C425 Study guide with Key Concepts

Study Guide to Prepare for the Objective Assessment ** The OA requires critical thinking and is scenario based. You will need to APPLY the knowledge that you have learned on the assessment. Topic 1: Overview of the US Healthcare System (20% weighted) Topic 1 Publisher PowerPoints: Chapter 1: https://lrps.wgu.edu/provision/207540327 Chapter 2: https://lrps.wgu.edu/provision/207540427 Chapter 3: https://lrps.wgu.edu/provision/207540643 Chapter 6: https://lrps.wgu.edu/provision/207540933 Chapter 8: https://lrps.wgu.edu/provision/207541092 Chapter 13: https://lrps.wgu.edu/provision/207541579  Key concepts to focus on: o What is the definition of health? o Describe the types of Insurances  Medicare  Parts A, B, C and Medicare Advantage  Medicaid  CHIP  Private o Discuss Medicare and Medicaid (federal and state) legislation o Discuss Managed Care Organizations o Discuss Accountable Care Organizations o Discuss Workers Compensation o Discuss VA Medical Care o Discuss Reimbursement methods o Discuss Risk Pooling o Discuss the Affordable Care Act o Discuss the Health Insurance Portability and Accountability Act (HIPAA) o Discuss HITECH Act o Discuss the Stark regulation (law) o Discuss ERISA o Discuss Anti-trust regulations  Demand-side incentives  Supply-side regulation o Describe Resource-Based Relative Value Scale o Describe the Flexner Report o Discuss the h istory of health insurance Topic 2: Healthcare Delivery Processes (18% weighted)

Topic 2 Publisher PowerPoints: Chapter 7 : https://lrps.wgu.edu/provision/207541017 Chapter 8: https://lrps.wgu.edu/provision/207541092 Chapter 9: https://lrps.wgu.edu/provision/207541150 Chapter 10: https://lrps.wgu.edu/provision/207541311  Key concepts to focus on: o Discuss the various Healthcare delivery processes to include the following:  Telemedicine and Remote monitoring  Outpatient / primary care  Facility types and the care provided at each  Managed care / integrated care  HMO  PPO – in network / out of network  POS  Long-term care  Intermediate care  Home health care – what services are offered? o Discuss Hospital delivery processes  Inpatient vs Outpatient  Hill-Burton Act  Types of hospitals o Describe the impact on structure and processes of healthcare delivery  Reasons for high health care costs  Globalization o Describe:  Adult Day Care  Senior Centers  Assisting Living Facilities  Different types of nursing facilities  Subacute Care Facilities  Respite Care  Restorative Care  Hospice Care o Describe the difference between an Acute, Subacute and Chronic Condition Topic 3: Major Stakeholders (17% weighted) **Be sure to read Chapter 4, this is a traditionally difficult topic for student to pass. Topic 3: Publisher PowerPoints: Chapter 2: https://lrps.wgu.edu/provision/207540427 Chapter 3: https://lrps.wgu.edu/provision/207540643 Chapter 4: https://lrps.wgu.edu/provision/207540728 Chapter 5: https://lrps.wgu.edu/provision/207540856 Chapter 6: https://lrps.wgu.edu/provision/207540933  Key concepts to focus on:

 Certification / Accreditation – describe the certification requirements to participate in CMS and what role the Joint Commission accreditation plays in hospitals participating in Medicare and Medicaid  Explain the role ( purpose ) of the se agencies and who they serve: (These agencies are also important in Topic 1 – focus for topic 1 is purpose / compliance and topic 3 is the purpose and relationship with other stakeholders)  Centers for Medicare and Medicaid Services (CMS)  Center of Disease Control (CDC)  World Health Organization (WHO  Office of National Coordinator (ONC)  US Department of Health and Human Services (HHS)  National Institutes of Health (NIH)  Office of Civil Rights (OCR) - enforces HIPAA compliance  Department of Treasury  Agency for Healthcare Research & Quality (AHRQ) – clinical practice guidelines  Occupational Safety and Health Administration (OSHA)  Food and Drug Administration (FDA) – food, drugs (medications / vaccines), and medical devices  National Committee for Quality Assurance Topic 4: Distribution of Healthcare Services (22% weighted) Topic 4 Publisher PowerPoints: Chapter 11: https://lrps.wgu.edu/provision/207541394 Chapter 12: https://lrps.wgu.edu/provision/207541449  Key concepts to focus on: o Describe p opulations with special health needs such as:  Racial/ethnic minorities  Women and children  Geographic and socio-economic disparities  Uninsured  Homeless  Mental health  Chronic illness/disability o Discuss the determinants of health  What are the i mplications to access to care? o What challenges are associated with healthcare? Discuss each of the following:  Costs  Barriers  Access to care  Quality  What are healthcare policy solutions to a ccess and quality care ?

 What is the r ole of the government in determining access and quality healthcare? o What is patient literacy and how does it relate to healthcare access? o What is the purpose of Public Health? o Explain the challenges associated with costs, barriers to care, and access to care (discuss determinants of access to care)? Topic 5: Future of Healthcare (23% weighted) ** This topic is the highest weighted and is also difficult for students to pass. Chapter 14 is a must read!! Topic 5 Publisher PowerPoints: Chapter 14: https://lrps.wgu.edu/provision/207541650  Key concepts to focus on: o How do external factors influence healthcare?  Clinical advances / Future models of delivery of care  Technological innovation  Technology driven home visits / Virtual Care  Gene therapy  G lobal health issues – describe the role / impact of each:  Import / export of medications / travel outside US for treatment (medical tourism)  Healthcare worker shortage / Future workforce challenges  Prevention and control of infectious diseases  Ecological events  CDC  Policy / Healthcare reform – describe each of the following:  ACA expansion  Single payer system / Universal coverage  American Health Care Act  Economic forces – describe how economic forces impact healthcare  Nation’s economic health / national debt  Medicare’s generational impact  Evidence-based care – describe the role of the Agency for Healthcare Research and Quality (AHRQ) and describe what clinical practice guidelines are and the role they play in healthcare  What are some of the economic factors that affect the future of healthcare?  What are some of the workforce factors that affect the future of healthcare?  Which clinical advances are likely to have the most impact on healthcare delivery, and how will they impact traditional structures?  How might international trends impact US healthcare policy and practice?