Accountable care organizations (ACOs)
A health care organization characterized by a payment and care delivery model that seeks to tie provider reimbursements to quality metrics and reductions in the total cost of care for an assigned population of patients.
Advanced practice nurses (APNs)
Nurses with advanced education beyond the baccalaureate degree who are prepared to manage and deliver health care services to individuals, families, groups, communities, and populations; includes clinical nurse specialists, nurse practitioners, nurse midw
Advocate
One who pleads the cause of another
Affordable Care Act (ACA)
The comprehensive health care reform law enacted in March 2010. The law was enacted in two parts: The Patient Protection and Affordable Care Act was signed into law on March 23, 2010 and was amended by the Health Care and Education Reconciliation Act on M
Capitation rate
Rate paid to a physician or group of physicians that is a set amount for each enrolled person assigned to them, per period of time, whether or not that person seeks care
Concierge care
A type of primary care medical practice in which physicians charge individual clients a membership fee (on average of $1500 to $1900 per year; range reported as $60 to $15,000 per year) in return for enhanced health care services or amenities
Fee-for-service
Individual health care payment arrangement in which the person pays for each visit.
Gatekeeper
A physician or APN who provides primary care and who makes referrals for emergency services or specialty care.
Health insurance exchanges
A set of state-regulated and standardized health care plans in the United States, from which individuals may purchase health insurance eligible for federal subsidies.
Health maintenance organizations (HMOs)
The prototypical managed care structure that encompasses two possibilities: (1) a health plan in which providers assume some of the financial risk and (2) a health plan that uses primary care providers as gatekeepers.
Health savings accounts (HSAs
Health care reimbursement accounts established for the employee.
High-deductible health insurance plans (HDHPs)
A health insurance plan with lower premiums and higher deductibles than a traditional health plan.
Hospitalist
A physician whose professional focus is caring for the hospitalized individual.
Indemnity insurance plan
A type of medical plan that reimburses the patient and/or provider as expenses are incurred.
Independent practice associations (IPAs)
Organizations composed of independent physicians in solo or group practices who provide health care services to members of an HMO in their private offices, eliminating the expense of the staff model HMO, which furnished and owned the facility in which car
Insurance
Individual payment to a fund to provide protection for each contributor against financial losses resulting from an unlikely, but possible, occurrence.
Managed care
A system that seeks to manage the cost of health care, the quality of that health care, and access to care. It is based on the belief that health care costs can be controlled by "managing" the way in which health care is delivered.
Medicaid
Title XIX Social Security Amendment (1965), a combined federal and state program. The program provides access to care for the poor and medically needy of all ages.
Medicare
A federal health insurance program that finances medical care for people over 65, disabled individuals who are entitled to Social Security benefits, and people with end-stage renal disease requiring dialysis or a kidney transplant.
Nursing centers
Organizations that give an individual access to professional nursing services. The key components of a community nursing center include a nurse as chief manager, nursing staff who are accountable and responsible for care and professional practice, and nur
Point-of-service (POS)
A health care plan in which members decide how to receive services at the time of service; it combines HMO and indemnity features. As with HMOs, providers are paid through a capitation or risk-based system and, as with preferred provider organizations, in
Preferred provider organizations (PPOs)
A network of providers who agree to deliver services for a discounted fee. The provider generally incurs no financial risk; the financial burden is on the client rather than the provider.
Primary care provider (PCP)
Health care providers who provide care in the managed care arena. They can be physicians or midlevel practitioners (physicians' assistants, nurse practitioners, or nurse midwives) who provide basic health care services.