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69 Cards in this Set
- Front
- Back
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Continuing care retirement community (CCRC) |
Residences on a retirement campus, typically in apartment complexes designed for functional older adults. Unlike ordinary retirement communities that offer only specialized housing, these offer a comprehensive program of social services, meals, and access to contractual medical services in addition to housing. |
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Continuing life care community (CLCC) |
The most expensive of CCRC options. These offer unlimited assisted living, medical treatment, and skilled nursing care without any additional charges as the resident’s needs change over time. |
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Deinstitutionalization |
The movement through which severely mentally ill patients previously confined to large state or county psychiatric hospitals were discharged to community boarding or nursing homes. |
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Naturally occurring retirement community (NORC)
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Apartment complexes, neighborhoods, or sections of communities where residents have opted to remain in their homes as they age.
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Respite care
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Temporary surrogate care given to a patient when that patient’s primary caregiver must be absent. It includes any family managed care program that helps to avoid or forestall the placement of a patient in a full-time institutionalized environment by providing planned, intermittent caregiver relief. |
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Skilled nursing facility (SNF)
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A facility, or distinct part of one, primarily engaged in providing skilled nursing care and related services for people requiring medical or nursing care, or rehabilitation services.
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CH 10: Mental Health Care
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CH 10 |
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“Carve-out” |
A process through which insurers outsource subscribers’ mental illness care oversight to firms specializing in managing service use for mental health diagnoses. |
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Comorbidity
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When two disorders or illnesses occur in the same person, simultaneously or one after another, they are called comorbid. In particular, many people addicted to drugs are also diagnosed with other mental disorders.
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Disability-adjusted life years (DALYS)
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The total number of years lost to illness, disability, or premature death within a given population.
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Managed Behavioral Healthcare Organization (MBHO)
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A corporate entity to which a health plan may outsource the management of mental health services for its subscribers. This entity assumes the financial risks and benefits of managing treatment budgets and authorization for access to mental health services.
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Mental health parity
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Equating annual and aggregate lifetime insurance coverage limits for mental health services with annual and aggregate lifetime insurance coverage for medical care.
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National alliance on mental illness
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A grassroots organization dedicated to advocating for access to services, treatment, supports, and research for the mentally ill.
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Nonquantitative treatment limitations (NQTLs)
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Limitations or restrictions of covered insurance benefits which though not numerically expressed, otherwise limit the scope or duration of benefits for treatment.
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Recovery Oriented Systems of Care (ROSC)
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A holistic, integrated, person-centered and strength-based approach to mental health interventions. This approach views recovery as a process of pursuing a fulfilling life and seeks to enhance a person’s positive self-image and identity through linking their strengths with family and community resources.
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CH 8: Financing |
Financing |
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Balanced Budget Act of 1997 (BBA)
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This act took important incremental steps by extending healthcare coverage to uninsured children through a $16 billion allocation for a new State Children’s Health Insurance Program (SCHIP). It also proposed to reduce growth in Medicare and Medicaid spending by $125.2 billion in 5 years.
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Bundled payment for care initiatives (BPCI)
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This initiative recognizes that separate Medicare fee-for-service payments for individual services provided during a beneficiary’s single illness often result in fragmented care with minimal co-ordination across providers and settings and results in rewarding service quantity rather than quality.
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Community-rated insurance
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Insurance plans in which all individuals in a defined group pay premiums without regard to age, gender, occupation, or health status. Community rating helped ensure nondiscrimination against groups with varying risk characteristics to provide coverage at reasonable rates for the community as a whole.
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Consumer-Driven Health Plan (CDHP)
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Developed in a reaction to the managed care backlash, the goals of rhese plans were to have employees take more responsibility for healthcare decisions and exercise more cost consciousness.
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Department of Health and Human Services (DHHS)
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The federal government’s principal agency concerned with health protection and promotion and provision of health and other human services to vulnerable populations.
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Disease Management Programs
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MCO programs that attempt to control costs and improve care quality for individuals with chronic and costly conditions through methods such as the use of evidence-based clinical guidelines, patient self-management education, disease registries, risk stratification, proactive patient outreach, and performance feedback to providers.
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Emergency Medical Treatment and Labor Act (EMTALA)
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This act requires hospitals to treat everyone who presents in their emergency departments, regardless of ability to pay. Stiff financial penalties, and as risk of Medicare decertification by hospitals inappropriately transferring patients, accompanies the EMTALA legal provisions.
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Experience-rated insurance |
Insurance plans in which insurance on historically documented patterns of healthcare service utilization for defined populations of subscribers to determine premium charges. |
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Financial risk-sharing
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A concept used by MCOs to transfer some measure of financial risk from insurers to beneficiaries. Such transfers of financial risk to beneficiaries commonly take the form of copayments and deductibles. |
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Healthcare Effectiveness Data and Information Set (HEDIS)
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Provides a standardized method for MCOs to collect, calculate, and report information about their performance to allow employers, other purchasers, and consumers to compare different health insurance plans.
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HMO Act of 1973
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Federal legislation enacted by the Nixon administration that provided loans and grants for the planning, development, and implementation of combined insurance and healthcare delivery organizations and required that a comprehensive array of preventive and primary care services be included in the HMO arrangement.
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Indemnity insurance
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A form of insurance in which the insurance company sets allowable charges for services that it will reimburse after services are delivered and allows providers to bill patients for any uncovered excess costs.
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Independent Payment Advisory Board (IPAB)
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Created by the ACA. The mission of this entity is to recommend policies to Congress to curb Medicare spending including suggestions to improve co-ordination of care, eliminate waste, encourage best practices, and prioritize primary care.
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National Committee on Quality Assurance (NCQA)
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Primary functions of the this entity are accreditation for MCOs, PPOs, managed behavioral healthcare organizations, new health plans, and disease management programs; certifying organizations that verify provider credentials and consultation on physician organizations, utilization management organizations, patient-centered medical homes, and disease management organizations and programs.
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Self-funded health insurance
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A mechanism through which, the employer (or other group, such as a union or trade association) collects premiums and pools these into a fund or account that it uses to pay for medical benefit claims instead of using a commercial carrier.
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Chapter 6: Medical Education |
CH 6 |
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Accreditation council for graduate medical education (ACGME)
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The independent, not-for-profit professional organization that accredits 3-7 year programs of advanced education and clinical practice required by physicians to provide direct patient care in a recognized medical specialty.
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Agency for Healthcare Research and Quality (AHRQ)
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The federal agency charged with research to develop and disseminate evidence-based practice guidelines.
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American Board of Medical Specialities (ABMS)
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An independent, not-for-profit organization. It assists its 24 specialty member boards to develop and utilize professional and educational standards that apply to the certification of physician specialists in the United States and internationally.
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Capitation
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A managed care reimbursement method that prepays physicians for services on a per-member per-month basis whether or not services are used.
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Evidence-based clinical practice guidelines
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Systematically developed protocols based on extensive research that are used to assist practitioner and patient decisions about appropriate healthcare decisions.
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Flexner Report
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Landmark report resulting from a comprehensive review of the quality of education in U.S. and Canadian medical schools, funded by the Carnegie Foundation. Issued in 1910, the report was a searing indictment of most medical schools of the time. The report gave increased leverage to medical education reformers and stimulated financial support.
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Graduate medical education consortia
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Formal associations of medical schools, teaching hospitals, and other organizations involved in the training of medical residents.
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International medical graduates (IMGs)
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Physicians trained in medical schools outside the United States who fill the annual shortfall in U.S. medical school graduates required to staff hospitals.
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Osteopathic medicine
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A philosophy of medical education with particular focus on the musculoskeletal system.
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Physician compare
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The CMS website, mandated by the ACA, to provide basic contact, practice characteristics and clinical quality data on Medicare participating physicians and other healthcare professionals.
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Terms in Chapter 7: The Health Care Workforce
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Workforce |
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National Health Care Workforce Commission (NHCWC)
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This body has the mandate to evaluate and make recommendations for numerous dimensions of the nation’s healthcare workforce including education and training support for existing and potential new workers at all levels, efficient workforce deployment, professional compensation, and co-ordination among different types of providers.
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National Institute for Complementary and Alternative Medicine
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A division of the National Institutes of Health devoted to conducting and reporting on research focused on complementary and alternative therapies.
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Never-events
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Egregious medical errors occurring in hospitals, the treatment for which the DHHS will not provide reimbursement.
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Physician assistant (PA)
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Provides healthcare services under the supervision of a physician; trained to provide diagnostic, preventive, and therapeutic healthcare services as delegated by physicians.
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Therapeutic science practitioner
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These include physical therapists, occupational therapists, speech language pathology and audiology therapists, radiation therapists, and respiratory therapists, representing some of the allied health disciplines in this category.
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Terms in Chapter 3: Health Information Technology
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HIT |
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Certification
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A regulatory process, much less stringent than licensure, under which a state or professional organization attests to an individual’s advanced training and performance abilities in a field of healthcare practice. |
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Computerized decision support system (CDSS)
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An electronic information- based system in which individual patient data is matched with a computerized knowledge base such as evidence-based clinical practice guidelines, to assist healthcare providers in formulating accurate diagnoses, recommendations, and treatment plans.
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Computerized physician order entry (CPOE)
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A process in which a physician enters patient treatment orders into an individual patient’s electronic health record.
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Federated model of health information exchange
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An HIE design in which member institutions maintain their own data at their respective sites in the standardized format used by an HIE.
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Health information exchange (HIE)
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A network that enables a basic level of interoperability among electronic health records maintained by individual physicians and healthcare organizations. HIEs are organized and governed by regional health information organizations (RHIOs).
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Health Information Technology for Economic and Clinical Health Act (HITECH Act)
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A component of the American Recovery and Reinvestment Act of 2009 dedicated to promoting nationwide adoption and use of electronic health records.
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Meaningful use
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The criterion defined by the ONC in collaboration with the Centers for Medicare and Medicaid Services that entails meeting a set of time-delineated requirements for eligible professionals and hospitals to qualify for incentive payments under the HITECH Act.
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Monolithic model of health information exchange
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An HIE design in which all member institutions send clinical data to one central repository where all data reside together in one universal and standardized format. In this model, authorized users may access individual, transinstitutional patient records from the central repository.
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Office of the National Coordinator for Health Information Technology (ONC)
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The federal principal agency created to co-ordinate nationwide efforts to implement health information technology and exchange of health information.
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Regional health information organization (RHIO)
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Organizations that create systems agreements, process, and technology to manage to facilitate exchange of health information between institutions and across different vendor platforms within specific geographic areas. RHIOs administer HIEs |
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Terms in Chapter 12: Research: How Health Care Advances
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Research |
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Analytic studies
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Test hypotheses and try to explain biologic phenomena by seeking statistical associations between factors that may contribute to a subsequent occurrence and the initial occurrence itself.
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Basic science research
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Conducted by biochemists, physiologists, biologists, pharmacologists, and others concerned with sciences that are fundamental to understanding the growth, development, structure, and functions of the human body and its responses to external stimuli.
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Comparative effectiveness research
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Research designed to inform healthcare decisions by providing evidence on the effectiveness, benefits, and harms of different treatment options. Evidence is generated from research studies that compare drugs, medical devices, tests, surgeries, or ways to deliver health care.
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Descriptive studies
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Studies intended to identify factors and conditions that determine the distribution of health and disease among specific populations.
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Empirical quality standards
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Derived from distributions, averages, ranges, and other measures of data variability, empirical quality standards compare information collected from a number of similar health service providers to identify practices that deviate from norms. |
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Experimental studies |
In these studies, the investigator actively intervenes by manipulating one variable to see what happens with the other. Control populations are used to ensure that other nonexperimental variables are not affecting the outcome.
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Explicit quality standards
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Standards that are professionally developed and agreed on in advance of a quality assessment. Explicit standards minimize the variation and bias that result when judgments are internalized.
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Implicit quality standards
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Standards that rely on the internalized judgments of expert individuals conducting a quality assessment and as such are subject to variation and bias.
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Institutional review board (IRB)
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Professionally constituted, expert groups of individuals who judge the merit of research studies and ensure appropriate and ethical participant safeguards are provided to protect research subjects’ safety.
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