D545 Healthcare Administration Evolution,
Systems, and Leadership STUDY GUIDE WITH-
CORRECT VERIFIED SOLUTIONS | 2026
UPDATE
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 to 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 Organizational 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 of physicians and
hospitals that are referred to as preferred providers
Clinic
A facility that provides ambulatory care services ranging from basic primary care to urgent care
Healthcare Facility
A broad term that encompasses various types of organizations where healthcare services are
provided
Urgent Care Center
A facility that is usually located at a different location from the hospital and offers extended
hours
Ambulatory Care Center
A medical care facility that provides outpatient services (also referred to as an outpatient care
center)
Systems, and Leadership STUDY GUIDE WITH-
CORRECT VERIFIED SOLUTIONS | 2026
UPDATE
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 to 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 Organizational 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 of physicians and
hospitals that are referred to as preferred providers
Clinic
A facility that provides ambulatory care services ranging from basic primary care to urgent care
Healthcare Facility
A broad term that encompasses various types of organizations where healthcare services are
provided
Urgent Care Center
A facility that is usually located at a different location from the hospital and offers extended
hours
Ambulatory Care Center
A medical care facility that provides outpatient services (also referred to as an outpatient care
center)
