C425 Study guide with Key Concepts 1.23

Study Guide to Prepare for the Objective 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  Medicaid  CHIP  Private o Discuss Medicare and Medicaid (federal and state) legislation o Discuss Workers Compensation o Discuss VA Medical Care o Discuss Reimbursement methods o Discuss the Affordable Care Act o Discuss the Health Insurance Portability and Accountability Act (HIPPA) o Discuss the Stark regulation (law) 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 history 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   Topic 3: Major Stakeholders (17% weighted)   ** This topic has the most fails!     Make sure you read the information!       Read Chapter 4 if you do not have healthcare experience.   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:   o Major stakeholders    Patients – describe the role of each of the following:  Patient  Family  Community  Providers – describe the role and licensure requirements for providers and Professionals – describe the roles of each of the healthcare professionals listed  MD/DO  Generalist / Specialist / Hospitalist  Dentists – describe the 8 specialty roles:  Orthodontics; Oral and maxillofacial surgery; Pediatric dentistry; Periodontics; Prosthodontics; Endodontics; Public health dentistry; and Oral pathology  Non-physician practitioners (NPP’s) – describe the role and the value NPP’s bring to healthcare  Healthcare Professionals – o Pharmacists, o Nurses, o Healthcare Administrators,

 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? Topic 5:   Future of Healthcare (23% weighted) ** This topic is the highest weighted and has the 2 nd most fails.     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 C425 SharePoint Site link: C425-Healthcare Delivery Systems, Regulation, and Compliance - Home (sharepoint.com)