Welcome to the HC Ideas PP Certification course with Sai Buri Healthcare Components.
My name is Shalane Hutchins and I'll be your instructor today.
Today we'll discuss the different components of the health care industry.
Health care today is very specialized, with highly technical procedures and tools to enable diagnosis that is more precise and with treatment that is more impersonal. Yet it extends our life span.
Because of this patient's physical health and quality of life have been approved, such that lifespans have increased to 70 80 and even 100 years.
Health care organizations, also called health systems and integrated delivery systems, arose to meet economic and political pressures.
Health care is very complicated, expensive and rapidly changing as a result of technology, demographics, economics and politics.
Economic and political forces for change arise from the cost of health care and the complex methods of financing it. For example, the Affordable Care Act,
a C A. Some call it obamacare, was created to provide protections and patient rights to make health care coverage more fair and easy to understand. Along with providing tax credits to make it more affordable,
consider the 2020 pandemic conditions many people have lost their jobs and their employer sponsored health care. Should they require a hospital stay? The cost could be so dramatic that whatever savings 1 may have could be wiped out.
The average cost of a hospital state is $3900 per day, with a total state averaging $15,000.
Different sources of care emerged to meet the demand for health care. They include public clinics,
nursing homes, pharmacies, specialty hospitals,
home care programs, home meal programs, hospice endurable, medical equipment suppliers.
Large general hospitals provide a wide range of acute care and other services spending many parts of the continuum of care.
Hospitals may also be specialized for only psychiatric or rehabilitation services.
A health care system is formed when the providers of care services or supplies contract with each other to become business associates.
Government regulation, intermediary contracts and the courts have assigned healthcare organizations responsibility from managing and maintaining quality, cost and access to their services
providers. Ah provider has different definitions in healthcare. A classical definition is a person who helps in identifying, preventing or treating illness or disability.
CMS, or the Center for Medicare and Medicaid Services, expands the definition of a health care provider
as an individual or an institution that provides health care services.
HHS or the Health and Human Services, defines health care providers and covered health care providers as a provider of medical or health services and any other person or organization who furnishes bills or is paid for health care. In the normal course of business,
organized physician services were established to provide comprehensive care as an independent organization capable of accepting contracts for large patient populations and managing their health care needs.
Some of the most common names are independent physician associations, or I P. A s
medical service organizations, RMS owes or physician's hospital organizations. PH is
organizations such as the American Cancer Society and American Lung Association affect people's held by funding research, developing educational programs and assisting people who need treatment.
The national provider identify is a unique identification number for covered health care providers.
It's purposes is to improve the efficiency and effectiveness of the electronic transmission of health information.
All individual HIPPA covered Health care providers or organizations must obtain an MP I for using all hip, a standard transactions even if a billing agency prepares the transaction
once a signed of providers in P I. It's permanent and remains regardless of job or location changes.
N P I is a tim position intelligence free numeric Identify air. This means the numbers do not carry any other information about the health care providers, such as state in which they live or their medical specialty
The pharmaceutical industry is a branch of the chemical industry that manufactures drugs.
Pharmaceutical companies are research and development organisations with unique ethical and regulatory requirements that must be met or people can suffer terrible consequences.
Medical supply firms produce and distribute the thousands of supplies, drugs and equipment that other health care organizations use to provide health care.
Examples of some pharmaceutical companies are Amgen, Novartis, Pfizer, GlaxoSmithKline and AstraZeneca.
You may have heard of them.
Pharmaceutical representatives visit an attempt to persuade a doctors to provide in prescribe certain companies products more often than others.
Ah, pharmacy is defined as a store where medical drugs are dispensed or compounded and sold like your Walgreens, your CVS, you're right. Eight
pharmaceutical products are listed in accordance with the U. S. FDA Food and Drug Administration's Drug Listing Act.
Drugs produced are identified and reported using a unique three segment number called the National Drug Code, or the In D C Code, which is a universal product identify for human drugs.
A payer in health care, generally refers to the entities other than the patient
that finance or reimburse the cost of health services.
A payer can be an insurance company authorized to provide health insurance.
Health Maintenance Organization,
a legal entity that is self insured and provides benefits for healthcare services to its employees or state or local government that makes payments for health care services.
In Ohio, there's the Ohio Healthy Start program, which is free or low cost for families and Children.
Family must meet the state income guidelines to qualify for the benefits.
Most health care providers in health plans do not carry out all of their health care activities or functions by themselves. Instead, they often use the services of other people or businesses.
The hip of privacy rule allows covered providers in health plans to disclose protected health information, or pH I to these business associates. If they can assure that the business associate will use the information for the Onley, the purposes for which it was engaged.
Safeguard the information from misuse and help the covered entity comply with some of the duties. Under the privacy rule,
examples of business associates include health care clearinghouses. They translate acclaim from non standard format into a standard transaction. For a payer,
a consultant could be used to perform reviews or any other administrative functions.
An attorney whose legal services involved access to protected health information
in a pharmacy who manages a health plan for pharmacists network.
Now let's test your knowledge. True or false? An example of a business associate is an accountant.
true or false. A patient who pays his own bill is considered a payer
and true or false. Ah, pharmacy is a pharmaceutical organization.
and summary. We've covered the different components of the health care industry. These components will be important to you as you advance to the next module. See you in the next video