D391: Healthcare Ecosystem Exam 3 Questions
With Correct Answers!!
healthcare ecosystem
a system composed of elements that create a community
healthcare system
an organization of individuals, institutions, and resources that deliver services to clients
stakeholders
a group of people with a common interest, especially in a business
provider
a person or institution that performs a service; for example, a healthcare worker performs health
services.
healthcare producers
diverse individuals with various skills and knowledge who provide services to patients
product
multiple client services and treatment in the healthcare system
licensure
education and qualifications for healthcare providers
payers
individuals or organizations who cover the costs of healthcare services, either through self-pay or
insurance companies
purchasers
an individual or organization that purchases healthcare coverage on behalf of their employees
investors
,individuals or organizations who invest in healthcare services
National Committee for Quality Assurance (NCQA)
monitors payer organizations
Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
helps improve and monitor providers' quality of care
U.S. Department of Health and Human Services
government organization that protects consumers from harm
government regulations
helps reduce harm to healthcare patients and employees
health insurance
payment for health services
fee-for-service
providers receive payment for services performed
health maintenance organizations
a model in which providers are paid capitation payments, restricting patients to a preferred list of
providers and controlling access to care
insurance risk
an event covered by insurance; the risk of payment is borne by the insurer, so insurance
companies work hard to manage risk for both individuals and groups
insurance expenses
payments such as deductibles, premiums, and co-pays
Moral hazards
,situation in which individual incurs no consequence for a decision, allowing for extravagant
choices such as using more medical services than are necessary
adverse selection
in insurance terms, a situation in which the insured person has information that the insurer does
not have, gaining coverage at a cost below the true level of risk
value-based care
provider of service awards for quality patient care
wellness and prevention
reduce cost and improve patient outcomes
legislation
standardizes care and protects patients
Affordable Care Act
a law that states everyone in the United States can receive affordable, accessible, quality care
Medicare
health insurance for people over age 65 and people on social security disability
reimbursement
funds paid to providers for services rendered
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
Medicaid
, insurance for the low socioeconomic population
Children Health Insurance Program (CHIP)
insurance for families with children that do not qualify for Medicaid
group health insurance
insurance offered by an employer or union
health savings account
tax-free financial healthcare account that pays for future medical expenses
cost sharing
Healthcare payments are shared by the insured and the company.
premiums
monthly payments for health insurance
self-pay
paying for medical care up-front
efficiency
obtaining the most significant health benefit in a way that minimizes costs and resource use
quality
evidence-based care that delivers positive outcomes
SHARE approach
a decision-making framework involving a client and care providers
S: seek your patient's participation
H: help your patient explore and compare treatment options
A: assess your patient's values and preferences
With Correct Answers!!
healthcare ecosystem
a system composed of elements that create a community
healthcare system
an organization of individuals, institutions, and resources that deliver services to clients
stakeholders
a group of people with a common interest, especially in a business
provider
a person or institution that performs a service; for example, a healthcare worker performs health
services.
healthcare producers
diverse individuals with various skills and knowledge who provide services to patients
product
multiple client services and treatment in the healthcare system
licensure
education and qualifications for healthcare providers
payers
individuals or organizations who cover the costs of healthcare services, either through self-pay or
insurance companies
purchasers
an individual or organization that purchases healthcare coverage on behalf of their employees
investors
,individuals or organizations who invest in healthcare services
National Committee for Quality Assurance (NCQA)
monitors payer organizations
Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
helps improve and monitor providers' quality of care
U.S. Department of Health and Human Services
government organization that protects consumers from harm
government regulations
helps reduce harm to healthcare patients and employees
health insurance
payment for health services
fee-for-service
providers receive payment for services performed
health maintenance organizations
a model in which providers are paid capitation payments, restricting patients to a preferred list of
providers and controlling access to care
insurance risk
an event covered by insurance; the risk of payment is borne by the insurer, so insurance
companies work hard to manage risk for both individuals and groups
insurance expenses
payments such as deductibles, premiums, and co-pays
Moral hazards
,situation in which individual incurs no consequence for a decision, allowing for extravagant
choices such as using more medical services than are necessary
adverse selection
in insurance terms, a situation in which the insured person has information that the insurer does
not have, gaining coverage at a cost below the true level of risk
value-based care
provider of service awards for quality patient care
wellness and prevention
reduce cost and improve patient outcomes
legislation
standardizes care and protects patients
Affordable Care Act
a law that states everyone in the United States can receive affordable, accessible, quality care
Medicare
health insurance for people over age 65 and people on social security disability
reimbursement
funds paid to providers for services rendered
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
Medicaid
, insurance for the low socioeconomic population
Children Health Insurance Program (CHIP)
insurance for families with children that do not qualify for Medicaid
group health insurance
insurance offered by an employer or union
health savings account
tax-free financial healthcare account that pays for future medical expenses
cost sharing
Healthcare payments are shared by the insured and the company.
premiums
monthly payments for health insurance
self-pay
paying for medical care up-front
efficiency
obtaining the most significant health benefit in a way that minimizes costs and resource use
quality
evidence-based care that delivers positive outcomes
SHARE approach
a decision-making framework involving a client and care providers
S: seek your patient's participation
H: help your patient explore and compare treatment options
A: assess your patient's values and preferences
