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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] |
United States
The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country primarily located in North America. It consists of 50 states, a federal district, five major unincorporated territories, nine Minor Outlying Islands, and 326 Indian reservations. The United States is also in free association with three Pacific Island sovereign states: the Federated States of Micronesia, the Marshall Islands, and the Republic of Palau. It is the world's third-largest country by both land and total area. It shares land borders with Canada to its north and with Mexico to its south and has maritime borders with the Bahamas, Cuba, Russia, and other nations. With a population of over 333 million, it is the most populous country in the Americas and the third most populous in the world. The national capital of the United States is Washington, D.C. and its most populous city and principal financial center is New York City. Paleo-Americ ... [...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] |
Workplace Wellness
Workplace wellness, also known as corporate wellbeing outside the United States, is a broad term used to describe activities, programs, and/or organizational policies designed to support healthy behavior in the workplace. This often involves health education, medical screenings, weight management programs, and onsite fitness programs or facilities. Recent developments in wearable health technology have led to a rise in self-tracking devices as workplace wellness. Other common examples of workplace wellness organizational policies include allowing flex-time for exercise, providing onsite kitchen and eating areas, offering healthy food options in vending machines, holding "walk and talk" meetings, and offering financial and other incentives for participation. Over time, workplace wellness has expanded from single health promotion interventions to describe a larger project intended to create a healthier working environment. Companies most commonly subsidize workplace wellness program ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
