# Introduction to Healthcare Study Guide  ## Metadata - Author: [[Stanford University]] - Full Title: Introduction to Healthcare Study Guide - Category: #articles - Summary: Healthcare involves interactions between patients, providers, and intermediaries like insurance companies. Intermediaries help manage payments and risk between patients and providers. Different payment models influence how healthcare services are provided and incentivized. - URL: https://readwise.io/reader/document_raw_content/172551030 ## Highlights - Physician practices are organizations in which physicians work, independent entities that are privately owned and operated. • Solo practice contains one physician who is the owner and manager of the staff (one specialty) • Group practices can contain 2-3 doctors in a partnership or up to 100’s of physicians and can be called medical groups or physician organizations. • Larger groups are much like corporations where doctors are hired as employees and do none or less of the management of the staff. ([View Highlight](https://read.readwise.io/read/01hxmv0cx7asbe38tar6zq1x8k)) - Physician Network: a group of physicians or practices with whom the insurer works, and which the members covered by the insurer are required or encouraged to use • In-network: If a payer (insurance company) and a practice agree on a payment arrangement, then we say the physicians in the practice will be “in-network” for the payer, and the payer covers all or contributes to the costs of their care. • Out-of-network: Any doctors or groups not a part of network are called ‘out-of-network’ and patients will need to get prior authorization to see one of those doctors or pay out of pocket. ([View Highlight](https://read.readwise.io/read/01hxmv5dnx05734819ej6chy25)) - Allowed amounts: Also called negotiated rates. The agreed upon amounts an intermediary would pay a practice ([View Highlight](https://read.readwise.io/read/01hxmvc0yakjfs5ymy8389c73w)) - Medicare: The US government payer that provides coverage for people over age 65, and some others ([View Highlight](https://read.readwise.io/read/01hxmvk24jbr0f5y3tcf8657rn))