Population-based model for healthcare delivery and payment Risk adjustment model

Population-based model for healthcare delivery and payment Risk adjustment model that uses patient demographic characteristics and medical conditions to predict the patient’s healthcare costs. The amount paid to a healthcare provider for services provided to a patient; also known as reimbursement Statistical process that considers the underlying health status and health spending of patients when examining their health outcomes or healthcare costs Type of risk used in ACO payment methodology where the ACO shares in any savings generated by the organization but does not share in the losses. Assignment of a beneficiary to a particular organization Amount the payer will reimburse providers for the service Amount the provider is actually charging for a service Type of risk used in ACO payment methodology where the ACO must share in the loss if the cost of care for their attributed beneficiaries is greater than the benchmark as well as any savings if the cost of care is lower than the benchmark. 1. Accountable care organization 2. Allowable charge 3. Attribution 4. Billed charges 5. CMS-HCC Model 6. Two-sided risk 7. One-sided risk

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