A gatekeeper is a primary care provider who acts as an agent for patients. They coordinate medical care so that patient receives appropriate services and also provide referrals to specialists. Typically‚ primary care physicians include family practitioner‚ generalist physician and pediatrician. Ideally‚ gatekeepers are much like family doctors‚ they focus on the health of the person as a whole instead of a single organ. They help emphasize prevention care and establish appropriate health screening
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(POS)‚ Indemnity Plans‚ and Consumer-Driven Health Plans (CDHP) such as‚ Health Reimbursement Plans‚ and Flexible Savings Accounts‚ (Bayes‚ 2008). Bayes (2008) stated “PPOs are used by hospitals‚ physicians‚ clinics‚ and pharmacies that help provide care for their insured consumers.” The plan covers “discounts for fee-for services to the physicians to help with their fee schedules.” Patients or consumers are responsible for “annual premiums‚ deductibles” that generate from “low with high premiums or
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EDIT Fee for service payments As the name implies‚ fee for service payments are made based on invoices for services delivered. In this system‚ neither the healthcare provider nor the payer have any certainty as to medical costs. The risk of cost overruns caused by more people than expected needing healthcare is assumed by the payer (insurance company) and not the providers. EDIT Fee For Service in the healthcare debate Some critics believe that the fee for service system provides healthcare
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Fixes promised by managed care have not materialized. Premiums are rising. Hassles for patients and physicians abound. Nearly 45 million Americans are uninsured. Over the next decade‚ these problems will worsen and new challenges will arise. Although new technology will increase efficiency‚ the cost of new tests and treatments will outweigh the savings. As physicians get better at treating problems‚ they will lengthen patients’ lives and increase the number of people requiring care. As baby boomers
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Healthcare Organization ’s - HMO vs. PPO Angela MacLeod‚ Ifeoma Jonathan HCS-413 April 17‚ 2011 Jeffery Dodd Healthcare Organization ’s - HMO vs PPO Introduction A health care system is the organization of people‚ institutions‚ and resources to deliver health care services to meet the health needs of target populations. There are two widely known and used healthcare organizations that deliver insurance to the vast majority of the population‚ Health Maintenance Organizations (HMO)
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their own health plan according to their financial situations with savings account options. After reading this information‚ the reader will have a clearer idea of the options available through health care coverage. Preferred provider organizations (PPOs) are based on membership to a specific health care provisions arrangement. As part of the PPO‚ the provider participates in this arrangement providing patients with services guided by discounted fee-for-service. This type of service is at a discount
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profit because a fee-for-service was still the predominant form of payment (Zuckerman‚ 2011‚ p. 6). However‚ during the 1990s many medical facilities faced foreclosure and buyouts because of the rise of the managed care industry (Zuckerman‚ 2011‚ p. 6). More recently‚ the Affordable Health Care Act (ACA) has caused many healthcare organizations to reevaluate their strategic plans and missions statements‚ so that they may survive on making less of a profit while still offering a variety of medical
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Matrix As you learn about health care delivery in the United States‚ it is important to understand the various models of health insurance to develop a working knowledge as you progress through the course. The following matrix is designed to help you develop that knowledge and assist you in understanding how health care is financed and how health insurance influences patients and providers as important foundational information for your role as a future health care worker. Fill in the following matrix
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enrollee to a healthcare provider; it is the sole reimbursement for providing services to a defined population. Capitation payments are expressed as some dollar amount per member per month‚ where the word "member" typically means enrollee in some managed care plan. Under fee-for-service‚ all volumes less than breakeven
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Syllabus College of Natural Sciences HCS/451 Version 5 Health Care Quality Management and Outcomes Analysis Copyright ©‚ 2012‚ 2010‚ 2007‚ 2005‚ 2004 by University of Phoenix. All rights reserved. Course Description This course examines the relationships between health care quality and organizational performance management. The student is introduced to the rationale for performance management and the role of the governing body of the health care organization in ensuring compliance with the standards of
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