HEALTHCARE FINAL EXAM GLOSSARY TERMS
readmissions reduction program
mandated by the ACA, a medicare program through which payments to hospitals are reduced based on the readmission of patients with specified diagnoses within 30 days prior hospitalization. penalty determinations are based on 3 prior years' hospital discharge data
value-based purchasing (VBP)
mandated by the ACA; medicare program through which participating hospitals may earn incentive payments based on clinical outcomes and patient satisfaction or incur reductions in medicare payments based on a compliance with medicare determined criteria for "clinical processes of care" and "patient experience of care measures"
natural history of disease
matrix used by epidemiologists and health services planners that places everything known about a particular disease or condition in the sequence of its origin and progression when untreated; the metric identifies causes and states of a particular disease or condition and facilitates matching of causes and stages with appropriate types of intervention intended to prevent the conditions's occurrence or to arrest its progress after onset
primary prevention
measures designed to promote health and prevent disease or other adverse health occurrences, health education to encourage good nutrition, exercise, and genetic counseling and specific protections, immunization and the use of seat belts
ecological models
models that identify cause of public health problems rooted in the physical and/or social environment behavior related to an individual. they take into account the vast number or determinants that impact the health status of groups of people and facilitate decisions about the most expeditious path to developing effective interventions
individual mandate
under the ACA, the requirement that all american citizens (with specific exclusions) obtain health insurance coverage or pay a penalty
co-morbidity
when two disorders or illnesses occur in the same person, simultaneously or one after another, they are called co-morbid
mental health parity
equating annual and aggregate lifetime insurance coverage limits for mental health services with annual and aggregate lifetime insurance coverage for medical care
non quantitative treatment limitation (NQTLs)
limitations or restrictions of covered insurance benefits which though not numerically expressed, otherwise limit the scope or duration of benefits for treatment. in assuring parity of mental health with medical/surgical benefits, insurance plans must apply in a "comparable and no more stringent manner" to mental health has compared and medical/surgical benefits
tertiary prevention
rehabilitation and maximizing remains functional capacity when disease or condition has occurred and left residual damage
disease management programs
MCO programs that attempt to control costs and improve care quality for individuals with chronic and costs conditions through methods such as the use of evidence-based clinical guidelines, patient self-management education, disease registries, risk stratification, proactive patient outreach, and performance feedback to providers. programs may also use clinical specialists who provide monitoring and supply to patients with disease management issues
Hill-Burton act
a 1946 law that provided funding to construct new and expand existing US hospitals
diagnosis-related groups (DRGs)
a case payment system that radically changed hospital reimbursement shifting hospital reimbursement from the retrospective to a prospective basis. it provided incentives for the hospital to spend only what was needed to achieve optimal patient outcomes. if outcomes could be achieved at a cost lower than the present payment, the hospital received an excess payment for those cases. if the hospital spent more to treat cases than allowed, it absorbed the excess costs. this payment system was widely adopted by nongovernmental health insurers
health information technology for economic and clinical health act (HITECH Act)
a component of the american revery and reinvestment act of 2009 dedicated to promoting nationwide adoption and used of electronic health records
financial risk-sharing
a concept used by MCOs to transfer some measure of financial risk from insurers to beneficiaries. such transfers of financial risk due to beneficiaries commonly take the form of co-payments and deductibles. co-payments require that beneficiaries pay a set fee each time they receive a covered service, such as a co-pay for each physician office visit. a deductible requires beneficiaries to meet a predetermined, out-of-pocket expenditure level before the MCO assumes payment responsibility for the balance of charges
managed behavioral healthcare organization (MBHO)
a corporate entity to which a health plan may outsource the management of mental health services for its subscribers. the MBHO assumes the financial risks and benefits of managing treatment budgets and authorization for access to mental health services
national institute for complementary and alternative medicine
a division of the national institute of health devoted to conducting and reporting on research focused on complimentary and alternative therapies
skilled nursing facility (SNF)
a facility, or distinct part of one, primarily engaged in providing skilled nursing care and related services for people requiring medical or nursing care, or rehabilitation services. it provides by or under the direct supervision of licensed nursing personnel and provides 24 hour nursing care and other types of services
indemnity insurance
a form of insurance in which the insurance company sets allowable charges for services that will reimburse after services are delivered and allows providers to bill patients for any uncovered excess costs
national alliance on mental illness
a grassroots organization dedicated to advocating for access to services, treatment, supports and research for the mentally ill
Accountable care organizations (ACO)
a group of providers and suppliers of health care, health-related services and others involved in caring for medicare patients that voluntarily work together to co-ordinate care for the patients they serve under the original Medicare (not Medicare advantage managed care) program. the ACA enables this program to share in savings to the federal government based on the performance in improving quality and reducing health care costs
recovery oriented systems of care (ROSC)
a holistic, integrated person-centered and strength based approach to mental health interventions. it views recovery as a process of pursuing a fulfilling life and seeks to enhance a person's positive self-image and identify through linking their strengths with family and community resources. it shifts care from the old episodic care model to one that emphasizes continuity and provides choice through the treatment planning process
teaching hospitals
a hospital affiliated with a medical school that provides clinical education for medical students, medical and dental residents and other health professionals
medicaid
a joint federal/state program that provides insurance coverage for a prescribed scope of basic health care services to americans who quality based on income parameters established on a state-by-state basis. it is not an "entitlement" program funded by payroll taxes, it is funded by personal income and corporate and excise taxes with funs transferred from more economically affluent individuals to those in need. it directly reimburses service providers. rate-setting formulas, procedure and policies vary widely among states and as such has been described as "50 different programs"
informed consent
a legally recognized patient right, formalized in document for a patient's signature, to ensure patients' understanding of the risks and benefits of medical intervention
capitation
a managed care reimbursement method that prepays physicians for services on a per-member per-month basis whether or not services are used. if a physician exceed the predetermined amount, he or she may incur a financial penalty. if the physician uses fewer resources than predicted, he or she may retain the excess as profit
self-funded health insurance
a mechanism through with an employer collects premiums and pools these into a fund or account that it uses to pay for medical benefit claims instead of using a commercial carrier. they often use the services of an actuarial firm to set premium rates and a third party administrators to administer benefits, pay claims and collect data on utilization
block grants
a mechanism to shift the federal government's direct support and administration of health care programs to state and local governments
health information exchange (HIE)
a network that enables a basic level of interoperability among electronic health records maintained by individual physicians and health care organizations. they are organized and governed by regional health information organizations (RHIOs)
osteopathic medicine
a philosophy of medical education with particular focus on the musculoskeletal system. graduates receive a DO rather than MD degree and are considered as rigorously trained and qualified as their MD counterparts
hospice
a philosophy supporting a coordinated program of care for the terminally ill that focuses on maintaining comfort and quality of life. the most common criterion for admission into hospice is a diagnosis of terminal illness with a limited life expectancy of 6 months or less
hospitalist
a physician typically board certified in internal medicine who specializes in the care of hospital patients. they may be an employee of one or more hospitals or an employee of one or more companies that contract with hospitals to provide services
"carve-out"
a prices through which insurers outsource subscribers' mental illness care oversight to firms specializing in managing service use for mental health diagnoses
computerized physician order entry (CPOE)
a process in which a physician enters patient treatment orders into an individual patients electronic health record
vertical integration
a process through which one entity unites related and complementary organizations to create a system that provides a continuum of care. in its most complete form, encompasses medical and health-related services required throughout an individual's life span
assisted living
a program that provides and/or arranges for daily meals, personal and other supportive services, health care, and 24 hour oversight to persons residing in a group residential facility who need assistance with the activities of daily living
nurse practitioner
a registered nurse, typically with a master's degree who may specialize in a particular area of nursing practice such as a primary care, geriatrics, psychiatry, emergency medicine or other medial fields. they function under the supervision of physicians and provide diagnostic, preventive and therapeutic health care services and may prescribe medications as allows by law as delegated by physicians
certification
a regulatory proces, much less stringent than licensure, under which a state or professional organization attests to an individual's advanced training and performance abilities in a field of health care practice. specific professions set standards for approval by their respective state or professional organizations
health services research
a research field combining perspectives and methods of epidemiology, sociology, economics and clinical medicine. they also use process and outcome measures reflecting behavioral and economic variables associated with questions of treatment effectiveness cost-benefit
patient-centered medical home (PCMH)
a team-based model of care led by a personal physician who proved continuous and coordinated care throughout a patient's lifetime to maximize health outcomes, including appropriately arranging patients' care with other qualified professionals for preventive services treatment of acute and chronic illness and assistance with end-of-life issues
academic health center
a university-affiliated complex of professional academic and clinical care facilities such as medicine, nursing, pharmacy, dentistry, and allied health professions that are the principal places of education and training for physicians and other health care personnel, the sites for most basic medical research and the settings for clinical trials. they are major providers of highly sophisticated patient care required by trauma centers; burn centers; neonatal intensive care centers; and the technologically advanced treatment of cancer, heart disease, neurologic and other acute and chronic conditions. they provide much of the primary care for the economically disadvantaged populations in the geographical area
Oregon death with dignity act 1994
also known as the Oregon physician-assisted suicide act, it legalized allowing "an adult resident of Oregon, who is terminally ill to voluntarily request prescription for medication to take his or her life" the person must have "an incurable and irreversible disease that will within reasonable medical judgement produce death within 6 months"
monolithic model of health information exchange
an HIE design in which all member institutions send clinical data to one central repository where all data reside together in one universal and standardized format. in this model, authorized users may access individual, transinstiutional patient records from the central repository
federated model of health information exchange
an HIE design in which member institutions maintain their own data at their respective sites in the standardized format used by an HIE. in this model individual, transinstiutional patient records are assembled in real time by searching all institutions' databases only when requested by authorized users for a particular episode of care
computerized decision support system (CDSS)
an electronic information-based system in which individual patient data is matched with a computerized knowledge base such as evidence-based clinical practice guidelines, to assist health care providers in formulating accurate diagnoses, recommendations, and treatment plans. it may generate "hard stops" to prevent a disallowed practice or severe errors or "soft stops" that warn off less severe errors and allow physicians to choose to ignore or follow the warning
american board of medical specialties (ABMS)
an independent, not-for-profit organization assists its 24 specialty member boards to develop and utilize professional and educational standards that apply to the certification of physician specialities in the united states and internationally
naturally occurring retirement community (NORC)
apartment complexes, neighborhoods or sections of communities where residents have opted to remain in their homes as they age
explicit quality standards
are professionally developed and agreed on in advance of a quality assessment. explicit stands minimize the variation and bias that result when judgements are internalized
health information administrator
are responsible for the activities of the medical records departments of hospitals, skilled nursing facilities, managed care organizations, rehabilitation centers, ambulatory care facilities and other licensed health care entities. they maintain information systems to permit patient data to be received, recorded, stored and retrieved to assist in diagnosis and treatment and supply research data for tracking disease patterns, evaluating the quality of patient care, verifying insurance claims and maintaining patient record confidentiality. a bachelor's degree in this is the entry-levelcredential
registration
begun as a method to facilitate contacts among professionals and potential employers, is the least restrictive form of health professional regulation. most registration programs are voluntary and range from listings of individuals offering a specific services to professional or occupational groups requiring educational qualifications and testing
laboratory technologists and technicians
clinical laboratory personnel who analyze body fluids, tissues, and cell checking for bacteria and other micro-orgnasims analyze chemical content of body fluids, test drug levels in blood to monitor the effectiveness of treatment and match blood for transfusion. technologists typically have a bachelor's or higher degree; technicians typically hold associate's degrees of certifications
assessment (as a core function of public health)
collecting and analyzing data to define population health status and quantify existing or emerging health problems
voluntary ambulatory health agency
community-based not-for-profit organization governed by a volunteer board of directors that may provide direct medical care, education, advocacy, or a combination of these services, many voluntary agencies were established by interest groups to address unmet health or health-related needs of specific population groups. sources of financial support may include government grants, fee for services, third party reimbursement, and private contribution
federally qualified health center (FQHC)
community-based primary care center staffed by a multidisciplinary team of health care and related support personnel, with fees adjusted based on ability to pay. they also provide services to link patients with other community resources funded by the health resources and services administration to serve the neediest populations. they must meet specific operating parapets and may be organized as part of a local health department, a large number services organization, or as a stand-alone, not-for-profit agency
basic science research
conducted by biochemists, physiologists, biologists, pharmacologists and others concerned with sciences that are fundamental to understanding the growth, development, structure and functions of the human body and its responses to external stimuli. much is conducted at the cellular level
independent payment advisory board (IPAB)
created by the ACA, the mission is to recommend policies to congress to curb medicare spending including suggestions to improve coordination of care, eliminate waste, encourage best practices and prioritize primary care. beginning in 2015 and every other year after, it also charges with submitting recommendations to the president and congress to slow overall growth in national health care expenditures
empirical quality standards
derived from distributions, averages, ranges, and other measures of data variability, compare information collected from a number of similar health service providers to identify practices that deviate from norms
bundled payment for care improvement initiative (BPCI)
developed by the CMS (center for medicare and medicaid innovation CMMI) that was created by ACA; recognizes that separate medicare fee-for-service payments for individual services provided during a beneficiary's single illness often result in fragmented care with minimal co-ordination across providers and settings and results in rewarding service quantity rather than quality. it is designed to test whether, as prior research has shown, payments for bundled "episodes of care" can align incentives for hospitals, post-acute care providers, physicians and other health care personnel to work closely together across many settings to achieve improved patient outcomes at lower costs
consumer-driven health plan (CDHP)
developed in a reaction to the managed care backlash, the goals of this were to have employees take more responsibility for health care decisions and exercise more cost consciousness. it consists of either a health reimbursement arrangement (HRA) or a health savings account (HSA)
secondary prevention
early detection and prompt treatment of a disease or condition to achieve an early cure, if possible or to slow progression, prevent complications, and limit disability. most preventive health care is currently focused on this level
never events
egregious medical errors occurring in hospitals, the treatment for which the DHHS will not provide reimbursement
emergency medical treatment and labor act (EMTALA)
enacted in 1995 federal budget because of concerns about inappropriate patients transfers between hospitals prompted by payment considerations. it requires hospitals to treat everyone who presents in their emergency departments, regardless of ability to pay. stiff financial penalties and as risk of medicare decertification by hospitals inappropriately transferring patients
national prevention, health promotion and public health council
established by the ACA and chairs by the US surgeon general and organization charged with developing and leading a national prevention strategy and making recommendations to the president and congress for federal policy changes that support public health goals. the council provides leadership to and coordination of public health activities of 17 federal departments, agencies and offices and receives input from a 22 nonfederal member, presidentially appointed prevention advisory group
national health care workforce commission (NHCWC)
established by the ACA, has the mandate to evaluate and make recommendations for numerous dimensions of the nation's health care workforce including education and training support for existing and potential new workers at all levels, efficient deployment professional compensation and coordination among different types of providers
urgent care center
facilities that provide walk-in, extended hour access for acute illness and injury care that is either beyond the scope or the availability of the typical primary care practice or retail clinic.
HMO act of 1973
federal legislation enacted by the Nixon administration that provided loans and grants for the planning, development, and implementation of combined insurance and health care delivery organizations and required that a comprehensive away of preventive and primary care services be included in the HMO arrangement. by linking the payment for services with the quality of care, this act paved they way for the proliferation of managed care principles that became the bedrock of US health insurance reform in the succeeding three decades
graduate medical education consortia
formal associations of medical schools, teaching hospitals and other organizations involved in the training of medical residents. the consortia provide centralized coordination and direction that encourages the members to function collectively with major aims to improve the structure and governance of residency programs, to increase residents' ambulatory care training experiences and to address imbalances in physician specialty and location
preferred provider organization (PPO)
formed by physicians and hospitals to serve the needs of private, third-party payers and self-insured firms, they guarantee a certain volume of business to hospitals and physicians in return for a negotiated discount in fees. they often attractive features to both physicians and hospitals.
policy development
generating recommendations from available data to address public health problems, analyzing options for solutions and mobilizing public and community organizations through implementation plans
assurance (as a core function of public health)
governmental public health agency responsibility to ensure that basic components of the health care delivery system are in place
medicare
guarantees a minimum level of health insurance benefits to all americans beginning at age 65 (and other special needs groups without regard to age). is funded by a large sum of payroll taxes levied on all american workers
population health focus
health care system orientation to providing medical care and health-related services that shift emphasis from individual medical interventions with piecemeal reimbursement to providers accountability for the outcomes of medical care and overall health status of a defined population group
managed care backlash
in the 1990s organized medicine, the health care providers, and consumers railed against MCO policies on choice of providers, referrals, and other practices that were viewed as unduly restrictive. public concerns driving sentiments toward more government regulation of the managed care industry included the belief that managed care was hiring the quality of patient care and that other sectors of the health care industry. since 1998 all 50 state legislatures enacted over 900 laws and regulations addressing both consumer and provider protections relative to manage care policies
therapeutic science practitioner
include physical therapists, occupational therapists, speech language pathology and audiology therapists, radiation therapists and respiratory representing some of the allied health disciplines in this category. depending on the field required credentials range from bachelors to doctoral level education
behavioral scientists
include professionals in social work, health education, community mental health, alcoholism and drug abuse services and other health and human service areas. bachelor's or master's level degree professionals in these fields counsel and support individuals and families in addressing the personal, economic, and social problems associated with illness, addictions, employment challenges and disabilities
community-rate insurance
insurance plans in which all individuals in a define group pay premiums without regard to age, gender, occupation, or health status. help ensure nondiscrimination against groups with varying risk characteristics to provide coverage at reasonable rates for the community as a whole
experience-rate insurance
insurance plans that use historically documents patterns of health care services utilization for defined populations of subscribers to determine premium charges
retail clinic
operated at retail sites such as pharmacies and supermarkets under consumer-friendly names such as "minute clinic" and "take care" staffed by nurse practitioners or physician assistants; a physician is not required on site; clinics have physician consultation available by phone
regional health information organization (RHIO)
organization that create systems agreements, process, and technology to manage and facilitate exchange of health information between institutions and across different vendor platforms within specific geographic areas
healthy systems agencies
organizations created by the national health planing and resources development act of 1974 that include broad representation of health care providers and consumers on governing boards and committees to deliberate and recommend health care resource allocations to their respective federal and state governing bodies
the health insurance portability and accountability act of 1996
permitted individuals to continue insurance coverage after a loss or change of employment by mandating the renewal of insurance coverage except for specific reasons; regulated the circumstances in which an insurance plan may limit benefits because of preexisting conditions
international medical graduates (IMGs)
physicians trained in medical schools outside the united states who fill the annual shortfall in US medical school graduates required to staff hospitals. responsibility for evaluating credentials of these students entering the United States' residency programs lies with the educational commission for foreign medical graduates
palliative care
treatment given to relive the symptoms of a disease rather than attempting to cure the disease
clinical research
primary focuses on steps in the process of medical care such s the early detection, diagnosis and treatment of disease or injury; the maintenance of optimal, physical, mental, and social functioning; the limitation and rehabilitation of disability; and the palliative care of those who are irreversibly ill. it is conducted by a variety of professionals in medicine, nursing, and allied health, often in collaboration with basic scientists
institutional review board (IRB)
professionally constituted expert groups of individuals who judge the merit of research studies and ensure appropriate and ethical participant safeguards are provided to protect research subjects' safety. a primary function of this is to ensure fully informed consent and research subjects' understanding of risks and benefits of participation
healthcare effectiveness data and information sets (HEDIS)
provides a standardized method for MCOs to collect, calculate and report information about their performance to allow employers, other purchasers and consumers to compare different health insurance plans. it has evolved through several stages of development and continuously refines its measurements through rigorous reviews and independent audits
physician assistant (PA)
provides health care services under the supervision of a physician. most hold a master's degree. they are training to provide diagnostic, preventive, and therapeutic health care services as delegate by physicians. they take medical histories, order and interpret laboratory tests and x-rays, make diagnoses, and prescribe medications as allowed by law. many are employed in specialities such as internal medicine, pediatrics, family medicine, orthopedics, emergency medicine and surgery
comparative effectiveness research
research designed to inform health care decisions by providing evidence of the effectiveness, benefits, and harms of different treatment options. evidence is generated from research studies that compare drugs, medical devices, tests, surfers or ways to deliver health care
continuing care retirement community (CCRC)
residences on a retirement campus, typically in apartment complexes designed for functional older adults. unlike ordinary retirement communities that only specialized housing, it offers a comprehensive program of social services, meals and access to contractual medical services in additional housing
ambulatory care
services that do not require an overnight hospital stay
implicit quality standards
standards that rely on the internalized judgements of expert individuals conducting a quality assessment and such are subject to variation and bias
evidence based clinical practice guidelines
systematically developed protocols based on extensive research that are used to assist practitioner and patient decisions about appropriate health care decisions. they define parapets for specific diagnostic and treatment modalities in patient diagnosis and management
respite care
temporary surrogate are given to a patient when that patient's primary caregiver must be absent. it includes an family managed care program that helps to avoid or forestall the placement of a patient in a full-time institutionalized environment by providing planned, intermittent caregiver relief
analytic studies
test Hypotheses and try to explain biologic phenomena by seeking statistical associations between factors that may contribute to a subsequent occurrence and the initial occurrence itself
clinical trials
tests a new treatment or drug against a prevailing standard of care. they may use control groups who receive a placebo to minimize subject bias. to further reduce bias, clinical trials may randomly assign volunteer patients to treatment and control groups. a most rigorous form is "double-blind" in which neither the patients nor the researchers know who is receiving a test drug or placebo until the trail's conclusion
health insurance exchange
the ACA requires states to establish health benefit exchanges (american health benefit exchanges) and to create separate exchanges for small employers with up to 100 employers. the exchanges intend to create a competitive health insurance market by providing web-based, easily understandable, comparative information to consumer on plan choice and to standardize rules regarding health plan offers and pricing
physician compare
the CMS website, mandated by the ACA to provide basic contact, practice characteristics, and clinical quality data on medicare participating physicians and other health care professionals
balanced budget act of 1997 (BBA)
the act was characterized as containing "some of the most sweeping and significant changes to medicare and medicaid since their inception in 1965". it took important incremental steps by extending health care coverage to uninsured children though a $16 billion allocation for a new state children's health insurance program (SCHIP). it also increase beneficiary premiums for medicare part B and required new prospective payment systems for hospital outpatient services, skilled nursing facilities, home health agencies and rehabilitation hospitals. it reduced allowances for the medical education expenses of teaching hospitals and funded incentives to hospitals for voluntarily reducing the numbers of medical residents. was opening the medicare program to private insurers through the medicare+choice program, for the first time allowing financial risk-sharing for the medicare program with the private sector through managed care plans
meaningful use
the criterion defined by the ONC in collaboration with the centers for medicare and medicaid services that entails meeting a set of time-delineated requirements for eligible professional and hospitals to qualify for incentive payments under the HITECH act
agency for healthcare and research and quality (AHRQ)
the federal agency charged with research to develop and disseminate evidence-based practice guidelines. is a major collaborating agency in several ACA implantation initiatives
department of health and human services (DHHS)
the federal government's principal agency concerned with health protection and promotion and provision of health and other human services to vulnerable populations. in addition to administering the medicare and medicaid programs, it includes over 300 operate programs
office of the national coordinator for health information technology (ONC)
the federal principal agency created to coordinate nationwide efforts to implement health information technology and exchanged of health information
accreditation council for graduate medical education (ACGME)
the independent, not-for-profit professional organization that accredits 3-7 year programs of advanced education and clinical practice required by physicians to provide direct patient care in a reorganized medical speciality
experimental studies
the investigation actively intervenes by manipulating one variable to see what happens with the others. although they are the best test of cause and effect, such studies are technically difficult to carry out and often raise ethical issues. control populations are used to ensure that other non experimental variables are not affecting the outcome
Flexner report
the landmark report resulting from a comprehensive review of the quality of education in US and Canadian medical schools, funded by the Carnegie foundation. issued in 1910, the report was a scaring indictment of most medical schools of the time. as a result some schools closed while others including Harvard. Western John Hopkins received praise. the report gave increased leverage to medical education reformers and stimulated financial support from foundation and wealthy individuals which enabled university-affiliated medical schools to gain significant influence over the direction of medical education
deinstitutionalization
the mental health movement beginning in the 1960s through which severely mentally ill patients previously confined to large state or county psychiatric hospitals were discharged to community boarding or nursing homes. the movement marked a major shift of mental health service provision from primarily inpatient steins to community-based facilities
continuing life care community (CLCC)
the most expensive of CCRC options, offer unlimited assisted living, medical treatments, and skilled nursing care without any additional charges as the resident's needs change over time
national committee on quality assurance (NCQA)
the most influential managed care quality assurance organization formed in 1979 by the merger of two managed care trade organizations, the american managed care and review association and the group health association of america under the title of the american association of health plans . the primary function are accreditation for MCOs, PPOs, managed behavioral health care organizations, new health plans and disease management programs; certifying organizations that verify provider credentials and consultation on physician organizations, utilization management organizations, patient-centered medical homes and disease management organizations and programs
licensure
the most restrictive form of health professional regulation is administered by individual states. it defines professional's scope of practice and educational and testing requirements to legally engage in the practice of a profession
social security act of 1935
the most significant social initiative ever passed by congress; it was the legislative basis for a number of major health and welfare programs, including medicare and medicaid programs
prevention and public health fund
the nation's first mandatory funding streams dedicated to improving public health. the fund is intended to eliminate the prior shortcoming of unpredictable federal budge appropriations for public health and prevention programs. the ACA manages to improve health and health restrain the rate of growth in private and public sectors health car costs through programs at the local, state, and federal levels to "curb tobacco us, increase access to primary preventive care services and help state and local governments respond to public he halt threats and outbreaks
disability-adjusted life years (DAYLS)
the total number or years of life lost to illness, disability, or premature death within a given population
rural health networks
to address challenges of providing a continuum of care with sore resources, networks join rural health care providers in formal not-for-profit corporations or through informal lineage to achieve a defined set of mutually beneficial purposes. networks may advocate at local and state levels on rural health care issues, cooperate in joint community outreach activities, and seek opportunities to negotiate with insurers to cover services for their communities' populations