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If individuals had to pay for their healthcare costs each year without insurance, some families would become bankrupt when faced with a catastrophic illness and a very large medical bill. The insurance industry was born to help large groups of people share the risk...

Preventive care services have a threefold purpose. They can reduce health risks by engaging in wellness promotion. They can promote screening or testing to ensure early detection and diagnosis of conditions, and they can provide interventions to prevent disabilities,...

Pre-existing conditions are health concerns that exist prior to an individual’s enrollment in a health plan. Historically, illness burden has precluded an individual from qualifying for coverage or finding affordable rates.

A personal health record (PHR) is a patient’s healthcare profile. Unlike an electronic medical record or electronic health record, these data are collected and maintained by the individual. In the future, PHRs will be electronically connected to provider EHRs for...

Payment integrity is the process by which the correct payments for the correct covered lives, for the correct services are paid to the correct provider(s). This process involves detecting and minimizing fraud, waste, abuse, and misuse of healthcare dollars.

The domain dedicated to preventing and reducing the harm that may be caused during a patient’s interaction with the medical system. This can help improve healthcare outcomes while reducing costs.

To deliver the most appropriate care to specific cohorts within a population, providers are encouraged to keep lists of patients who have common conditions or concerns. These registries can be paper-based or preferably computerized. With these lists, physicians and...

This is a voluntary medication benefit program that started in 2006. Participants with a standard plan have 75 percent of their drug costs covered until they reach a cost of $2,830. Any expense higher than this is paid out of pocket until the cost reaches $4,550. Once...

This is the fraction of the collected insurance premium revenue dedicated to providing health services and improving the quality of care compared to the total revenue that includes expenditure for business administration, marketing, and profit.

The 2009 Health Information Technology for Economic and Clinical Health Act (HITECH Act) is part of the American Recovery and Reinvestment Act (ARRA) which included funding for Medicare and Medicaid incentives for the ‘Meaningful Use” (MU) of certified electronic...