Health Ecosystem D391 WGU Exam questions with accurate solutions

The whole structure that supports healthcare provision

Healthcare Ecosystem

An organization of individuals, institutions and resources that deliver services to clients

Healthcare System

A group of people with a common interest, especially in a buisness

Stakeholders

The 5 P's of the US Healthcare Ecosystem

Patient's

Providers

Professional Administrators

Policymakers

Payers

The most common consumer

Patient

The primary goal of the healthcare ecosystem

To raise the standard of healthcare offered to members.

What are the fundamental components of a healthcare system?

Organization, funding, and delivery

What is an example of an advanced practice professional?

A registered nurse

A healthcare administrator

A nurse practitioner

A care coordinator

A nurse practitioner

What do health services include?

Emergency, preventative, rehabilitative, long-term, hospital, diagnostic, primary, palliative, and home care.

Why is cultural competence important in health services?

Because it creates competition between providers

Because it avoids conflicts with the client

Because the hospital can charge for this type of service

Because clients' values and preferences will be respected

Because client's values and preferences will be respected

Which of the following is a component of the Quadruple Aim of healthcare?

Patients of low socioeconomic populations receive less care than other populations.

It aims to improve the overall health of a given population.

Increase the working hours for health professionals.

Utilization of as many resources as possible

It aims to improve the overall health of a given population

What are the Providers?

A person or institution that performs a service

Health and Human Services

Diagnostic/Lab Techs

Doctors, Mid-level Providers, and Nurses

Mental Health providers (occupational and physical)

Focuses on physical health, enables clients to perform daily activities such as bathing or dressing

Therapists; Occupational Therapy

Mental Health Providers

Evaluates a person's mental health

Examples of mental health providers

Psychiatrist (specialize in mental health-can prescribe meds), Psychologist (study of the human mind and behavior, provides counseling, cannot prescribe meds)

Clinical Social Workers

Provides assessments, diagnose and counseling

Five institutional providers

1.Primary Care (a core component of healthcare delivery)

2.Post acute short-term care (provide nursing and physical therapy services so clients can become more independent after medical services)

3.Hospitals (In-Patient- offer medical, surgical, and nursing care to those who are ill or injured)

4.Long-term care (include nursing homes, assisted living facilities, and retirement communities, is to provide clients with a superior quality of life)

5.Institutional providers (Hospital, Critical Care, Skilled nursing facility, Home Health Agency, Hospice)

What does primary care offer?

Mental health services

Psychiatric

Laboratory integrated

Pharmacy services

Who monitors payers organizations, accredits health insurance companies?

National Committee for Quality Assurance (NCQA)

Who helps improve and monitor providers' quality of care?

Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

What government organization that protects consumers from harm.

Is responsible for ensuring that states and national health regulations are enforced?

U.S. Department of Health and Human Services

Who Increased the number of beds, improved the distribution of those beds and improved the quality of hospital facilities?

The Hill Burton-Act (The Hospital Survey and Construction Act of 1946

Ensures the privacy of people's protected information (PHI)

The Health Insurance Portability and Accountability Act of 1996

Paying the practitioner or hospital a fixed amount for a specific service

Capitation

The Balanced Budget Act of 1997

Known as Medicare Advantage and CHIP, designed to balance the federal budget

When was Medicare and Medicaid established?

Established in 1965 under the title XVII and Title XIX of the Social Security Act

Federally funded nonprofit health centers or clinics that serve medically underserved areas and populations. Federally qualified health centers provide primary care services to undeserved populations

Federally Qualified Health Center (FQHC)

Who is responsible for ensuring that regulations for Medicare and Medicaid are enforced?

Centers for Medicare and Medicaid Services (CMS)

Who licenses providers and makes state laws for health?

State Department of Health

An Approach to delivering high quality, cost-effective primary care (Keiser Permanente)

Patient Centered Medical Home (PCMH)

Five Main Funding Models

1.Self-Funded

2.Bismark

3.Beveridge

4.National Health Insurance

5.Bis-Bev

Patient Safety and Quality Improvement Act of 2005 (PSQIA)

Sought to promote a culture of safety and encouraged the development of quality improvement strategies

Affordable Care Act of 2010 (ACA)

To move the US system to a universal coverage.

Expanded Medicaid and CHIP.

Established requirements for Indviduals and businesses to buy and provide coverage.

Provided government subsidies to assist with those requirements.

Introduced health insurance exchanges to help consumers compare and purchase insurance plans.

Supported healthcare deliver and payment.

The Hospital Readmissions Reduction Program (HRRP)

Financially penalizes hospitals that have higher-than-expected 30-day readmission rates

Moral Hazards

When an individual incurs no consequence for a decision allowing for extravagant choices such as using more medical services than necessary

In 1973, to address the rising cost of health insurance, the Nixon Administration promoted a new model called

Health maintenance organizations (HMOs)

The abolishment of the Fee-For-Service came with the

Affordable Care Act of 2010 (ACA)

Adverse Selection

is where a consumer does not purchase health insurance until they need coverage.

Value-Based-Care

Provider of service awards for quality patient care

Wellness and prevention

Reduce cost and improve patient outcomes

Which is a single-payer model?

The National Health Insurance Model

The Bismarck Model

The equity model

Market-driven healthcare

The National Health Insurance Model

Which of the following models is a social health insurance model?

The Bismarck Model

The equity model

The National Health Insurance Model

Market-driven healthcare

The Bismark Model

What is one of the five main funding models of the U.S. healthcare system?

The national health insurance model

The Medicaid model

The Medicare model

The private insurance model

The private insurance model

Legislation

Standardizes care and protects patients

Which health plan is regulated under the Employee Retirement Income Security Act (ERISA)?

Self-insured

Medicare

Medicaid

Tricare

Self-insured

Which is an example of fraud by a provider?

Kickbacks

Charging deductibles

Writing prescriptions

Collecting co-payments

Kickbacks

Federal Trade Commission (FTC)

Responsible for enforcing antitrust laws

When was Medicaid created?

In 1965 to support low-income families

Which government program allows clients to qualify for dual-eligibility to pay for additional services beyond those covered by the program?

CHIP

HMO

Medicare

Medicaid

Medicare

Plan-do-study-act (PDSA)

Plan-Propose idea

Do-Implement idea

Study-Analize data and information

Act-Share information

STEEEP

Safety, timeliness, effectiveness, efficiency, equity, and patient-centered care.

What can affect efficiency and quality?

Factors like lack of collaboration among providers and institutions and lack of available resources

Efficiency

Obtaining the most significant health benefit in a way that minimizes costs and resource use

Quality

Evidence-based care that delivers positive outcomes

SHARE decision making model

S: seek your patient's participation

H: help your patient explore and compare treatment options

A: assess your patient's values and preferences

R: reach a decision with your patient

E: evaluate your patient's decision

DECIDE decision making model

D. = Define the Problem (Think)

E. = Explore the Alternatives (Understand)

C. = Consider the Consequences (Wonder)

I = Identify Your Values (Look into Yourself)

D. = Decide and Take Action (Act as Necessary)

E. = Evaluate Your Decision (Design)

The Quadruple Aim Framework

Focuses on reducing costs, improving population health, improving patient experience, or improving team well-being.

Programmatic community services

Community outreach

Mental and behavioral health

Clinics

Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)

Transportation

Electronic Medical Record (EMR)

A collection of medical information on a patient providing a 360-degree view for the medical team

Health Information Exchange (HIE)

Distributing patient information among the healthcare team to deliver quality care. Allows health professionals to access and share a client's medical information. It has contributed to the faster delivery of services to clients in the community.

Providers receive payment for services performed

Fee-For-Service

People who qualify for both Medicare and Medicaid are referred to as:

Dual Eligible

An important law that established a new reimbursement and incentive structure for doctors treating medicare patients:

Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)

The largest integrated healthcare system in the United States

The Veterans Health Administration (VHA)