insured.Self-insured plans are governed by state regulations under ERISA. Identify insurance regulations and reimbursement procedures for affordable quality care. ️look it up Identify fundamental federal- and state-level government insurance regulations and reimbursement procedures to ensure compliance. ️look it up What is the difference in coverage between Medicare Parts A, B, C, and D? ️Medicare Part A is hospital coverage. Part B is Medicare's principal benefit, which covers physician and other outpatient-provider services. Part C called Medicare Advantage (MA)government worked with private Health Maintenance Organizations (HMOs) to participate in Part C. Part D HMO for prescriptions Capitation ️Is the fixed payment for each patient given to a doctor or person providing medical services Food and Drug Administration (FDA) ️approves food, drugs, biological products, and medical devices Federal Trade Commission (FTC) ️federal agency responsible for enforcing antitrust laws and preventing monopolies from developing Tricare, VA, BIA ️Tricare is healthcare insurance for active and retired military service people and their families Which agency collects Medicare funds from employers? ️The IRS is responsible for collecting Medicare funds from employers. Tricare is what type of health insurance? ️Tricare is insurance for military members and their families globally.