Bundled Payments. Dual Eligibles. Managed Care. These terms–along with other insurance jargon–are responsible for describing everything from how providers are paid for services rendered to who is eligible for certain insurance benefits.
The incredible folks over at the Association of State and Territorial Health Officials (ASTHO) compiled a 48 page glossary to help facilitate conversations about Medicaid between medical professionals and public health practitioners. We think this resource can be used to learn about a dozens of important, everyday terms that medical students should know should keep in mind! Here’s just a snippet of what ASTHO has put together:
- Accountable Care Organization (ACO): “A group of healthcare providers that provides coordinated care and care management to improve the quality of patient care and control costs. In this provider group, payments are tied to the achievement of healthcare quality goals and outcomes that result in cost savings.” [ACO’s began as Medicare demonstration projects and are now being expanded to private payers and Medicaid (i.e. Patient centered medical homes).]
- Bundled Payments: “Use of a single payment for all services related to a treatment or condition, possibly spanning multiple providers in multiple settings.” The payer (government or private) compensates the provider based on the expected cost for defined episodes (i.e knee replacement).
- Capitation: A payment system that compensates providers “a fixed amount for each person served regardless of the amount and intensity of services provided to each person in a set period of time. This capitation rate is often expressed in per member per month (PMPM) units.” Services provided under a capitation agreement can include preventive, diagnostic, and treatment services; immunizations, injections, and medications administered in the office; outpatient lab tests; health education; and vision and hearing screenings.
And on and on it goes. DGR. FQHC. GME. LTC.
Bookmark this amazing glossary to help you decode the health systems around you!