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Must Know Terms Cheat Sheet

NURS 412
Winter 2016
Section 1
1. Health Policy: The aggregate
principles, stated or unstated, that
characterize the distribution of
resources, services, and political
influences that impact the health of
the population.
2. Politics: How we make decisions
for the whole societydecisions
that we enforce with rules, laws,
and money.
3. Stakeholder: Actors (persons or
organizations) who have a vested
interest in the policy that is being
promoted. These interested
parties can usually be grouped
into the following categories:
international, public, national
political, commercial/private,
nongovernmental organization,
labor, users/consumers.
4. Policy Advocacy: Refers to
advocacy tactics, strategies and
initiatives which target changes to
policies and legislation. These
actions seek to establish new
policies, improve existing policies,
or challenge the development of
policies.
5. Lobby: A group of persons who
work together to influence
government decisions that relate to
a particular industry, issue, etc.
6. Policy Implications: Possible
consequences or repercussions of
policy.
7. Affordable Care Act: Provides
Americans with better health
security by putting in place
comprehensive health insurance
reforms that aim to expand
coverage, hold insurance
companies accountable, lower
health care costs, guarantee more
choice, and enhance the quality of
care for all Americans.
8. Health Care Delivery: How health
care services are delivered.

9. Health Care Financing: How


health care services are financed.

Section 2
10.
Medicaid: A health
insurance program for low-income
families and children, pregnant
women, the elderly, and people
with disabilities. Some states have
expanded this program to cover all
adults below certain income levels.
The federal government provides
part of the funding for this program
and sets guidelines for the
program, and states administer the
program. This programs benefits
vary somewhat between states and
may have a different name in
different states.
11.
Apple Health: Washington
States Medicaid Program
12.
Integration: A term used
by policymakers and administrators
in Washington State to refer to the
law that the state will fully
integrate the financing and
delivery of physical health services,
mental health services and
chemical dependency services in
the Medicaid program through
managed health care by 2020.
13.
Medicare: A Federal health
insurance program for people who
are age 65 or older and certain
younger people with disabilities. It
also covers people with End-Stage
Renal Disease.
Section 3
14.
Fee-for-Service: Health
care provider is paid for each
service rendered

15.
Episode of Illness: One
payment for all services delivered
during one illness/episode
16.
Per Diem Payments:
Payments for one patients services
delivered in a hospital setting in
one day
17.
Capitation Payments: One
payment for each patients care
during a set time interval.
18.
Global Budget: Payment for
all services delivered to all patients
within a set time interval.
19.
Bundled Payment: Bundled
payment is a single payment to
providers or health care facilities
(or jointly to both) for all services
to treat a given condition or
provide a given treatment.
20.
Managed Care: A strategy
that utilizes mixture of cost control
mechanisms: changing the
utilization management, price
discounts, and in some cases
supply controls.
21.
Health Maintenance
Organization (HMO): Works with
a network of providers. Must see
a provider who is contracted with
your insurance company. You will
pay the full cost for seeing a
provider outside the network. You
will need a referral from your
primary care provider to see a
specialist.
22.
Preferred Provider
Organization (PPO): Prefer you
see provider in network. If you
see a provider outside the network
you will pay more to see that
provider, but insurance will pay for
some of the cost. You may not need
a referral to see a specialist.

Section 4
23.
Triple Aim: Improve the
patient experience of care
(including quality and satisfaction);
improve the health of populations;

and reduce the per capita cost of


health care.
24.
Value-Based Purchasing:
Linking provider payments to
improved performance by health
care providers. This form of
payment holds health care
providers accountable for both the
cost and quality of care they
provide. It attempts to reduce
inappropriate care and to identify
and reward the best-performing
providers.
25.
Accountable Care
Organization (ACO): A group of
health care providers who give
coordinated care, chronic disease
management, and thereby improve
the quality of care patients get.
The organizations payment is tied
to achieving health care quality
goals and outcomes that result in
cost savings.
26.
Accountable Communities
of Health (ACH): A designated
region that works to bring together
health care, community services,
social services and public health
strategies in supportive
environments to address the needs
of the whole person. These regions
will drive physical and behavioral
health care integration by making
financing and delivery adjustments,
starting with Medicaid.
27.
Primary Care: Health
services that cover a range of
prevention, wellness, and
treatment for common illnesses.
Providers in this setting include
MDs, RNs, ARNPs, PAs. They often
maintain long-term relationships
with their patients and coordinate
patient care with specialists.
28.
Ambulatory Care: Medical
care provided on an outpatient
basis.
29.
Medical Home: A model of
primary care that is patientcentered, comprehensive, team-

based, coordinated, accessible, and


focused on quality and safety.

Section 5
30.
Premium: A monthly fee
which allows you to keep and use
the insurance.
31.
Out of Pocket Costs:
Copayments, coinsurance, and
anything you pay directly to your
provider.
32.
Deductible: A dollar amount
set by your insurance company
which you will need to pay before
your insurance company will share
your healthcare costs with you.
33.
Copay: A set amount you
pay for certain services when you
get them. Your insurance company
pays for the rest. The payment is
paid to your provider. Your
insurance company lets you know
what services require this payment
and when.
34.
Coinsurance: This is similar
to a copay. Instead of a set dollar
amount your insurance company
may have you pay a percent of the
cost of a medical service.
35.
Out-of-pocket maximum:
This is another dollar amount set
by your insurance company. Once
youve paid this set dollar amount
your insurance company will pay
for all of your medical services that
are provided by someone in their
network.
Section 6
36. Ecological Model: Emphasizes the
importance of the social and physical
environments that strongly shape
patterns of disease and injury as well as
our response to them over the entire life
cycle.

37. Ecology: A science studying the


relationships between a group of living
things and their environment.
38. Structural competency: The
trained ability to discern how a host of
issues defined clinically as symptoms,
attitudes, or diseases (e.g., depression,
HTN, obesity, smoking, medication noncompliance, trauma, psychosis) also
represent the downstream implications of
a number of upstream decisions about
such matters as health care and food
delivery systems, zoning laws, urban and
rural infrastructures, medicalization, or
even about the very definitions of illness
and health.
39. Upstream: A metaphor used to
better identify root causes of disease and
health, as well as the policies that might
productively address such causes of
disease and health. It is about moving
toward prevention and creating those
conditions in which people can be
healthy.
40. Stakeholder Analysis: Used to plan
for organizational or policy change:
project planning, implementation, and
evaluation.
41. Stake/Interests: Actual or potential
impact (positive or negative) of the
decision on a stakeholder group.
42. Capacity/Influence: Ability to enact
the proposed policy change or sway the
policy issue
43. Ethics: The study of human
behavior, ethical principles, and moral
theories in order to determine that we
are acting in the best interests of the
individual, the community, and the
organization.
44. Autonomy: The right of the patient
to request or refuse treatment.

45. Beneficence: Our obligation to


practice medicine in a way that benefits
the patient, one that brings them to a
condition equal to or better than that
which brought them into our care.
46. Nonmaleficence: Our obligation to
practice medicine in a way that does no
harm to the patient.
47. Justice: Our obligation to consider
the needs of the individual person as well
as the needs of the community.

48. The Death with Dignity Act: An


Act that allows terminally ill adults
seeking to end their life to request lethal
doses of medication from medical and
osteopathic physicians. These terminally
ill patients must be competent adults
who are Washington state residents and
who have six months or less to live.

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