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accountable care organizations (ACOs)
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payment model in large health systems where individual physician practices or a collection of physician practices contract with a payer, typically under a fee-for-service payment model, to provide care to a population
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bundled payments
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payment model in which physician practices receive payment based on episodes of client care according to a defined set of diagnoses and services provided to the client over a specific period; also known as episode-based payments
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capitation
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payment model in which physician practices receive payment per client per period, which is usually 1 month; health plan rules govern which clients are included in the physician practice
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care delivery models
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delivery strategies that prescribe the specific ways in which professionals work together to provide health care services
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care deserts
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areas in the United States where individuals have limited access to health care services such as hospitals or health clinics; also called medical deserts
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episode-based payments
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payment model in which physician practices receive payment based on episodes of client care according to a defined set of diagnoses and services provided to the client over a specific period; also known as bundled payments
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fee-for-service
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payment model in which physician practices are paid a flat rate for each client visit, test, or procedure performed; through this model, practices can achieve higher revenue with more clients and procedures each day
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health disparities
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systematic differences in health that exist between socioeconomic positions, social classes, genders, ethnicities, sexual orientations, or other social groups with differentiated access to material and non-material resources
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health literacy
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the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions
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health outcomes
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the results of a health intervention
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Healthy People
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a 10-year HHS plan that establishes public health priorities and data-driven objectives to improve public health and well-being over a decade
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integrated service lines
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hospitals and health systems organize around specific disease states such as cancer, heart disease, and diabetes throughout the continuum of client care
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leading health indicators (LHIs)
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small subset of high-priority Healthy People 2030 objectives selected to drive action toward improving health and well-being
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marginalized communities
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communities excluded from the dominant group’s cultural, economic, educational, or social life
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maternal care deserts
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areas within the United States where individuals have limited to no access to maternal care services
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medical deserts
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areas within the United States where individuals have limited access to health care services such as hospitals or health clinics; also called care deserts
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medical homes
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care delivery model in which an integrated team of health care providers such as nurses, physicians, and care managers provides care that addresses the “whole person”
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pay for performance
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payment model in which physicians are paid according to prescribed practice performance on defined metrics, which are based upon the quality of care and/or utilization of care services
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payment models
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mechanism by which health care services are established and paid for
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pharmacy deserts
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areas in the United States where individuals have limited to no access to pharmacy services
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provider-sponsored health plans
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health plans that are either sponsored or acquired by hospitals, physician groups, or health systems that assume responsibility for the total cost of care for clients enrolled in the health plan
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public health policy
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laws, regulations, programs, behaviors, and decisions implemented in a society to promote public health
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Quintuple Aim
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a proposed update to the Institute for Healthcare Improvement’s Triple Aim
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retainer-based payment
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payment model in which physician practices or other organizations receive capitation payments from the client; also known as “concierge” payments
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shared savings programs
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payment model in which physicians or health care practices receive payment throughout the contract year; total costs of care for a specific client population are compared with a cost target at the end of year, which can lead to a lump-sum payment incentive or penalty for not meeting prescribed goals
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supply chain
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participants at each step in the process that takes a product from raw materials to a finished good that is sold to customers
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telehealth
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the provision of health care using technology, including the internet, computers, tablets, and smartphones
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Triple Aim
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a framework developed by the Institute for Healthcare Improvement that describes an approach to optimizing health system performance
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universal health care system
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a system in which all people have access to the full range of quality health services they need, when and where they need them, without financial hardship