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Accountable Care Organization
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. 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 Fisher in 2006 during a discussion of the Medicare Payment Advisory Commission. In 2009, the term was included in the federal Patient Protection and Affordable Ca ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] [Amazon] |
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 m ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] [Amazon] |
Managed Care Organization
In the United States, managed care or managed healthcare is a group of activities intended to reduce the cost of providing health care and providing health insurance while improving the quality of that care. It has become the predominant system of delivering and receiving health care in the United States 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 programs may be provided in a variety of settings, s ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] [Amazon] |
Medical Home
The medical home, also known as the patient-centered medical home or primary care 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 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 coordi ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] [Amazon] |
Electronic Health Record
An electronic health record (EHR) is the systematized collection of electronically stored patient and population 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 Allergy, allergies, immunization status, laboratory test results, radiology images, vital signs, personal statistics like age and weight, and billing information. For several decades, EHRs have been touted as key to increasing quality of care. EHR combines all patients' demographics into a large pool, which assists providers in the creation of "new treatments or innovation in healthcare delivery" to improve quality outcomes in healthcare. Combining multiple types of clinical data from the system's health records has helped clinicians identify and st ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] [Amazon] |
Independent Practice Association
In the United States, an independent practice association (IPA), also known as an independent provider association, independent physician association, individual practice association or integrated physician association, 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 ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] [Amazon] |
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. With the advent of nurses as PCPs, the term PCP has also been expanded to denote primary care providers. 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 under ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] [Amazon] |
United States Department Of Justice
The United States Department of Justice (DOJ), also known as the Justice Department, is a United States federal executive departments, federal executive department of the U.S. government that oversees the domestic enforcement of Law of the United States, federal laws and the administration of justice. It is equivalent to the Ministry of justice, 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 United States Cabinet, Cabinet. Pam Bondi has served as U.S. attorney general since February 4, 2025. The Justice Department contains most of the United States' Federal law enforcement in the United States, 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. Th ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] [Amazon] |
United States Antitrust Law
In the United States, antitrust law is a collection of mostly federal laws that govern the conduct and organization of businesses in order to promote economic competition and prevent unjustified monopolies. The three main U.S. antitrust statutes are the Sherman Act of 1890, the Clayton Act of 1914, and the Federal Trade Commission Act of 1914. Section 1 of the Sherman Act prohibits price fixing and the operation of cartels, and prohibits other collusive practices that unreasonably restrain trade. Section 2 of the Sherman Act prohibits monopolization. Section 7 of the Clayton Act restricts the mergers and acquisitions of organizations that may substantially lessen competition or tend to create a monopoly. The Robinson–Patman Act, an amendment to the Clayton Act, prohibits price discrimination. Federal antitrust laws provide for both civil and criminal enforcement. Civil antitrust enforcement occurs through lawsuits filed by the Federal Trade Commission (FTC), the Antitrus ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] [Amazon] |
American Hospital Association
The American Hospital Association (AHA) is a health care industry trade group. It includes nearly 5,000 hospitals and health care providers. The organization, which was founded in Cleveland, Ohio in 1898, with offices in Chicago, Illinois and Washington, D.C. is currently headquartered in Chicago. The organization has lobbied against Medicare for All proposals and opposed "free care to low-income people who lack medical insurance." It has also filed lawsuits to stop the U.S. government from requiring that hospitals make their prices public, as well as lobbied against various proposals to reduce health care costs for patients and taxpayers. History In 1870, there were only about 100 general hospitals in the United States, but the institution was growing rapidly. Hospital administrators formed an organization, The Association of Hospital Superintendents of the United States and Canada, which held its first meeting in 1899 in Cleveland, Ohio, where seven of the eight superintende ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] [Amazon] |
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 "G ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] [Amazon] |
CalPERS
The California Public Employees' Retirement System (CalPERS) is an agency in the California executive branch that "manages pension and health benefits for more than 1.5 million California public employees, retirees, and their families".CalPERSFacts at a glance: general. January 2009. Retrieved December 24, 2008. In fiscal year 2020–21, CalPERS paid over $27.4 billion in retirement benefits,CalPERSFacts at a Glance - Public Employees' Retirement Fund (PERF), 2020-21CalPERS. 2021. Retrieved October 09, 2021. and over $9.74 billion in health benefits.CalPERSFacts at a Glance - Health Benefits, 2019-20CalPERS. 2021. Retrieved October 09, 2021. CalPERS manages the largest public pension fund in the United States, with more than $469 billion in assets under management as of June 30, 2021. CalPERS is known for its Activist shareholder, shareholder activism; stocks placed on its "Focus List" may perform better than other stocks, which has given rise to the term "CalPERS ef ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] [Amazon] |
Dignity Health
Dignity Health (formerly Catholic Healthcare West) was a California-based not-for-profit public-benefit corporation that operated hospitals and ancillary care facilities in three states. Dignity Health was the fifth-largest hospital system in the nation and the largest not-for-profit hospital provider in California. Formerly a Catholic institution, the organization went independent in 2012 and adopted its new name. In February 2019, Dignity Health merged with Catholic Health Initiatives, becoming CommonSpirit Health. Its headquarters are located in the China Basin Landing building in San Francisco. History Catholic Healthcare West was founded in 1986, when the Sisters of Mercy Burlingame Regional Community and the Sisters of Mercy Auburn Regional Community merged their health care ministries into one organization. In 2010, Dignity Health, Blue Shield of California, and Hill Physicians Medical Group formed an Accountable Care Organization that covers 41,000 individuals in ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] [Amazon] |
