NHA: Health Care Systems and Settings
ambulatory Correct Answer: Able to walk
Certified health coach or patient navigator Correct Answer: A health coach or navigator often directs
patients through the health care system. Navigators and patient coaches help organize patient care,
connect patients to additional resources, and help patient's understand the health care system. Many
health coaches and patient navigators have a chronic disease focus area, such as cancer, heart disease,
or diabetes.
Computerized physician order entry (CPOE) Correct Answer: A process of electronic data entry of
provider instructions for treatment.
Accountable care organizations (ACOs) Correct Answer: These group of physicians, hospitals, and other
health care providers come together voluntarily to provide coordinated high-quality care to their
Medicare patients. When an ACO succeeds in delivering high-quality care and spending health care
dollars wisely, it will share in the savings it achieves for the Medicare program.
Capitation (partial or full) Correct Answer: In this payment model, patients are assigned a per-member,
per-month payment based on their age, race, sex, lifestyle, medical history, and benefit design. Payment
rates are tied to expected usage regardless of how often the patient visits. Like bundled payment
models, providers have an incentive to help patients avoid high-cost procedures and tests to maximize
their compensation. Under partial-or blended-capitation models, only specific types or categories of
services are paid on a basis of capitation.
Global budget Correct Answer: The is a fixed total dollar amount paid annually for all care. However,
participating providers can determine how money is spent. Global budgets limit the level and the rate of
increase of health care cost. They typically include a quality component as well.
Health maintenance organization (HMO) Correct Answer: This plan contracts with a medical center or
group of providers to provide preventive and acute care for the insured person. HMOs generally require
referrals to specialists, as well as precertification and preauthorization for hospital admissions,
outpatient procedures, and treatments.
Patient-centered medical home (PCMH) Correct Answer: In this care delivery model, a primary care
provider (PCP) coordinates treatment to make sure patients receive the required care when an where
they need it, and in a way they can understand.
Pay for performance Correct Answer: This reimbursement model compensates providers only if they
meet certain measures for quality and efficiency. Generating quality benchmark measures connects
provider reimbursement directly to the quality of care they provide.
Preferred provider organization (PPO) Correct Answer: These plans have more flexibility than HMO
plans. An insured person doesn't need a PCP, but can go directly to a specialist with out referrals.
Although patients can see providers in or out of their network, an in-network provider usually costs less.
, General practitioners (GP's) Correct Answer: Are medical doctors who treat acute and chronic illnesses
ad provide preventive care and health education to patients. A GP may take a holistic approach of
general practice that takes into consideration the biological, psychological, and social aspects relevant to
the care of each patient's illness.
Family practitioners Correct Answer: Offer care to the whole family, from newborns to older adults.
They are familiar with a range of disorders and diseases. However, preventive care is their primary
concern. This is one of the specialists most often chosen by physicians.
Internists Correct Answer: Provide comprehensive care of adults, often diagnosing and treating chronic,
long-term conditions. They also offer treatment for common illnesses and preventive care. Internists
must have a broad understanding of the body and its alignments to be able to diagnose conditions and
provide treatment.
Allergists Correct Answer: Evaluate disorders and diseases of the immune system. This includes adverse
reactions to medications and food, anaphylaxis, problems related to autoimmune disease, and asthma.
Anesthesiologists Correct Answer: Manage pain or use sedation during surgical procedures.
Cardiologists Correct Answer: Specialize in diagnosing and treating diseases or conditions of the heart
and blood vessels.
Dermatologist Correct Answer: Specialize in conditions of the skin.
Endocrinologists Correct Answer: Specialize in hormonal and glandular conditions . They often work
with patients who have diabetes mellitus.
Gastroenterologists Correct Answer: Specialize in managing diseases of the gastrointestinal tract: the
stomach, intestines, esophagus, liver, pancreas, colon, and rectum.
Gynecologists Correct Answer: Specialize in the female reproductive system and fertility disorders.
Hematologists Correct Answer: Deal with blood and blood-producing organs. They often work with
patients who have anemia, leukemia, and lymphoma.
Hepatologists Correct Answer: Specialize in the study of body parts such as the liver, biliary tree,
gallbladder, and pancreas.
Neonatologists Correct Answer: Specialize in the care of newborns.
Nephrologists Correct Answer: Specialize in kidney care and treating diseases of the kidneys.
Obstetricians Correct Answer: Specialize in the care of women during and after pregnancy.
Oncologists Correct Answer: Specialize in the treatment and care of patients who have cancer.
Ophthalmologists Correct Answer: Specialize in eye conditions.
ambulatory Correct Answer: Able to walk
Certified health coach or patient navigator Correct Answer: A health coach or navigator often directs
patients through the health care system. Navigators and patient coaches help organize patient care,
connect patients to additional resources, and help patient's understand the health care system. Many
health coaches and patient navigators have a chronic disease focus area, such as cancer, heart disease,
or diabetes.
Computerized physician order entry (CPOE) Correct Answer: A process of electronic data entry of
provider instructions for treatment.
Accountable care organizations (ACOs) Correct Answer: These group of physicians, hospitals, and other
health care providers come together voluntarily to provide coordinated high-quality care to their
Medicare patients. When an ACO succeeds in delivering high-quality care and spending health care
dollars wisely, it will share in the savings it achieves for the Medicare program.
Capitation (partial or full) Correct Answer: In this payment model, patients are assigned a per-member,
per-month payment based on their age, race, sex, lifestyle, medical history, and benefit design. Payment
rates are tied to expected usage regardless of how often the patient visits. Like bundled payment
models, providers have an incentive to help patients avoid high-cost procedures and tests to maximize
their compensation. Under partial-or blended-capitation models, only specific types or categories of
services are paid on a basis of capitation.
Global budget Correct Answer: The is a fixed total dollar amount paid annually for all care. However,
participating providers can determine how money is spent. Global budgets limit the level and the rate of
increase of health care cost. They typically include a quality component as well.
Health maintenance organization (HMO) Correct Answer: This plan contracts with a medical center or
group of providers to provide preventive and acute care for the insured person. HMOs generally require
referrals to specialists, as well as precertification and preauthorization for hospital admissions,
outpatient procedures, and treatments.
Patient-centered medical home (PCMH) Correct Answer: In this care delivery model, a primary care
provider (PCP) coordinates treatment to make sure patients receive the required care when an where
they need it, and in a way they can understand.
Pay for performance Correct Answer: This reimbursement model compensates providers only if they
meet certain measures for quality and efficiency. Generating quality benchmark measures connects
provider reimbursement directly to the quality of care they provide.
Preferred provider organization (PPO) Correct Answer: These plans have more flexibility than HMO
plans. An insured person doesn't need a PCP, but can go directly to a specialist with out referrals.
Although patients can see providers in or out of their network, an in-network provider usually costs less.
, General practitioners (GP's) Correct Answer: Are medical doctors who treat acute and chronic illnesses
ad provide preventive care and health education to patients. A GP may take a holistic approach of
general practice that takes into consideration the biological, psychological, and social aspects relevant to
the care of each patient's illness.
Family practitioners Correct Answer: Offer care to the whole family, from newborns to older adults.
They are familiar with a range of disorders and diseases. However, preventive care is their primary
concern. This is one of the specialists most often chosen by physicians.
Internists Correct Answer: Provide comprehensive care of adults, often diagnosing and treating chronic,
long-term conditions. They also offer treatment for common illnesses and preventive care. Internists
must have a broad understanding of the body and its alignments to be able to diagnose conditions and
provide treatment.
Allergists Correct Answer: Evaluate disorders and diseases of the immune system. This includes adverse
reactions to medications and food, anaphylaxis, problems related to autoimmune disease, and asthma.
Anesthesiologists Correct Answer: Manage pain or use sedation during surgical procedures.
Cardiologists Correct Answer: Specialize in diagnosing and treating diseases or conditions of the heart
and blood vessels.
Dermatologist Correct Answer: Specialize in conditions of the skin.
Endocrinologists Correct Answer: Specialize in hormonal and glandular conditions . They often work
with patients who have diabetes mellitus.
Gastroenterologists Correct Answer: Specialize in managing diseases of the gastrointestinal tract: the
stomach, intestines, esophagus, liver, pancreas, colon, and rectum.
Gynecologists Correct Answer: Specialize in the female reproductive system and fertility disorders.
Hematologists Correct Answer: Deal with blood and blood-producing organs. They often work with
patients who have anemia, leukemia, and lymphoma.
Hepatologists Correct Answer: Specialize in the study of body parts such as the liver, biliary tree,
gallbladder, and pancreas.
Neonatologists Correct Answer: Specialize in the care of newborns.
Nephrologists Correct Answer: Specialize in kidney care and treating diseases of the kidneys.
Obstetricians Correct Answer: Specialize in the care of women during and after pregnancy.
Oncologists Correct Answer: Specialize in the treatment and care of patients who have cancer.
Ophthalmologists Correct Answer: Specialize in eye conditions.
