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healthcare

healthcare delivery models

TermDefinition
Accountable care organizations (ACOs) groups of physicians, hospitals, and other health care providers come together to voluntarily to provide coordinated high-quality care to their Medicare patients. when ACO succeeds, will share the savings for the medicare program
Capitation (partial or full) pt's are assigned a per member per month payment based on their age, race, sex, lifestyle, medical history, and benefit design
Global budget fixed total dollar amount paid annually for all care. participating providers can determine how money is spent. limit the level and the rate of increase of health care cost. include a quality component as well
Health maintenance organization (HMO) contracts with a medical center or providers to provide preventive and acute care for insured people. generally require referrals and precertification and preauthorization for hosp admissions, outpatients procedures, treatments.
Patient centered medical home (PCMH) a PCP coordinates treatment to make sure patients receive the required care when and where they need it and in a way they can understand.
Pay for performance reimbursement model compensates providers only if they meet certain measures for quality and efficiency. generating quality benchmark measures connects provider reimbursement directly to the quality of care they provide.
Preferred provider organization (PPO) more flexibility than HMO. insured people don't need a PCP, but doesn't need a referral. although patients can see providers in or out of their network, and in network provider usually costs less.
Created by: elshalance
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