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Managed-care
The term managed care or managed healthcare is used in the United States to describe a group of activities intended to reduce the cost of providing health care and providing American health insurance while improving the quality of that care ("managed care techniques"). It has become the predominant system of delivering and receiving American health care since its implementation in the early 1980s, and has been largely unaffected by the Affordable Care Act of 2010. ...intended to reduce unnecessary health care costs through a variety of mechanisms, including: economic incentives for physicians and patients to select less costly forms of care; programs for reviewing the medical necessity of specific services; increased beneficiary cost sharing; controls on inpatient admissions and lengths of stay; the establishment of cost-sharing incentives for outpatient surgery; selective contracting with health care providers; and the intensive management of high-cost health care cases. The p ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Anthem (company)
Elevance Health, Inc. is an American health insurance provider. The company's services include medical, pharmaceutical, dental, behavioral health, long-term care, and disability plans through affiliated companies such as Anthem Blue Cross and Blue Shield, Empire BlueCross BlueShield in New York State, Anthem Blue Cross in California, Wellpoint, and Carelon. It is the largest for-profit managed health care company in the Blue Cross Blue Shield Association. As of 2022, the company had 46.8 million members within their affiliated companies' health plans. Prior to June 2022, Elevance Health was named Anthem, Inc. Based on its 2021 revenues, the company ranked 20th on the 2022 Fortune 500. History Anthem In 1946, Anthem began in Indianapolis, Indiana, as Mutual Hospital Insurance Inc. and Mutual Medical Insurance Inc. The companies grew significantly, controlling 80% of the medical insurance market in Indiana by the 1970s. In 1972, The two firms, then known as Blue Cross of Indian ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Long-term Care
Long-term care (LTC) is a variety of services which help meet both the medical and non-medical needs of people with a chronic illness or disability who cannot care for themselves for long periods. Long-term care is focused on individualized and coordinated services that promote independence, maximize patients' quality of life, and meet patients' needs over a period of time. It is common for long-term care to provide custodial and non-skilled care, such as assisting with activities of daily living like dressing, feeding, using the bathroom, meal preparation, functional transfers and safe restroom use. Increasingly, long-term care involves providing a level of medical care that requires the expertise of skilled practitioners to address the multiple long-term conditions associated with older populations. Long-term care can be provided at home, in the community, in assisted living facilities or in nursing homes. Long-term care may be needed by people of any age, although it is a m ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Integrated Delivery System
An integrated delivery system (IDS), also known as integrated delivery network (IDN), is a health system with a goal of logical integration of the delivery (provision) of health care as opposed to a fragmented system or a disorganized lack of system. The term has sometimes been used in a broad sense with reference to managed care in general (as opposed to fee-for-service care), but in the United States it now more often refers to any specific network of health care organizations constituting a corporate group that attempts to integrate care to some degree (that is, to coordinate the patient journey across care transitions). Some IDSs have an HMO component, while others are a network of physicians only, or of physicians and hospitals. Thus, the term is used broadly to define an organization that provides a continuum of health care services. Background The guiding business model and philosophical goal of the IDN is to serve as a self-contained healthcare ecosystem, with the abilit ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Balance Billing
Balance billing, sometimes called surprise billing, is a medical bill from a healthcare provider billing a patient for the difference between the total cost of services being charged and the amount the insurance pays. It is an especially common problem in the United States with providers who are out of network, and therefore not subject to the rates or terms of providers who are in-network. Balance billing has a variable prevalence by market and specialty. Advocates of balance billing argue that it increases the incomes of high-quality healthcare providers, and serves as a measure of their dissatisfaction with insurance company fees. Critics say that balance billing lets providers raise charges through stealth rather than transparent pricing, creates unnecessary administrative costs and patient confusion, and allows providers to simply pass along costs to patients, rather than helping them to secure good value. It is thought to erode political consensus in favor of a one-tier syste ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Blockchain
A blockchain is a type of distributed ledger technology (DLT) that consists of growing lists of records, called ''blocks'', that are securely linked together using cryptography. Each block contains a cryptographic hash of the previous block, a timestamp, and transaction data (generally represented as a Merkle tree, where data nodes are represented by leaves). The timestamp proves that the transaction data existed when the block was created. Since each block contains information about the previous block, they effectively form a ''chain'' (compare linked list data structure), with each additional block linking to the ones before it. Consequently, blockchain transactions are irreversible in that, once they are recorded, the data in any given block cannot be altered retroactively without altering all subsequent blocks. Blockchains are typically managed by a peer-to-peer, peer-to-peer (P2P) computer network for use as a public distributed ledger, where nodes collectively adhere to ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Centers For Medicare And Medicaid Services
The Centers for Medicare & Medicaid Services (CMS), is a federal agency within the United States Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership with state governments to administer Medicaid, the Children's Health Insurance Program (CHIP), and health insurance portability standards. In addition to these programs, CMS has other responsibilities, including the administrative simplification standards from the Health Insurance Portability and Accountability Act of 1996 (HIPAA), quality standards in long-term care facilities (more commonly referred to as nursing homes) through its survey and certification process, clinical laboratory quality standards under the Clinical Laboratory Improvement Amendments, and oversight of HealthCare.gov. CMS was previously known as the Health Care Financing Administration (HCFA) until 2001. CMS actively inspects and reports on every nursing home in the United States. This includes maintaini ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Envision Healthcare
Envision Healthcare is an American healthcare company and national hospital-based physician group. History In December 2016, Envison and AMSURG merged, and shortly thereafter the company's stock replaced Legg Mason in the S&P 500 index. In 2017, the company's subsidiary EmCare, came under scrutiny due to healthcare consumers being shocked by high medical bills from Envision's out-of-network healthcare providers. In August 2017, Envision sold its ambulance unit, American Medical Response, for $2.4 billion to KKR, which combined it with a similar company it already owned. In 2017, the company reported a net loss of $232.5 million on revenue of $7.8 billion. In June 2018, KKR announced that it was acquiring the rest of Envision for $9.9 billion, including the assumption or repayment of debt. In February 2020, Envision Healthcare appointed James Rechtin as CEO. In April 2020, they were considering bankruptcy. In October 2020, it was announced that Cigna and Envision had renewe ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
UnitedHealth Group
UnitedHealth Group Incorporated is an American multinational managed healthcare and insurance company based in Minnetonka, Minnesota. It offers health care products and insurance services. UnitedHealth Group is the world's seventh largest company by revenue and the largest healthcare company by revenue, and the largest insurance company by net premiums. UnitedHealthcare revenues comprise 80% of the Group's overall revenue. The company is ranked 11th on the 2022 Fortune Global 500. UnitedHealth Group has a market capitalization of $400.7 billion as of March 31, 2021. History In 1974, Richard Taylor Burke founded Charter Med Incorporated, a Minnetonka, Minnesota-based privately held company. In 1977, the United HealthCare Corporation was created to reorganize the company and became the parent company of Charter Med. United HealthCare's charter was to manage the newly created Physicians Health Plan of Minnesota, an early health management organization. In 1988, United HealthC ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Reference Price
A reference price (RP) is the price that a purchaser announces that it is willing to pay for a good or service. It is used by high-volume purchasers to inform suppliers. RP requires consumers to have access to price and quality information, which is not general practice in many industries. Further, it does not help consumers with urgent needs, cognitive and/or other impairments. Reference pricing requires sufficient competition. Otherwise, consumers have no choice about providers, who in turn face less pricing pressure. Reference pricing could encourage lower quality. "Reference price" in this context is distinct from its use in behavioral pricing scholarship. In that literature, a "reference price" refers to a mental standard of comparison or a posted statement of "normal" prices used to judge whether an offered price is good deal -- as in "Was $100, now $70." Reference prices in this context are related to work by Nobel Prize winner Richard Thaler on "transaction utility" in hi ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
High-deductible Health Plan
In the United States, a high-deductible health plan (HDHP) is a health insurance plan with lower premiums and higher deductibles than a traditional health plan. It is intended to incentivize consumer-driven healthcare. Being covered by an HDHP is also a requirement for having a health savings account. Some HDHP plans also offer additional "wellness" benefits, provided before a deductible is paid. High-deductible health plans are a form of catastrophic coverage, intended to cover for catastrophic illnesses. Adoption rates of HDHPs have been growing since their inception in 2004, not only with increasing employer options, but also increasing government options. As of 2016, HDHPs represented 29% of the total covered workers in the United States; however, the impact of such benefit design is not widely understood.Waters, T.M., Chang, C.F., Cecil, W.T., Kasteridis, P., and Mirvis, D"Impact of High-Deductible Health Plans on Health Care Utilization and Costs" ''Health Services Researc ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Indemnity
In contract law, an indemnity is a contractual obligation of one party (the ''indemnitor'') to compensate the loss incurred by another party (the ''indemnitee'') due to the relevant acts of the indemnitor or any other party. The duty to indemnify is usually, but not always, coextensive with the contractual duty to "hold harmless" or "save harmless". In contrast, a "guarantee" is an obligation of one party (the ''guarantor'') to another party to perform the promise of a relevant other party if that other party defaults. Indemnities form the basis of many insurance contracts; for example, a car owner may purchase different kinds of insurance as an indemnity for various kinds of loss arising from operation of the car, such as damage to the car itself, or medical expenses following an accident. In an agency context, a principal may be obligated to indemnify their agent for liabilities incurred while carrying out responsibilities under the relationship. While the events giving ris ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Patient Education
Patient education is a planned interactive learning process designed to support and enable expert patients to manage their life with a disease and/or optimise their health and well-being. Overview Education may be provided by any healthcare professional who has undertaken appropriate training education, education on patient communication and education is usually included in the healthcare professional's training. However, further training is required to develop specialist skills needed to facilitate self-management and behaviour change. Health education is also a tool used by managed care plans, and may include both general preventive education or health promotion and disease or condition specific education. Important elements of patient education are skill building and responsibility: patients need to know when, how, and why they need to make a lifestyle change. Group effort is equally important: each member of the patient's health care team needs to be involved. It can also hel ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
