An Accountable Care Organization (ACO) is a healthcare delivery model that aims to improve the quality of care and reduce costs by coordinating care across different providers and settings. ACOs bring together a group of healthcare providers, such as ...
ACO REACH is a program run by the Centers for Medicare and Medicaid Services (CMS) that aims to provide support and resources to Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP). The purpose of ACO ...
The term at-risk patient population is commonly used to refer to individuals who are more likely to develop health problems, require increased medical care, or have adverse outcomes due to factors such as age, underlying health conditions, lifestyle habits, ...
Funding models refer to the methods used to finance healthcare services, treatments, and programs in the U.S.. Some common funding models include: Fee-for-service (FFS) – Healthcare providers are paid for each service or procedure they perform. Capitation – Healthcare ...
Gaps in care is similiar to quality gaps. Gaps in care refer to missed or delayed healthcare services or treatments that a patient needs to maintain or improve their health. These gaps can occur due to various reasons, such ...
A Health Maintenance Organization (HMO) is a type of insurance that operates as a managed care organization that provides a network of healthcare providers for its members to choose from. This type of insurance is typically based on a ...
Medicare is a national health insurance program in the United States, providing coverage to people who are 65 years of age or older, some people with disabilities, and people with End-Stage Renal Disease (ESRD). It was created in 1965 ...
Medicare Advantage (MA) is an alternative to traditional Medicare and is offered by private health insurance companies. It provides Medicare-covered benefits and may offer additional benefits such as vision, dental, and prescription drug coverage. People who are eligible for ...
The Medicare Shared Savings Program (MSSP) is a program under the Medicare program in the United States that incentivizes healthcare providers to coordinate care and reduce costs for Medicare beneficiaries. MSSP is an Accountable Care Organization (ACO) model that ...
Point of care (POC) refers to the location where healthcare services are provided. This can include a variety of settings, such as a doctor’s office, clinic, hospital, or even a patient’s home. The term “point of care” is used ...
A Population-Based Risk Contract (PBRC) is a type of payment model used in healthcare that aims to incentivize providers to improve the health of a specific patient population and reduce the overall cost of care. Under a PBRC, a ...
Quality gaps refer to the difference between the current level of healthcare provided and the optimal level of healthcare that should be provided. These gaps can occur in various areas of healthcare, including access to care, preventive care, chronic ...
Risk adjustment is a method used in the health insurance industry to account for differences in the health status of enrollees in a health plan. The goal of risk adjustment is to ensure that health plans are not penalized ...
A risk-based contract is a type of agreement between a health insurer and a healthcare provider, in which the provider is financially responsible (or partially responsible) for the cost of providing care to a specific population of patients. The ...
