Daniel Karnuta HMGT 3311 Test 1
Study online at https://quizlet.com/_go9twt
1. Affordable Care Act Established the triple aim in 2010
- What Year?
- What did it establish?
2. What law passed in Aug IRA - Inflation Reduction Act - $740B
2022 and how did it af- Healthcare Components Included
fect healthcare - Allow CMS to negotiate some drug prices
- Extended subsidiaries for some ACA insurance exchange participants
(make insurance more affordable)
- Capped OOP Drug costs for Medicare Patients
3. What is the aim of the Get the right care for the right patient everytime?
CMS
4. How is CMS trying to con- From moving from a quantity of care reimbursement system to value
trol costs based pricing model
- prospective more = fee for service = quantity of care model
- fee for service pays provider with fixed cost upfront
5. What is the triple aim cost, access, quality
6. What is the rise in 36 million to 50 million
the uninsured popula- 2001 - 2010
tion from 2001 to 2010
7. ACA impact of Uninsured 50 mil in 2010 to 25.3 mil in 2023
from 2010 - 2023
8. What are the key provi- Provide insurance coverage for almost all individuals
sions of the ACA - state insurance exchanges
- expansion of medicaid
Create health plan medical loss ratio and premium rate reviews
1/8
, Daniel Karnuta HMGT 3311 Test 1
Study online at https://quizlet.com/_go9twt
- insurers have to spend at least 80-85% of premium revenue on actual
medical care rather than administrative costs or profits.
- or else the rest has to be sen back a rebates to the policyholders
Emphasize bundled payments and VBP
- Bundled Payment: A single, fixed payment is made for a patient's
entire course of treatment for a specific condition or procedure, rather
than separate payments for each service
- Value-Based Purchasing: A payment model that links Medicare reim-
bursements to healthcare quality and patient outcomes rather than the
quantity of services provided.
Created Accountable Care Organizations
- Group of healthcare providers who work together to improve quality
of care and reduce costs by keeping patients healthy
- Initially created to serve Medicare beneficiaries
- Rewarded for reducing cost and improving quality
9. Medical Loss Ratio If an insurance company:
Collects $10 million in premium revenue.
Spends $8.2 million on medical claims and quality improvements.
MLR = 8.2/10 = 82%
10. Consumer Price Index measures how much things are going up every year
11. How much of US GDP is 17.6%
Healthcare
12. Chronic disease
2/8
Study online at https://quizlet.com/_go9twt
1. Affordable Care Act Established the triple aim in 2010
- What Year?
- What did it establish?
2. What law passed in Aug IRA - Inflation Reduction Act - $740B
2022 and how did it af- Healthcare Components Included
fect healthcare - Allow CMS to negotiate some drug prices
- Extended subsidiaries for some ACA insurance exchange participants
(make insurance more affordable)
- Capped OOP Drug costs for Medicare Patients
3. What is the aim of the Get the right care for the right patient everytime?
CMS
4. How is CMS trying to con- From moving from a quantity of care reimbursement system to value
trol costs based pricing model
- prospective more = fee for service = quantity of care model
- fee for service pays provider with fixed cost upfront
5. What is the triple aim cost, access, quality
6. What is the rise in 36 million to 50 million
the uninsured popula- 2001 - 2010
tion from 2001 to 2010
7. ACA impact of Uninsured 50 mil in 2010 to 25.3 mil in 2023
from 2010 - 2023
8. What are the key provi- Provide insurance coverage for almost all individuals
sions of the ACA - state insurance exchanges
- expansion of medicaid
Create health plan medical loss ratio and premium rate reviews
1/8
, Daniel Karnuta HMGT 3311 Test 1
Study online at https://quizlet.com/_go9twt
- insurers have to spend at least 80-85% of premium revenue on actual
medical care rather than administrative costs or profits.
- or else the rest has to be sen back a rebates to the policyholders
Emphasize bundled payments and VBP
- Bundled Payment: A single, fixed payment is made for a patient's
entire course of treatment for a specific condition or procedure, rather
than separate payments for each service
- Value-Based Purchasing: A payment model that links Medicare reim-
bursements to healthcare quality and patient outcomes rather than the
quantity of services provided.
Created Accountable Care Organizations
- Group of healthcare providers who work together to improve quality
of care and reduce costs by keeping patients healthy
- Initially created to serve Medicare beneficiaries
- Rewarded for reducing cost and improving quality
9. Medical Loss Ratio If an insurance company:
Collects $10 million in premium revenue.
Spends $8.2 million on medical claims and quality improvements.
MLR = 8.2/10 = 82%
10. Consumer Price Index measures how much things are going up every year
11. How much of US GDP is 17.6%
Healthcare
12. Chronic disease
2/8
