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Medicare Shared Savings Program
An accountable care organization (ACO) is a healthcare organization that ties provider reimbursements to quality metrics and reductions in the cost of care. ACOs in the United States are formed from a group of coordinated health-care practitioners. They use alternative payment models, normally, Capitation (healthcare), capitation. The organization is accountable to patients and third-party payers for the quality, appropriateness and efficiency of the health care provided. According to the Centers for Medicare and Medicaid Services, an ACO is "an organization of health care practitioners that agrees to be accountable for the quality, cost, and overall care of Medicare beneficiaries who are enrolled in the traditional fee-for-service program who are assigned to it". History The term ''accountable care organization'' was first used by Elliott S. Fisher, Elliott Fisher in 2006 during a discussion of the Medicare Payment Advisory Commission. In 2009, the term was included in the fed ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Capitation (healthcare)
Capitation is a payment arrangement for health care service providers. It pays a set amount for each enrolled person assigned to them, per period of time, whether or not that person seeks care. The amount of remuneration is based on the average expected health care utilization of that patient, with payment for patients generally varying by age and health status. Types There are differing arrangements in different healthcare systems. Capitation in the USA Primary capitation is a relationship between a managed care organization and primary care physician, in which the physician is paid directly by the organization for those who have selected the physician as their provider. Secondary capitation is a relationship arranged by a managed care organization between a physician and a secondary or specialist provider, such as an X-ray facility or ancillary facility such as a durable medical equipment supplier whose secondary provider is also paid capitation based on that PCP's enrolled ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Brookings Institution
The Brookings Institution, often stylized as simply Brookings, is an American research group founded in 1916. Located on Think Tank Row in Washington, D.C., the organization conducts research and education in the social sciences, primarily in economics (and tax policy), metropolitan policy, governance, foreign policy, global economy, and economic development. Its stated mission is to "provide innovative and practical recommendations that advance three broad goals: strengthen American democracy; foster the economic and social welfare, security and opportunity of all Americans; and secure a more open, safe, prosperous, and cooperative international system." Brookings has five research programs at its Washington campus: Economic Studies, Foreign Policy, Governance Studies, Global Economy and Development, and Metropolitan Policy. It also established and operated three international centers in Doha, Qatar (Brookings Doha Center); Beijing, China (Brookings-Tsinghua Center for Public P ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Health Management Organization
In the United States, a health maintenance organization (HMO) is a medical insurance group that provides health services for a fixed annual fee. It is an organization that provides or arranges managed care for health insurance, self-funded health care benefit plans, individuals, and other entities, acting as a liaison with health care providers (hospitals, doctors, etc.) on a prepaid basis. The Health Maintenance Organization Act of 1973 required employers with 25 or more employees to offer federally certified HMO options if the employer offers traditional healthcare options. Unlike traditional indemnity insurance, an HMO covers care rendered by those doctors and other professionals who have agreed by contract to treat patients in accordance with the HMO's guidelines and restrictions in exchange for a steady stream of customers. HMOs cover emergency care regardless of the health care provider's contracted status. Operation HMOs often require members to select a primary care p ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Pay For Performance (healthcare)
In the healthcare industry, pay for performance (P4P), also known as "value-based purchasing", is a payment model that offers financial incentives to physicians, hospitals, medical groups, and other healthcare providers for meeting certain performance measures. Clinical outcomes, such as longer survival, are difficult to measure, so pay for performance systems usually evaluate process quality and efficiency, such as measuring blood pressure, lowering blood pressure, or counseling patients to stop smoking. This model also penalizes health care providers for poor outcomes, medical errors, or increased costs. Integrated delivery systems where insurers and providers share in the cost are intended to help align incentives for value-based care. Professional societies in the United States have given qualified approval to incentive programs, but express concern with the validity of quality indicators, patient and physician autonomy and privacy, and increased administrative burdens. Studie ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Accountable Care System
An accountable care system is a system of healthcare provision which is intended to be integrated, and in particular to merge the funding of primary care with that for hospital care, therefore providing incentives to keep people healthy and out of hospital. It has features in common with accountable care organizations in the United States. England Accountable care systems were organisations in the English NHS which in some respects are intended to replicate the features of the American accountable care organization. They were defined by NHS England as an area ‘in which commissioners and providers, in partnership with local authorities, take explicit collective responsibility for resources and population health’. After a great deal of hostility to the use of the term it was announced in February 2018 that these organisations were in future to be called integrated care systems, and that all the 44 sustainability and transformation plans will be expected to progress in this direc ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Medical Home
The medical home, also known as the patient-centered medical home (PCMH), is a team-based health care delivery model led by a health care provider to provide comprehensive and continuous medical care to patients with a goal to obtain maximal health outcomes. It is described in the "Joint Principles" (see below) as "an approach to providing comprehensive primary care for children, youth and adults." The provision of medical homes is intended to allow better access to health care, increase satisfaction with care, and improve health. The "Joint Principles" that popularly define a PCMH were established through the efforts of the American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), American College of Physicians (ACP), and American Osteopathic Association (AOA) in 2007. Care coordination is an essential component of the PCMH. Care coordination requires additional resources such as health information technology and appropriately-trained staff to provide c ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Electronic Health Record
An electronic health record (EHR) is the systematized collection of patient and population electronically stored health information in a digital format. These records can be shared across different health care settings. Records are shared through network-connected, enterprise-wide information systems or other information networks and exchanges. EHRs may include a range of data, including demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, vital signs, personal statistics like age and weight, and billing information. For several decades, electronic health records (EHRs) have been touted as key to increasing of quality care. Electronic health records are used for other reasons than charting for patients; today, providers are using data from patient records to improve quality outcomes through their care management programs. EHR combines all patients demographics into a large pool, and uses this information to assi ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Independent Practice Association
In the United States, an independent practice association (IPA) is an association of independent physicians, or other organizations that contracts with independent care delivery organizations, and provides services to managed care organizations on a negotiated per capita rate, flat retainer fee, or negotiated fee-for-service basis.Margaret E. Lynch, Editor, "Health Insurance Terminology," Health Insurance Association of America, 1992, Peter R. Kongstvedt, "The Managed Health Care Handbook," Fourth Edition, Aspen Publishers, Inc., 2001 Operation An HMO or other managed care plan can contract with an IPA, which in turn contracts with independent care providers or physicians to treat members at discounted fees or on a capitation basis. The typical IPA encompasses all specialties, but an IPA can be solely for primary care, could be single specialty, or could be a set of other care providers such as psychologists or even providers of social services such as food pantries, homeless ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Primary Care Physician
A primary care physician (PCP) is a physician who provides both the first contact for a person with an undiagnosed health concern as well as continuing care of varied medical conditions, not limited by cause, organ system, or diagnosis. The term is primarily used in the United States. In the past, the equivalent term was 'general practitioner' in the US; however in the United Kingdom and other countries the term general practitioner is still used. A core element in general practice is continuity that bridges episodes of various illnesses. Greater continuity with a general practitioner has been shown to reduce the need for out-of-hours services and acute hospital admittance. Furthermore, continuity by a general practitioner reduces mortality. All physicians first complete medical school ( MD, MBBS, or DO). To become primary care physicians, medical school graduates then undertake postgraduate training in primary care programs, such as family medicine (also called family practi ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
United States Department Of Justice
The United States Department of Justice (DOJ), also known as the Justice Department, is a federal executive department of the United States government tasked with the enforcement of federal law and administration of justice in the United States. It is equivalent to the justice or interior ministries of other countries. The department is headed by the U.S. attorney general, who reports directly to the president of the United States and is a member of the president's Cabinet. The current attorney general is Merrick Garland, who was sworn in on March 11, 2021. The modern incarnation of the Justice Department was formed in 1870 during the Ulysses S. Grant presidency. The department comprises federal law enforcement agencies, including the Federal Bureau of Investigation, the U.S. Marshals Service, the Bureau of Alcohol, Tobacco, Firearms and Explosives, the Drug Enforcement Administration, and the Federal Bureau of Prisons. It also has eight major divisions of lawyers who rep ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Hennepin County Medical Center
Hennepin County Medical Center (HCMC) is a Level I adult and pediatric trauma center and safety net hospital in Minneapolis, Minnesota, the county seat of Hennepin County. The primary 484-bed facility is on six city blocks across the street from U.S. Bank Stadium, with neighborhood clinics in the Minneapolis Whittier and East Lake neighborhoods, and the suburban communities of Brooklyn Center, Brooklyn Park, Golden Valley, St. Anthony and Richfield. A new clinic in the North Loop neighborhood downtown opened in 2017. HCMC has recognized trauma surgery specialists, transplant services, stroke specialists, advanced endoscopy/hepatobilliary center, and hyperbaric oxygen chamber. A new outpatient clinic building opened in 2018. In March 2018, the provider that operates HCMC was rebranded as Hennepin Healthcare. However, the hospital retained the name HCMC. History The original hospital building, established in 1887 as Minneapolis City Hospital, before being referred to as "Genera ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
