Accountable Care Organization (ACO)
This new organizational structure is a departure from the traditional fee-for-service model of reimbursement.
Ambulatory Care
Health care settings located in areas that are convenient for people to walk into and receive care; may be provided in hospitals, clinics, or centers.
Capitation
Gives providers a fixed amount per enrollee of health plan.
Care Coordination
The deliberate organization of pt care activities between two or more participants (including the pt) involved in a pt's care to facilitate the appropriate delivery of healthcare services.
Community Health Centers
Regionalized services for vulnerable geographic populations with an emphasis on primary care and education. Their primary objective is to ensure that everyone who needs care has access regardless of ability to pay.
Consumer
The person who uses health care services (the pt).
Diagnosis-related Group (DRG)
Classification of pt's by major medical diagnosis for the purpose of standardizing health care costs.
Entitlement Reform
Proposed legislation making changes in entitlement benefits, such as Medicare and Medicaid, paid by the government to citizens, with the goal of improving the nation's budget.
Extended-care Services
Includes residential care and intermediate or skilled long-term care facility.
Fee-for-service
System in which a bill is generated and a fee is paid every time a provider does something for a pt.
Health Insurance Marketplace
Federal and state system designed to help people more easily find health insurance that fits their budget and needs with a plan offering comprehensive coverage, from doctors to medications to hospital visits; insurance options can be compared based on pri
Health Maintenance Organization (HMO)
Prepaid, group-managed care plan that allows subscribers to receive all the medical services they require through a group of affiliated providers; there may be no additional out-of-pocket costs, or subscribers may pay only a small fee, called a copayment.
Hospice
A type of end-of-life care for persons who are terminally ill, characterized by the following: (1) pt's are kept as free of pain as possible so that they may die comfortably and with dignity. (2) pt's receive continuity of care, are not abandoned and do n
Impatient
Person who enters a health care setting for a stay ranging from 24 hours to many years.
Managed Care
An organized, high-quality, cost-effective system of health care that influences the selection and use of health care services of a population.
Medicaid
Title XIX (Social Security Act, 1965) to make health care available to those people with less than the minimum income who do not qualify for Medicare.
Medical Home
An enhanced model of primary care that provides whole-person, accessible, comprehensive, ongoing, and coordinated pt-centered care.
Medical Neighborhood
A pt-centered medical home and the constellation of other clinicians providing health care services to pt's within it, along with community and social service organizations and state and local public health agencies.
Medicare
Title XVII (Social Security Act, 1965) to provide a measure of health coverage to all social security recipients.
Multiplayer System
A health care system in which care is paid for by both private insurance companies and the government.
Multispeciality Group Practice
Organization of physicians from different specialties joined to share income, expenses, facilities, equipment, and support staff; the group practice can better provide comprehensive care.
Outpatient
Person who requires health care services but does not need to stay in an institution for those services.
Palliative Care
Hospice care, taking care of the whole person � body, mind, spirit, heart and soul � with the goal of giving pt's with life-threatening illnesses the best quality of life they can have through the aggressive management of symptoms.
Patient Protection and Affordable Care Act (PPACA)
2010 federal legislation designed for comprehensive health reform, with an intent to expand coverage, control health care costs, and improve the health care delivery system.
Pay for Performance
A strategy using financial incentives to reward providers for achieving a range of payer objectives, including delivery efficiencies, submission of data and measures to the payer, and improved quality and pt safety.
Preferred Provider Organization (PPO)
A prepaid group practice that allows a third-party payer (such as an insurance company) to contract with a group of health care providers to administer services at a lower fee in return for prompt payment and a guarantee volume of pt's and services.
Respite Care
A type of care provided for care-givers of homebound ill, disabled, or elderly pt's.