WGU D391 – Key Words to Know
Healthcare System Basics
Healthcare Ecosystem – Network of organizations, people, and systems
involved in healthcare delivery.
Stakeholders – Groups with interest in healthcare outcomes (patients,
providers, payers, regulators).
Provider – Person or organization delivering care.
Payer – Insurance company or program paying claims.
Patient-Centered Care – Care based on patient needs, goals, and
preferences.
Care Coordination – Organizing care across providers/settings.
Continuum of Care – Healthcare across all stages (prevention to end-of-
life).
Levels of Care
Primary Care – First contact, routine/preventive care.
Secondary Care – Specialist care by referral.
Tertiary Care – Highly specialized hospital care.
Quaternary Care – Advanced/experimental specialty care.
Preventive Care – Services that prevent illness.
Acute Care – Short-term treatment for urgent illness/injury.
Long-Term Care – Ongoing support for chronic needs.
Rehabilitation – Recovery/restoration services.
Insurance / Finance
Premium – Monthly insurance payment.
Deductible – Amount patient pays before insurance begins paying many
costs.
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, Copay – Fixed fee for visit/service.
Coinsurance – Percentage of shared cost.
Out-of-Pocket Maximum – Most patient pays in a year.
Claim – Bill sent to insurer.
Reimbursement – Payment to provider.
Coverage – What insurance pays for.
Payment Models
Fee-for-Service – Paid for each service performed.
Value-Based Care – Paid based on outcomes/quality.
Capitation – Fixed payment per patient.
Bundled Payment – One payment for full episode of care.
Pay for Performance – Incentives tied to metrics.
Government Programs
Medicare – Federal insurance mainly age 65+.
Part A – Hospital
Part B – Medical/outpatient
Part C – Medicare Advantage
Part D – Drugs
Medicaid – Low-income eligible individuals/families.
Children's Health Insurance Program – Coverage for children.
U.S. Department of Veterans Affairs – Veteran healthcare.
Laws / Regulations
HIPAA – Protects privacy of health information.
Occupational Safety and Health Administration – Worker safety.
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Healthcare System Basics
Healthcare Ecosystem – Network of organizations, people, and systems
involved in healthcare delivery.
Stakeholders – Groups with interest in healthcare outcomes (patients,
providers, payers, regulators).
Provider – Person or organization delivering care.
Payer – Insurance company or program paying claims.
Patient-Centered Care – Care based on patient needs, goals, and
preferences.
Care Coordination – Organizing care across providers/settings.
Continuum of Care – Healthcare across all stages (prevention to end-of-
life).
Levels of Care
Primary Care – First contact, routine/preventive care.
Secondary Care – Specialist care by referral.
Tertiary Care – Highly specialized hospital care.
Quaternary Care – Advanced/experimental specialty care.
Preventive Care – Services that prevent illness.
Acute Care – Short-term treatment for urgent illness/injury.
Long-Term Care – Ongoing support for chronic needs.
Rehabilitation – Recovery/restoration services.
Insurance / Finance
Premium – Monthly insurance payment.
Deductible – Amount patient pays before insurance begins paying many
costs.
1
, Copay – Fixed fee for visit/service.
Coinsurance – Percentage of shared cost.
Out-of-Pocket Maximum – Most patient pays in a year.
Claim – Bill sent to insurer.
Reimbursement – Payment to provider.
Coverage – What insurance pays for.
Payment Models
Fee-for-Service – Paid for each service performed.
Value-Based Care – Paid based on outcomes/quality.
Capitation – Fixed payment per patient.
Bundled Payment – One payment for full episode of care.
Pay for Performance – Incentives tied to metrics.
Government Programs
Medicare – Federal insurance mainly age 65+.
Part A – Hospital
Part B – Medical/outpatient
Part C – Medicare Advantage
Part D – Drugs
Medicaid – Low-income eligible individuals/families.
Children's Health Insurance Program – Coverage for children.
U.S. Department of Veterans Affairs – Veteran healthcare.
Laws / Regulations
HIPAA – Protects privacy of health information.
Occupational Safety and Health Administration – Worker safety.
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