Buildingblocksofhealthreform.org
Consumer Decision Making
WebHealth Insurance Exchange. Policy Definition: A health insurance exchange, or marketplace, is a service that helps individuals, families, and small businesses shop for and enroll in affordable medical insurance accessible through websites, call centers, and in-person assistance. source
Actived: 9 days ago
URL: http://buildingblocksofhealthreform.org/consumer-decision-making.html
Value Based Care
WebOutcome Evidence. In 2019, the Centers for Medicare and Medicaid (CMS) announced that more than 1,500 participating hospitals will receive about $1.9 billion in bonuses for fiscal year 2020 under the Hospital Value-Based Purchasing Program, which adjusts payments to hospitals based on the quality and cost of inpatient care they provide.
Healthcare Management Strategies
WebDisease Management. Policy Definition: Disease management is a system of coordinated health care interventions and communications for populations with conditions in which patient self-care efforts are significant. Care managers can utilize these structured treatment plans to help individuals better manage their chronic disease, maintain and improve the …
Market Competition
WebMarket Consolidation. Policy Definition: Market consolidation is the practice of two or more health systems, hospitals, clinics or other healthcare entities coming together through acquisition or merger. Policies can regulate the merger of health care entities with intentions to maintain competition in the market, consumer choice, low cost and better quality in …
Covered Benefits
WebEmployee Retirement Income Security Act of 1974 (ERISA) Policy Definition: ERISA outlines a minimum set of standards to establish protections for enrollees in health plans in the private sector. Relevant amendments to ERISA in the realm of health benefits are the Consolidated Omnibus Budget Reconciliation Act (COBRA), which protects workers and …
Benefit Administration & Organization
WebAccreditation. Policy Definition: Accreditation is a comprehensive evaluation process in which a health care organization’s systems, processes and performance are examined by an impartial external organization (“accrediting body”) to ensure that it is conducting business in a manner that meets predetermined criteria and is consistent with national …
Risk Pooling & Plan Funding
WebRisk Pool. Policy Definition: A health insurance risk pool is a method to group individuals whose medical costs are combined to calculate premiums. Pooling risk allows the higher costs of the less healthy to be offset by the relatively lower costs of the healthy.
Alternative Payment Models
WebPolicy Examples. Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers, who come together voluntarily to ensure that patients get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors.
Convenience Care
WebOutcome Evidence. There are an estimated 8,100 urgent care locations (in 2018) and 2,805 retail clinic locations (in 2017) across the country. source & source; A “workplace,” or “onsite clinic” is a setting where an employer offers one or more medical and wellness services, delivered by licensed providers, to all or a designated portion of its active population and …
Public Group Exchange
WebPolicy Examples. The Utah Health Exchange, Avenue H, was created prior to the enactment of the ACA and was the only state-run Small Business Health Options Program (SHOP) exchange for small employers to participate in a defined contribution arrangement and compare, select, and enroll in commercial health insurance online.
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