healthcare reform: a lexicon for...

B R O U G H T T O Y O U B Y T H E M E D S C A P E C E N T E R F O R T H E A D V A N C E M E N T O F H E A L T H C A R E Q U A L I T Y T H R O U G H E D U C A T I O N 2 0 1 7

HEALTHCARE REFORM: A LEXICON FOR EDUCATORS

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AUTHOR: MAZI RASULNIA, PHD,

M CONSULTING LLC, BIRMINGHAM, AL

CO-AUTHOR: RELISA MITCHELL,

MEDSCAPE LLC, NEW YORK, NY

A guide to terminology in the fi elds of quality improvement, patient engagement, and interprofessional continuing education, including the associated organizations, legislation, and resources.

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H E A L T H C A R E R E F O R M : A L E X I C O N F O R E D U C A T O R S 2 0 1 7

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Medscape Education is committed to providing education designed to help the healthcare team, including the patient, succeed in the face of a new healthcare paradigm. Likewise, Medscape Education has taken a lead role in helping supporters of professional medical education identify opportunities in alignment with the 6 priorities of the National Quality Strategy. The new healthcare environment brings with it a host of new terminology, stakeholder organizations, and legislative issues. Medscape Education o� ers you this handy lexicon to help you know “who’s who” and “what’s what” in the quality improvement landscape.

NQS PRIORITY

Patient & Family Engagement

NQS PRIORITY

InterprofessionalContinuing Education

Performance-Based CME

Quality ImprovementEducation

QIEPatient Education/

Engagement

NQS PRIORITY

Patient & Family Engagement

Patient Education/Patient

Simulation

NQS PRIORITYClinical Processes/Effectiveness

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TICES: LARGE & SMALL PHYSICIANS

ACOs

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CARE RECORDS HOSPITALS INTEGRATED

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Clinical Processes/Effectiveness

NQS PRIORITIES

Patient SafetyClinical Processes/Effectiveness

NQS PRIORITIES

Care CoordinationClinical Processes/Effectiveness

Strategic Partnerships

Strategic

Government


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TABLE OF CONTENTS TABLE OF CONTENTS

ACTION 6 Accelerating Change

and Transformation in Organizations and Networks

ACO Accountable Care Organization 6

ACCME 6 Accreditation Council for Continuing Medical Education

ACPE Accreditation Council for 6 Pharmacy Education

Achievement (Adherence) 7

Actuarial value 7

APTC Advance Premium Tax Credit 7

ACI Advancing Care Information 7

ACA A� ordable Care Act 7

ACA, Section 3506 8 A� ordable Care Act Section 3506

AHRQ Agency for Healthcare Research 8and Quality

ABMS American Board of Medical 9Specialties

AIHC The American Interprofessional 9Health Collaborative

ANCC American Nurses 9 Credentialing Center

APM Alternative Payment Model 10

Behavioral economics 10

Biosimilar 10

BTE Bridges to Excellence 10

Bundled payment 11

BPCI Bundled Payments for Care 11Improvement

Cardiac Rehabilitation (CR) 11 Incentive Payment Model

Care coordination 11

CMS Centers for Medicare & 11Medicaid Services

CMS Innovation Center 12 Centers for Medicare &

Medicaid Services Innovation Center

Change management 12

CCMC Chronic Care Management Code 12

CCM Chronic Care Model 12

Clarity 13

CDS Clinical decision support 13

CQMs Clinical Quality Measures 13

Coaching 13

Collaborative care 13

Comparative e� ectiveness 13 research

CJR Comprehensive Care 14 for Joint Replacement

CPC+ Comprehensive Primary 14 Care Plus

CO-OP Consumer Operated and 14 Oriented Plan

CQI Continuous Quality Improvement 14

CoC Continuum of Care 14

Counseling, coaching, 15question prompts, motivational interviewing, decision aids, and helplines

Cueing 15

Data infrastructure 15

Data integration 15

Debriefi ng 15

Decision aids 15

Disease prevention and 16health promotion

Disease self-management 16

EHR Electronic health record 16

Engagement 17

Engagement behavior 17framework

EPMs Episode Payment Models 17

ECPs Essential community providers 17

EHB Essential Health Benefi ts 17

Evidence-based medicine 17or practice

FFS Fee for service 18

Feedback 18

Fidelity 18

FPPE Focused Professional Practice 18 Evaluation

Gap analysis or needs 18assessment

Genomics 19

HHS Health & Human Services 19

Health apps 19

HIE Health Information Exchange 19

HIT Health Information Technology 19

HITECH Health Information Technology 19

for Economic and Clinical Health

Health insurance marketplace 20

HIPAA 20 Health Insurance Portability and

Accountability Act/Patient Privacy

Health technology 20assessment

HEDIS Healthcare E� ectiveness Data 20and Information Set

HIMSS 21 Healthcare Information and

Management Systems Society

HCPFC 21 HIMSS Center for Patient- and

Family-Centered Care

HIMSS Patient Engagement 21Framework HIMSS Patient Engagement

Framework

Human patient simulators 21

IPA Independent Practice Association 21

IMDF Informed Medical Decisions 22 Foundation

IHI Institute for Healthcare 22 Improvement

Integrated care delivery 22

IDN Integrated Delivery Network 22

IACET International Association for 22 Continuing Education and Training ICD-9 International Classifi cation of 23

Diseases, Ninth Revision

Interoperability 23

Interprofessional 23collaborative practice

IPCE Interprofessional continuing 23 education

IPE Interprofessional education 24

Interprofessional teamwork 24

Joint Accreditaton 24

The Joint Commission 24

MOC Maintenance of Certifi cation 24

MU Meaningful use 25

MAP Measure Applications Partnership 25

MLR Medical Loss Ratio 26

MACRA Medicare Access and CHIP 26 Reauthorization Act

MLN Medicare Learning Network 26

MSSP Medicare Shared Savings 26 Program

Medicare Star Rating 26

MTM Medication Therapy 27 Management

MIPS Merit-Based Incentive Programs 27

Merit-Based Incentive 27Programs Composite Score

Minimally disruptive medicine 27

Multidisciplinary team approach 28

Narrow-network plan 28

NAM National Academy of Medicine 28

NCQA National Committee for Quality 28 Assurance

NLC National Learning Consortium 29

NPP National Priorities Partnership 29

NQF National Quality Forum 29

NQF measures 30 National Quality Forum measures

NQMC National Quality Measures 30 Clearinghouse

NQS National Quality Strategy 30

Navigator/patient navigator/ 31 patient navigation

Next generation 31

OCM Oncology Care Model 31

OPPE Ongoing Professional Practice 31 Evaluation

Outcome vs impact 31

Outcomes research 32

Patient activation 32

PAM Patient Activation Measure 32

Patient advocacy 32

Patient-centered care 33

PCMH Patient-Centered Medical Home 33

PCORI Patient-Centered Outcomes 33Research Institute

PCPCC Patient-Centered Primary Care 34 Collaborative

PGHD Patient-generated health data 34

Patient education 34

Patient empowerment 34

Patient engagement 35

Patient engagement Framework 35

Patient/family outreach 35

Patient health literacy 36

Patient-oriented research 36

Patient portal 36

PRO Patient-reported outcome 36

Patient technology 36competence

P4P Pay for performance 36

PMPM Per member per month 37

Performance improvement 37

PI CME Performance Improvement 38 Continuing Medical Education

Performance management 38

Performance recording 38

PHRs Personal health records 38

Personalized medicine 38

Pharmaceutical outcomes- 39 based contracting

Pharmacoeconomics 39

Pharmacogenomics 39

PQA Pharmacy Quality Alliance 39

PCPI Physician Consortium for 39Performance Improvement

PQRS Physician Quality Reporting 40 System

Pioneer ACO Model 40

Population health 40

Precision medicine 41

Predictive analytics 41

PCIP Primary Care Bonus Incentive 41 Payment Program

Provider/physician 41engagement

Public health 41

QCDR Qualifi ed Clinical Disease Registry 42

QHP Qualifi ed health plan 42

Quality and safety 42

QI Quality improvement 42

QIOs Quality Improvement Organizations 43

Quality measures 43

QPP Quality Payment Program 43

Real-world data 43

RMDs Remote monitoring devices 43

SDM Shared decision-making 44

Simulation 44

SSH Society for Simulation in 44 Healthcare

Standardized patient 44

Telemedicine 44

Transition and continuity 45

TOC Transition of care 45

US Department of Health & 45Human Services

USHIK US Health Information 46 Knowledgebase

URAC Utilization Review Accreditation 46Commission

VBP Value-based payment 46

Virtual procedure stations 47

Wireless and wearable health 47technology


AAA AAAAAACTIONAccelerating Change and Transformation in Organizations and Networks

The Accelerating Change and Transformation in Organizations and Networks (ACTION) initiative is a model of fi eld-based research designed to promote innovation in healthcare delivery by accelerating the di� usion of research into practice. As part of the Agency for Healthcare Research and Quality (AHRQ), the ACTION network includes 15 large partnerships and collaborating organizations that provide healthcare to more than 100 million Americans. (AHRQ, 2009)

The purpose of ACTION is to promote innovation in healthcare delivery by accelerating the development, implementation, di� usion, and uptake of demand-driven and evidence-based products, tools, strategies, and fi ndings. ACTION develops and di� uses scientifi c evidence about what does and does not work to improve healthcare delivery systems. It provides an impressive cadre of delivery-a© liated researchers and sites with a means of testing the application and uptake of research knowledge. This group was the successor to the Integrated Delivery System Research Network, a 5-year implementation initiative completed in 2005. (AHRQ, 2009)

SOURCE

Agency for Healthcare Research and Quality (AHRQ). (2009a). Accelerating Change and Transformation in Organizations and Networks (ACTION). Fact sheet: Field partnerships for applied research. Retrieved from http://www.ahrq.gov/research/fi ndings/factsheets/translating/action/index.html

ACOAccountable Care Organization

A group of doctors, hospitals, and other healthcare providers who voluntarily come together to provide coordinated, high-quality care for their Medicare patients. The goal of coordinated care is to

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Achievement (Adherence) Completing what is required in an individual’s plan of care, or the degree to which a patient correctly follows medical guidance.

SOURCE

http://www.medscape.com/viewarticle/498339

Actuarial valueThe percentage of total average costs for covered benefi ts that a plan will cover.

SOURCE

https://www.healthcare.gov/glossary/actuarial-value/

APTCAdvance Premium Tax Credit

A tax credit an individual can take in advance to lower their monthly health insurance payment (or “premium”).

SOURCE

https://www.healthcare.gov/glossary/advanced-premium-tax-credit/

ACIAdvancing Care Information

ACI replaces “meaningful use” and is 1 of 4 reporting categories required by MACRA. ACI streamlines reporting requirements and emphasizes information exchange. In addition, ACI is customizable to meet the needs of individual

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ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. When an ACO succeeds in both delivering high-quality care and spending healthcare dollars more wisely, it will share in the savings it achieves for the Medicare program. (CMS, 2013)

SOURCES

Centers for Medicare & Medicaid Services (CMS). (2013a). Accountable Care Organizations (ACO). Retrieved from https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO/index.html?redirect=/aco/

Medicare.gov. (n.d.). Accountable Care Organizations. Retrieved from http://www.medicare.gov/manage-your-health/coordinating-your-care/accountable-care-organizations.html

ACCMEAccreditation Council for Continuing Medical Education

A council that helps continuing medical education (CME) providers apply for accreditation as well as oversees, sets, and enforces standards in CME within the United States.

SOURCE

http://www.accme.org/cme-providers

ACPEAccreditation Council for Pharmacy Education

An agency that provides the accreditation of professional degree programs in pharmacy, and providers of continuing pharmacy education.

SOURCE

https://www.acpe-accredit.org/about/default.asp

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development, implementation, di� usion, and uptake Accreditation Council for Continuing Medical Education

development, implementation, di� usion, and uptake Accreditation Council for IPCE

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clinicians, and is aligned with other Medicare reporting programs.

SOURCE

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/Advancing-Care-Information-Fact-Sheet.pdf

ACAA� ordable Care Act

The Patient Protection and A� ordable Care Act (commonly referred to as ACA) was signed into law by President Barack Obama on March 23, 2010. Together with the Health Care and Education Reconciliation Act, the ACA represents the most signifi cant regulatory overhaul of the US healthcare system since the passage of Medicare and Medicaid in 1965. The US Department of HHS agency consumer information website highlights several provisions of the ACA (HHS, 2015), described below.

Regarding healthcare coverage, the ACA:■ Ends preexisting condition exclusions for children.

Health plans can no longer limit or deny benefi ts to children younger than 19 years due to a pre-existing condition.

■ Keeps young adults covered. If you are younger than 26 years, you may be eligible to be covered under your parent’s health plan.

■ Ends arbitrary withdrawals of insurance coverage. Insurers can no longer cancel your coverage just because you made an honest mistake.

■ Guarantees your right to appeal. You now have the right to ask that your plan reconsider its denial of payment.

Regarding costs, the ACA:■ Ends lifetime limits on coverage. Lifetime limits

on most benefi ts are banned for all new health insurance plans.

■ Reviews premium increases. Insurance companies must now publicly justify any unreasonable rate hikes.

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IPCEA� ordable Care Act

The Patient Protection and A� ordable Care Act (commonly referred to as ACA) was signed

A� ordable Care Act IPCE

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AA AA■ Helps plan subscribers get the most from their

premium dollars. Premium dollars must be spent primarily on healthcare, and not on administrative costs.

Regarding care, the ACA:■ Covers preventive care at no cost to plan

subscribers. Patients may be eligible for recommended preventive health services with no copayment.

■ Protects the choice of doctors. Patients can choose the primary care doctor they want from their plan’s network.

■ Removes insurance company barriers to emergency services. Patients can seek emergency care at a hospital outside of their health plan’s network.

The ACA contains what is known as the “individual mandate,” which requires most individuals to obtain health insurance or potentially pay a penalty for noncompliance.

SOURCE

US Department of Health and Human Services (HHS). (2015). About the law. Retrieved from http://www.hhs.gov/healthcare/rights/index.html

ACA, Section 3506A� ordable Care Act

A program to facilitate shared decision making, which calls for HHS to contract with an entity to develop independent standards for educational tools known as “patient decision aids” for preference-sensitive care. (IDMF, 2015)

SOURCE

Informed Medical Decisions Foundation (IDMF). (2015a). A� ordable care act Section 3506. Retrieved from http://www.informedmedicaldecisions.org/shared-decision-making-policy/federal-legislation/a� ordable-care-act/

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fi nancial security, and employer o� ers and coverage take-up.

Improve healthcare a� ordability, e� ciency, and cost transparency by improving the data, measures, and public reporting strategies for conveying information on healthcare price, cost, and quality, and by developing and spreading evidence and tools to measure and enhance the e© ciency of health systems—the capacity to produce better-quality health and outcomes while avoiding overutilization, or to maintain quality of health and outcomes with lower resource use. The AHRQ will analyze variations in quality and resource use and identify the factors that di� erentiate higher-performing from lower-performing systems.

SOURCES

Agency for Healthcare Research and Quality (AHRQ). (n. d.). Mission & Budget. Retrieved from http://www.ahrq.gov/cpi/about/mission/

Agency for Healthcare Research and Quality (AHRQ). (n. d.). AHRQ Profi le. Retrieved from http://www.ahrq.gov/cpi/about/profi le/index.html

National Healthcare Quality Report (AHRQ, 2013, p. 1). Retreived from http://www.ahrq.gov/research/fi ndings/nhqrdr/nhqr13/2013nhqr.pdf

ABMSAmerican Board of Medical Specialties

A nonprofi t organization of 24 medical specialty boards (known as the “Member Boards”). The ABMS is the largest physician-led specialty certifi cation organization in the United States. The ABMS Member Boards maintain a rigorous process for the evaluation and certifi cation of physicians in more than 150 medical specialties and subspecialties. More than 80% of practicing physicians in the United States have achieved board certifi cation by 1 or more of the Member Boards. (ABMS, 2015)

The ABMS Maintenance of Certifi cation® (MOC) program supports lifelong learning by physicians. The ABMS also collaborates with other professional medical organizations and agencies to set standards for graduate medical school education and accreditation of residency

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AHRQAgency for Healthcare Research and Quality

Formerly known as the Agency for Health Care Policy and Research, AHRQ is 1 of several agencies within HHS. The mission of AHRQ is to “produce evidence to make healthcare safer, higher quality, more accessible, equitable, and a� ordable, and to work within the U. S. Department of Health and Human Services and with other partners to make sure that the evidence is understood and used.” (AHRQ, n. d., Mission & Budget)

AHRQ’s priority areas of focus include the following:

Improve healthcare quality by accelerating implementation of patient-centered outcomes research (PCOR). AHRQ invests in developing PCOR methods and training, and in disseminating PCOR fi ndings. AHRQ will also invest in an initiative to disseminate and support the implementation of PCOR fi ndings in primary care practices.

Make healthcare safer. AHRQ researches the ways patients experience preventable harm during their healthcare, why this harm occurs, and how to prevent it. AHRQ translates the results into practical tools for providers to:

■ Make healthcare safer in hospitals and ambulatory and long-term care settings;

■ Reduce harm associated with obstetrical care to mothers and babies;

■ Improve safety and reduce medical liability by developing a guide for implementing a Communication and Resolution Program; and

■ Accelerate patient safety improvements in nursing homes. (AHRQ, n.d., p. 1)

Increase accessibility by evaluating the ACA coverage expansions. The AHRQ will lead HHS e� orts to evaluate the e� ects of the ACA-mandated Medicaid and Marketplace coverage expansions. The results will enable HHS and Congress to make better-informed decisions about the implementation of the ACA in terms of access, reduction in disparities, use and expenditures, outcomes,

QIEQIEprograms. The ABMS makes information available to the public about the board certifi cation of physicians and their participation in the ABMS MOC® program. (ABMS, 2015)

SOURCE

American Board of Medical Specialties (ABMS). (2015). Welcome to ABMS: American Board of Medical Specialties. Retrieved from http://www.abms.org/

AIHCThe American Interprofessional Health Collaborative

An organization that promotes the scholarship and leadership necessary to develop interprofessional education and transform health education across the learning continuum for students, practitioners, and educators. (AIHC, 2012)

SOURCE

American Interprofessional Health Collaborative (AIHC). (2012). Home page. Retrieved from http://www.aihc-us.org/

ANCCAmerican Nurses Credentialing Center

A subsidiary of the American Nurses Association credentialing program that certifi es and recognizes individual nurses in specialty practice areas; recognizes healthcare organizations for promoting safe, positive work environments; and accredits continuing nursing education organizations.

SOURCE

http://www.nursecredentialing.org

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boards (known as the “Member Boards”). The ABMS

American Nurses Credentialing CenterAmerican Nurses Credentialing

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AA BBBBBAPMAlternative Payment Model

One of two pathways by which healthcare providers can submit QPP data. The other pathway is called the MIPS. In order to qualify for incentives and benefi ts under MACRA, physicians are required to participate in APMs that are based on the same quality measures set down by MIPS. Since APM options are not yet available in much of the country, or are unavailable for providers with certain specialties, MACRA is trying to encourage providers to participate in developing a number of new payment models: specialty models, models in partnership with payers, models with networks of <15 providers, statewide payment models, and Medicaid-based models.

SOURCE

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/Quality-Payment-Program-MIPS-NPRM-Slides.pdf

Behavioral economicsThe investigation of why people make certain economic decisions, using a psychological framework.

SOURCE

http://www.nber.org/papers/w7948

BiosimilarBiological products that can be interchanged with products licensed by the US Food and Drug Administration.

SOURCE

http://www.fda.gov/Drugs/DevelopmentApprovalProcess/HowDrugsareDevelopedandApproved/ApprovalApplications/TherapeuticBiologicApplications/Biosimilars/

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Bundled paymentThe reimbursement of healthcare providers for expected costs of care administered while a patient in the hospital. (That is, the hospital receives a lump payment for an episode of care for a patient, such as admission to the hospital for a heart attack, and the bundled payment amount covers all care administered to the patient for the time he or she is in the hospital. This is in contrast to each physician performing his or her own services on the patient and billing separately for the services provided.)

SOURCE

https://innovation.cms.gov/initiatives/bundled-payments/

BPCIBundled Payments for Care Improvement

An initiative that links payments for multiple services benefi ciaries received during an episode of care that leads to more coordinated care at a lower cost to Medicare. (CMS, 2015)

SOURCE

Centers for Medicare & Medicaid Services (CMS). (n. d.). Bundled Payment for Care Improvement (BPCI) initiative: General Information. Retrieved from http://innovation.cms.gov/initiatives/bundled-payments/

Cardiac Rehabilitation Incentive Payment ModelA model that provides an incentive payment to hospitals where benefi ciaries are hospitalized for a heart attack or bypass surgery, which would be based

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IPCEThe reimbursement of healthcare providers for expected costs of care administered while a patient in the hospital. (That is, the hospital receives a lump payment for an episode of care for a patient,

The reimbursement of healthcare providers for

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BTEBridges to Excellence

An initiative created by a group of employers, physicians, health plans, and patients that has come together to create programs that will help realign medical incentives around 6 key attributes identifi ed by the IOM (2001) report. The IOM advocated bridging this chasm by redesigning the healthcare system around 6 key attributes to make the system safer, timelier, and more e� ective, e© cient, equitable, and patient-centered. (IOM, 2001; NCQA, 2013)

BTE has a number of programs that recognize and reward clinicians who deliver superior patient care. These programs measure the quality of care delivered in provider practices and place special emphasis on managing patients with chronic conditions, who are most at risk of incurring potentially avoidable complications. The BTE Recognitions cover all major chronic conditions plus o© ce systems and also include a real PCMH measurement scheme to promote comprehensive care delivery and strong relationships between patients and their care teams. (HCI3, 2012; NCQA, 2013)

Physicians, nurse practitioners, and physician assistants who meet performance benchmarks for BTE Recognition can earn a range of incentives, sometimes including substantial cash payouts. Insurers and employers fund these payouts from the savings they achieve through lower healthcare costs and increased employee productivity. (HCI3, 2012)

SOURCES

Health Care Incentives Improvement Institute (HCI3). (2012). What is Bridges to Excellence? Retrieved from http://www.hci3.org/node/1/

Institute of Medicine (IOM). (2011). Crossing the quality chasm: A new health system for the 21st century. Retrieved from http://www.iom.edu/~/media/Files/Report%20Files/2001/Crossing-the-Quality-Chasm/Quality%20Chasm%202001%20%20report%20brief.pdf National Committee for Quality Assurance (NCQA). (2013). Bridges to Excellence: Rewarding quality across the healthcare system. Retrieved from http://www.ncqa.org/Programs/Recognition/BridgestoExcellence.aspx

QIEQIEon benefi ciary utilization of cardiac rehabilitation and intensive cardiac rehabilitation services.

SOURCE

https://innovation.cms.gov/initiatives/cardiac-rehabilitation/

Care coordinationA function that helps ensure that a patient’s needs and preferences for health services and information sharing across people, functions, and sites are met over time.

SOURCES

Chen, W. T., Wantland, D., Reid, P., Corless, I. B., Eller, L. S., Iipinge, S., et al. (2013). Engagement with health care providers a� ects self-e© cacy, self-esteem, medication adherence and quality of life in people living with HIV. Journal of AIDS & Clinical Research, 4(11), 256.

Craig, C., Eby, D. & Whittington, J. (2011). Care coordination model: Better care at lower cost for people with multiple health and social needs. IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement. Retrieved from http://www.ihi.org/resources/Pages/IHIWhitePapers/IHICareCoordinationModelWhitePaper.aspx

Kowwitt, S. (2014). Patient engagement: What is it, why is it important, and how does peer support fi t in? Retrieved from http://peersforprogress.org/pfp_idea_exchange/patient-engagement-how-does-peer-support-fi t-in/

Truesdell, N. (2012). Practical strategies to engage patients with integrated health care. Retrieved from http://www.mehaf.org/blog/2012/09/11/practical-strategies-engage-patients-integrated-health-care/

CMSCenters for Medicare & Medicaid Services

The government agency that administers the Medicare program. CMS also works in partnership with state governments to administer Medicaid, the State Children’s Health Insurance Program (SCHIP or CHIP), and health insurance portability standards.

PEis in the hospital. This is in contrast to each physician

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IPCEA function that helps ensure that a patient’s needs and preferences for health services and information sharing across people, functions, and sites are met over time.

is in the hospital. This is in contrast to each physician

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CC CCCCCAdditional responsibilities for CMS include implementing the administrative simplifi cation standards from the HIPAA and developing and implementing quality standards and certifi cation for long-term care facilities, along with clinical laboratory quality standards under the Clinical Laboratory Improvement Amendments. CMS is also responsible for other tasks to advance health information technology, including the implementation of EHR incentive programs, the creation of standards for the certifi cation of EHRs, and the updating of privacy and security regulations under HIPAA. (CMS, 2015)

SOURCE

Centers for Medicare & Medicaid Services (CMS). (2015d). Home page of CMS. Retrieved from http://www.cms.gov/

CMS Innovation CenterCenters for Medicare & Medicaid Services Innovation Center

Established by section 1115A of the Social Security Act (as added by section 3021 of the ACA), this is a warehouse of various tested or promising payment and service delivery models. The CMS Innovation Center is currently focused on testing new payment and service delivery models, evaluating results, advancing best practices, and engaging a broad range of stakeholders to develop additional models for testing. (CMS, 2015)

SOURCE

Centers for Medicare & Medicaid Services (CMS). (2015a). About the CMS Innovation Center. Retrieved fromhttp://innovation.cms.gov/About/index.html.

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SOURCE

Improving Chronic Illness Care. (n. d.). Steps for improvement (1): Models; Chronic care model. Retrieved from http://www.improvingchroniccare.org/index.php?p=1:_Models&s=363

Clarity Providing transparency of information to individuals to enable and empower them to make decisions and take actions related to their care.

SOURCE

http://healtha� airs.org/blog/2012/11/28/a-call-for-clarity-in-health-care-the-fair-health-npic-database/

CDSClinical decision support

A collection of tools used to enhance decision making in the clinical workfl ow. These tools include computerized alerts and reminders to care providers and patients, clinical guidelines, condition-specifi c order sets, focused patient data reports and summaries, documentation templates, diagnostic support, and contextually relevant reference information. (AHRQ, 2009)

SOURCE

Agency for Healthcare Research and Quality (AHRQ). (2009a). Clinical decision support systems: State of the art. AHRQ Publication No. 09-0069-EF. Retrieved from http://healthit.ahrq.gov/sites/default/fi les/docs/page/09-0069-EF_1.pdf

CQMsClinical Quality Measures

Tools that help measure and track the quality of healthcare services provided by eligible professionals, eligible hospitals, and critical access hospitals within the healthcare system.

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Change managementThe application of evidence-based strategies, methodologies, and tools for preparing an organization to adapt to changing needs and achieving desired patient health outcomes.

SOURCE

Centers for Disease Control and Prevention (CDC). (n. d.). Change management. Retrieved from http://www2a.cdc.gov/cdcup/library/pmg/concept/chng_description.htm

CCMCChronic Care Management Code

New service billing code for payment of non-face-to-face chronic care management services for Medicare benefi ciaries with multiple (2 or more) signifi cant chronic conditions. Chronic care management services include regular development and revision of a plan of care, communication with other treating health professionals, and medication management. (Goodson & Engel, 2014)

SOURCE

Goodson, J. & Engel, J. (2014). Medicare’s chronic care management (CCM) code: Prepare now for 2015. SGIM Forum, 37(5), Retrieved from https://www.sgim.org/File%20Library/SGIM/Resource%20Library/Forum/2014/May2014-02.pdf

CCMChronic Care Model

An organizational approach to caring for people with chronic disease in a primary care setting. The system is population-based and creates practical, supportive, evidence-based interactions between an informed, activated patient and a prepared, proactive practice team. (Improving Chronic Illness Care, n.d.)

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SOURCE

Centers for Medicare & Medicaid Services (CMS). (2014a). Clinical quality measures basics. Retrieved from http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/ClinicalQualityMeasures.html

CoachingA method of directing or instructing a person to achieve a goal or develop a specifi c skill or competency. (Meakim et al., 2013)

SOURCE

Meakim, C., Boese, T., Decker, S., Franklin, A. E., Gloe, D., Lioce, L., Sando, C. R., & Borum, J. C. (2013). Standards of best practice: Simulation standard I: Terminology. Clinical Simulation in Nursing, 9(6S), S3-S11.

Collaborative careCare coordination and care management to provide a better monitoring of patients’ progress.

SOURCE

http://www.medicaid.gov/State-Resource-Center/Medicaid-State-Technical-Assistance/Health-Homes-Technical-Assistance/Downloads/HH-IRC-Collaborative-5-13.pdf

Comparative e� ectiveness researchResearch designed to inform healthcare decisions by providing evidence on the e� ectiveness, benefi ts, and harms of di� erent treatment options.

SOURCE

http://e� ectivehealthcare.ahrq.gov/index.cfm/what-is-comparative-e� ectiveness-research1/

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IPCEProviding transparency of information to individuals A method of directing or instructing a person

to achieve a goal or develop a specifi c skill or competency. (Meakim et al., 2013)

Providing transparency of information to individuals A method of directing or instructing a person

IPCE

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CC DDCJRComprehensive Care for Joint Replacement

A model that aims to support better and more e© cient care for benefi ciaries undergoing the most common inpatient surgeries for Medicare benefi ciaries: hip and knee replacements (also called lower extremity joint replacements).

SOURCE

https://innovation.cms.gov/initiatives/cjr/index.html

CPC+Comprehensive Primary Care Plus

A model that aims to strengthen primary care through a regionally based multipayer payment reform and care delivery transformation.

SOURCE

https://innovation.cms.gov/initiatives/comprehensive-primary-care-plus/

CO-OPConsumer Operated and Oriented Plan

A program that fosters the creation of qualifi ed nonprofi t health insurance issuers to o� er competitive health plans in the individual and small group markets.

SOURCE

https://www.cms.gov/CCIIO/Programs-and-Initiatives/Insurance-Programs/Consumer-Operated-and-Oriented-Plan-Program.html

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Counseling, coaching, question prompts, motivational interviewing, decision aids, and helplines Interventions that can be used to engage patients at various points of the care continuum. The ultimate goal of all the interventions is for patients to take action and be active participants in their healthcare decisions. (Truesdell, 2012).

SOURCE


Cueing Providing clues, triggers, prompts, hints, and instructional support to participants during simulation-based training or learning. (Paige & Morin, 2013)

SOURCE

Paige, J. B. & Morin, K. (2013). Simulation fi delity and cueing: A systematic review of the literature. Clinical Simulation in Nursing, 9(11), e481-e489.

Data infrastructureTechnology, processes, tools, and standards needed to promote data sharing and consumption. (HITRC, 2013)

SOURCE

Health Information Technology Research Center (HITRC). (2013). Continuous quality improvement (CQI) strategies to optimize your practice. Retrieved from http://www.healthit.gov/sites/default/fi les/tools/nlc_continuousqualityimprovementprimer.pdf

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CQIContinuous Quality Improvement

Routine patient feedback to practice, measuring patient outcomes against benchmarks or evidence-based practices and many other process and outcome measures.

SOURCES


Agency for Healthcare Research and Quality (AHRQ). (n.d.) Quality improvement. Retrieved from http://www.hrsa.gov/quality/toolbox/methodology/qualityimprovement/

CoCContinuum of Care

An integrated system of care that guides and tracks patient care over time through a comprehensive array of health services spanning all levels of intensity of care. Including all aspects of care provided at home, by primary providers, specialists, social and mental health workers, and others involved in delivering care for a patient as part of a comprehensive treatment plan. (Truesdell, 2012)

SOURCE


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Data integrationA combination of technical and business processes used to combine data from disparate sources into meaningful and valuable information. (HITRC, 2013)

SOURCE


Debriefi ngAn activity that follows a simulation experience led by a facilitator to provide feedback regarding the participants’ performance. (Meakim et al., 2013)

SOURCE

Meakim, C., Boese, T., Decker, S., Franklin, A. E., Gloe, D., Lioce, L., Sando, C. R., & Borum, J. C. (2013). Standards of best practice: Simulation standard I: Terminology. Clinical Simulation in Nursing, 9(6S), S3-S11.

Decision aidsTools designed for patients to become involved in decision making by making explicit the decision that needs to be made, providing information about the options and outcomes, and clarifying personal values. They are designed to complement, rather than replace, counseling from a health practitioner.

SOURCES

Agency for Healthcare Research and Quality (AHRQ). (n. d.) Patient decision aids. Retrieved from http://e� ectivehealthcare.ahrq.gov/index.cfm/tools-and-resources/patient-decision-aids/

Ottawa Research Institute. (2014). Patient decision aids. Retrieved from https://decisionaid.ohri.ca

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EEDDDisease prevention and health promotionServices to address the health of patients before the onset of illness or occurrence of disease that also encourage patients to lead healthy lives by changing behaviors.

Disease self-managementProviding education and tools needed to help patients cope with chronic diseases such as managing stress, encouraging physical activity and good nutrition, communicating e� ectively with healthcare providers, and developing action plans through structured planning and feedback exercises. (Truesdell, 2012).

SOURCE


EHRElectronic health record

An electronic version of a patient’s medical history that is maintained by care providers over time and is a real-time longitudinal health record generated by 1 or more encounters in any care delivery setting. Normally includes all of the key administrative clinical data relevant to that person’s care under a particular provider, including demographics, progress notes, problems, medications, vital signs, medical history, immunizations, laboratory data, and radiology reports.

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EngagementEngagement is the act of becoming involved that individuals must take in order to obtain the greatest benefi t from available healthcare services. (Center for Advancing Health, 2010)

SOURCE

Center for Advancing Health. (2010). A new defi nition of patient engagement: What is engagement and why is it important? Washington, DC: Author.

Engagement behavior frameworkA model with 10 measures to facilitate individuals/groups seeking and utilizing safe and appropriate care. It facilitates the path toward patient-centered care approaches. (Gruman et al., 2010)

SOURCE

Gruman, J., Rovner, M.H., French, M.E., Fe� ress, D., Sofaer, S. Shaller, D., & Prager, D. J. (2010). From patient education to patient engagement: Implications for the fi eld of patient education. Patient Education and Counseling. 78, 350-356.

EPMsEpisode Payment Models

New models that continue to shift Medicare reimbursements from quantity to quality by creating strong incentives for hospitals to deliver better care at a lower cost. These models would reward hospitals that work together with physicians and other providers to avoid complications, prevent hospital readmissions, and speed recovery in 3 areas: heart attacks, bypass surgery, and hip/femur fractures.

SOURCE

https://innovation.cms.gov/initiatives/epm/

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The EHR automates access to information and can streamline the clinician’s workfl ow. The EHR also has the ability to support other care-related activities directly or indirectly through various information technology (IT) interfaces, including evidence-based decision support, quality management, and outcomes reporting. (CMS, 2012)

The use of EHRs is intended to strengthen the relationship between patients and clinicians. The data, and the timeliness and availability of it, will enable providers to make better decisions and provide better care.

The EHR can improve patient care by (CMS, 2012):

■ Reducing the incidence of medical error by improving the accuracy and clarity of medical records;

■ Making the health information available, thereby reducing duplication of tests and delays in treatment, and encouraging patients to be well informed to make better decisions; and

■ Reducing medical error by improving the accuracy and clarity of medical records.

An EHR is di� erent from an electronic medical record (EMR). An EMR contains the standard medical and clinical data gathered in only 1 provider’s o© ce. EHRs go beyond the data collected in the individual provider’s o© ce and include a more comprehensive patient history. EHRs can contain and share information from all providers involved in a patient’s care. EHR data can be created, managed, and consulted by authorized providers and sta� from across more than 1 healthcare organization.

Unlike EMRs, EHRs also allow patients’ health records to move with them to other healthcare providers, specialists, hospitals, and nursing homes, and across states. (HealthIT.gov, 2013)

SOURCES

Centers for Medicare & Medicaid Services (CMS). (2012). Electronic health records. Retrieved from http://www.cms.gov/Medicare/E-Health/EHealthRecords/index.html HealthIT.gov. (2014c). What is an electronic medical record (EMR)? Retrieved from http://www.healthit.gov/providers-professionals/electronic-medical-records-emr

ECPsEssential community providers

Medical care providers who serve predominantly low-income or medically underserved patient populations. (HIVMA, 2013).

SOURCE

HIV Medicine Association (HIVMA). (2013). Health care reform & essential community providers: Information for Ryan White providers. Retrieved from http://www.hivma.org/uploadedFiles/HIVMA/Policy_and_Advocacy/Policy_Priorities/Healthcare_Reform_Implementation/Resources/HCR_Essential_Community_updated_june_fi nal.pdf

EHBEssential Health Benefi ts

A plan requiring nongrandfathered health plans in the individual and small group markets to cover Essential Health Benefi ts.

SOURCE

https://www.cms.gov/cciio/resources/data-resources/ehb.html

Evidence-based medicine or practiceUse of current and most accurate science and guidelines in making decisions about the care of individual patients. (Truesdell, 2012)

SOURCE


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FF HHFFSFee for service

Description of a healthcare delivery system through which some Medicaid enrollees are served. In this system, healthcare providers are paid for each medical service (such as an o© ce visit, test, or procedure). Individual states select payment methodologies such as FFS for Medicaid services in their Medicaid State plan. CMS [see CMS] reviews all state plans to ensure reimbursement methodologies are consistent with federal statutes and regulations. (CMS, 2013)

States may develop their FFS provider payment rates based on the costs of providing the service, a review of what commercial payers pay in the private market, or a percentage of what Medicare pays for equivalent services.

FFS payment rates are often updated based on specifi c trending factors, such as the Medicare Economic Index or a Medicaid-specifi c trend factor that uses a state-determined infl ation adjustment rate. The methodologies for service rates are described in the individual Medicaid state plan. (CMS, 2013)

SOURCE

Centers for Medicare & Medicaid Services (CMS). (2013c). Medicaid.gov. Fee-for-service. Retrieved from http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Delivery-Systems/Fee-for-Service.html

FeedbackInformation given or dialogue between participants, facilitator, simulator, or peer with the intention of improving the understanding of aspects of their performance. (Meakim et al., 2013).

SOURCE

Meakim, C., Boese, T., Decker, S., Franklin, A. E., Gloe, D., Lioce, L., Sando, C. R., & Borum, J. C. (2013, June). Standards of best practice: Simulation standard I: Terminology. Clinical Simulation in Nursing, 9(6S), S3-S11.

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GenomicsThe study of DNA to learn more about the genetic basis for health and disease.

SOURCE

https://www.genome.gov/18016863

HHSHealth & Human Services

See US Department of Health & Human Services (HHS).

Health appsApplication programs that o� er health-related services for smartphones and tablets.

HIEHealth Information Exchange

The capability to electronically move clinical information between disparate healthcare information systems while maintaining the meaning of the information being exchanged.

SOURCES

American Institutes for Research. (n.d.). Center for patient & consumer engagement. Retrieved from http://aircpce.org

Perna, G. (n.-d.). Mounting evidence in favor of patient activation. Retrieved from http://www.healthcare-informatics.com/blogs/gabriel-perna/mounting-evidence-favor-patient-activation

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FidelityDegree to which a simulation replicates reality. (Paige & Morin, 2013)

SOURCE

Paige, J. B. & Morin, K. (2013). Simulation fi delity and cueing: A systematic review of the literature. Clinical Simulation in Nursing, 9(11), e481-e489.

FPPEFocused Professional Practice Evaluation

A follow-up process to determine the merit of any items of concern found during the Ongoing Professional Practice Evaluation.

SOURCE

http://www.jointcommission.org/jc_physician_blog/oppe_fppe_tools_privileging_decisions/

Gap analysis or needs assessmentThe process of using quantitative and qualitative methods to systematically collect and analyze data to understand health or organizational needs. (CDC, 2010)

SOURCE

Centers for Disease Control and Prevention (CDC). (2010). Healthier worksite initiative: Needs assessment. Retrieved from http://www.cdc.gov/nccdphp/dnpao/hwi/programdesign/needsassessment.htm

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HITHealth Information Technology

The application of information processing involving both computer hardware and software that deals with the storage, retrieval, sharing, and use of healthcare information, data, and knowledge for communication and decision making.

SOURCES

American Telemedicine Association. (2012). What is telemedicine? Retrieved from http://www.americantelemed.org/about-telemedicine/what-is-telemedicine


HITECHHealth Information Technology for Economic and Clinical Health

The HITECH Act seeks to improve American healthcare delivery and patient care through an unprecedented investment in HIT. The HITECH programs provide the necessary assistance and technical support to providers, enable coordination and alignment within and among states, establish connectivity to the public health community in case of emergencies, and ensure the workforce is properly trained and equipped to be meaningful users of certifi ed EHRs. These programs collaboratively build the foundation for every American to benefi t from an EHR as part of a modernized, interconnected, and vastly improved system of care delivery. (HealthIT.gov, 2015)

Title IV, Division B of the HITECH Act establishes incentive payments under the Medicare and Medicaid programs for eligible professionals (EPs) and eligible hospitals (EHs) that meaningfully use Certifi ed EHR Technology (CEHRT). The HITECH program has been amended in several sections of the Social Security Act (SSA) to establish the availability of incentive payments to EPs and EHs to promote the adoption and meaningful use of CEHRT. (HealthIT.gov, 2015)

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HH HHSOURCE

HealthIT.gov. (2015). Health IT legislation and regulations. Retrieved from http://www.healthit.gov/policy-researchers-implementers/health-it-legislation

Health Insurance MarketplaceA shopping and enrollment service for medical insurance created by the ACA in 2010.

SOURCE

https://www.healthcare.gov/glossary/marketplace/

HIPAAHealth Insurance Portability and Accountability Act/Patient Privacy

A privacy rule that o� ers federal protection to individuals, specifying that an entity cannot use or disclose protected health information unless authorized by patients, except where this prohibition would result in unnecessary interference with access to quality healthcare or with certain other important public benefi ts or national priorities. (HHS, n.d.)

SOURCE

HHS. (n.d.). Health information privacy. Retrieved from http://www.hhs.gov/ocr/privacy/

Health technology assessmentThe study of DNA to learn more about the genetic basis for health and disease.

SOURCE


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HIMSSHealthcare Information and Management Systems Society

This global not-for-profi t organization’s central focus is on better health through IT. The organization’s goal is to lead e� orts to optimize health engagements and care outcomes using IT thought leadership, education, events, market research, and media services around the world. (HIMSS, 2015)

SOURCE

HIMSS. (2015). About HIMSS. Retrieved from http://www.himss.org/aboutHIMSS/

HCPFCHIMSS Center for Patient- and Family-Centered Care

A HIMSS Foundation and the National eHealth Collaborative project, the center educates and engages providers and patients to e-connect by understanding the value of the adoption and use of health IT. (HIMSS Foundation, 2015)

SOURCE

HIMSS Foundation. (2015a). HIMSS Center for patient and family-centered care. Retrieved from http://apps.himss.org/foundation/HCPFC-2.asp

HIMSS Patient Engagement FrameworkA model created to guide healthcare organizations in developing and strengthening their patient engagement strategies through the use of eHealth tools and resources. Designed to assist healthcare organizations of all sizes and in all stages of

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HEDISHealthcare E� ectiveness Data and Information Set

A set of standardized performance measures designed to ensure that consumers have the information they need to reliably compare the performance of healthcare plans. HEDIS is sponsored, supported, and maintained by the NCQA. (NCQA, 2014)

The performance measures in HEDIS are related to several signifi cant public health issues such as cancer, heart disease, smoking, asthma, and diabetes. These performance measures (NCQA, 2014) include a standardized survey of consumers’ experiences, which evaluates the performance of healthcare plans in areas such as customer service, access to care, and claims processing. Health plans seek NCQA (2014) accreditation by administering the HEDIS performance measures across their plans. In general, compliance with conventional reporting practices and HEDIS specifi cations for the following domains is measured:

■ E� ectiveness of care■ Access/availability of care■ Satisfaction with the experience of care■ Health plan stability■ Use of services■ Cost of care■ Informed healthcare choices■ Health plan descriptive information. (NCQA, 2014)

SOURCE

National Committee for Quality Assurance (NCQA). (2014). HEDIS 2014 Measures. Retrieved from http://www.ncqa.org/Portals/0/HEDISQM/HEDIS2014/List%20of%20HEDIS%202014%20Measures.pdf

QIEQIEimplementation of their patient engagement strategies. (HIMSS Foundation, 2015)

SOURCE

HIMSS Foundation. (2015). HIMSS Patient engagement framework. Retrieved from http://www.himss.org/ResourceLibrary/genResourceDetailPDF.aspx?ItemNumber=28305

Human patient simulators A full-sized patient mannequin that blinks, breathes, and has a heartbeat and pulse. Provides a virtual simulation of almost every major bodily function. Can be used for a range of scenarios from physical examination to major trauma.

IPAIndependent Practice Association

A type of health maintenance organization (HMO) or other legal entity in which individual practitioners or smaller groups of physicians see patients enrolled in the HMO but also treat their own patients who are not HMO participants. Compensation to the physician is based on either a per patient fee or a discounted fee schedule. (IRMI, 2015)

SOURCES

International Risk Management Institute, Inc. (IRMI). (2015). Independent Practice Association (IPA). Retrieved from http://www.irmi.com/online/insurance-glossary/terms/i/independent-practice-association-ipa.aspx

Physicians Practice. The Basics of Independent Practice Associations. Retrieved from http://www.physicianspractice.com/blog/basics-independent-practice-associations

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is on better health through IT. The organization’s goal

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I IIMDFInformed Medical Decisions Foundation

Now a division of Healthwise, an organization working to advance evidence-based shared decision making. The goal is to help people make better health decisions.

SOURCE

Informed Medical Decisions Foundation (IMDF). (n.d.). Home page. Retrieved from http://www.informedmedicaldecisions.org

IHIInstitute for Healthcare Improvement

Independent nonprofi t organization with a mission to improve healthcare by creating opportunities for healthcare professionals to learn and collaborate with faculty and colleagues.

SOURCE

http://www.ihi.org/about/Pages/default.aspx

Integrated care delivery Brings together inputs, delivery, management, and organization of services related to diagnosis, treatment, care, rehabilitation, and health promotion. Integration is a means to improve services in relation to access, quality, user satisfaction, and e© ciency. (Coulter, 2012)

SOURCE

Coulter, A. (2012). Patient engagement—What works? Journal of Ambulatory Care Management, 35(2): 80-89.

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IPCEBrings together inputs, delivery, management, and organization of services related to diagnosis,

IPCE

ICD-9International Classifi cation of Diseases, Ninth Revision

A classifi cation system designed to promote international comparability in the collection, processing, classifi cation, and presentation of mortality statistics. This includes the analysis of the general health situation of population groups. It is used to monitor the incidence and prevalence of diseases and other health problems. (CMS, 2013)

The ICD-9 provides a format for reporting causes of death on the death certifi cate. The reported conditions are then translated into medical codes through use of the classifi cation structure and the selection and modifi cation rules contained in the applicable revision of the ICD, published by the World Health Organization (WHO). These coding rules improve the usefulness of mortality statistics by giving preference to certain categories, by consolidating conditions, and by systematically selecting a single cause of death from a reported sequence of conditions. (CDC, 2009)

The ICD has been revised periodically. The ICD-10 was endorsed by the Forty-third World Health Assembly in May 1990 and came into use in WHO Member States as of 1994. The ICD-10 is currently being phased in to replace the ICD-9 in various segments of the US healthcare system. (CMS, 2013c) On October 1, 2014, ICD-10 code sets replaced ICD-9 code sets. The transition to ICD-10 is required for everyone covered by HIPAA. The change to ICD-10 does not a� ect current procedural terminology coding for outpatient procedures and physician services. The 11th revision of the ICD classifi cation has already started and will continue until 2015. (WHO, 2013)

SOURCES

Centers for Disease Control and Prevention (CDC). (2009). Classifi cation of diseases, functioning, and disability: International Classifi cation of Diseases, Ninth Revision (ICD-9). Retrieved from http://www.cdc.gov/nchs/icd/icd9.htm

Center for Medicare & Medicaid Services (CMS). (2013). The ICD-10 transition: An introduction. Retrieved from http://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD10_Introduction_060413[1].pdf

World Health Organization (WHO). (2015). International Classifi cation of Diseases (ICD). Retrieved from http://www.who.int/classifi cations/icd/en/

QIEQIEIDNIntegrated Delivery Network

Groups of physicians, hospitals, HMOs, and other facilities and providers that work together to o� er care to a specifi c geographic region or market. The make-up of the networks varies to address a spectrum of issues including capitation, excess capacity, decreased margins, and complaints from patients regarding access. (HIMSS, 2015)

The IDN concept was developed in the 1980s and has since evolved to the point where IDNs include many types of associations across the continuum of care. For example, 1 type of IDN might include a short- and long-term hospital, a health management plan, a physician-hospital organization, a home health agency, and hospice services. Multihospital systems and mergers may be considered limited IDNs, as di� erent entities are joining together to provide care. (HIMSS, 2015) Some members of an IDN may provide identical or complementary services to patients (horizontal integration), whereas others may provide various levels of care (vertical integration).

SOURCE

HIMSS. (2015). Healthcare IT Index. Retrieved from http://www.healthcareitnews.com/directory/integrated-delivery-network-idn

IACET International Association for Continuing Education and Training

Sets the standard for quality learning and development through accreditation.

SOURCE

http://iacet.org/about-iacet/who-we-are

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IPCE Continuing Education and Training

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Interoperability The ability of health information systems to work together within and across organizational boundaries in order to advance the e� ective delivery of healthcare for individuals and communities.

SOURCE


Interprofessional collaborative practiceWhen multiple healthcare workers from di� erent professional backgrounds work together with patients/families and communities to deliver the highest quality of care. (WHO, 2010)

SOURCE

World Health Organization (WHO). (2010). Framework for action on interprofessional education & collaborative practice. Retrieved from http://apps.who.int/iris/bitstream/10665/70185/1/WHO_HRH_HPN_10.3_eng.pdf

IPCE Interprofessional continuing education

When members from 2 or more professions learn with, from, and about each other to enable e� ective collaboration and improve health outcomes.

SOURCE


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I MMIPEInterprofessional education

When students from 2 or more professions learn about, from, and with each other to enable e� ective collaboration and improve health outcomes. (WHO, 2010)

SOURCE

World Health Organization (WHO). (2010). Framework for action on interprofessional education & collaborative practice. Retrieved from http://apps.who.int/iris/bitstream/10665/70185/1/WHO_HRH_HPN_10.3_eng.pdf

Interprofessional teamwork The levels of cooperation, coordination, and collaboration characterizing the relationships between professions in delivering patient-centered care. (IPC Expert Panel, 2011)

SOURCE

Interprofessional Education Collaborative (IPC) Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.: Author. Retrieved from http://www.aacn.nche.edu/education-resources/ipecreport.pdf

JAJoint Accreditation

Joint Accreditation o� ers organizations, including Medscape as of June 2016, the opportunity to be simultaneously accredited to provide medicine, pharmacy, and nursing continuing education activities through a single, unifi ed process, structure and set of accreditation standards, thereby promoting an interprofessional collaborative learning environment.

SOURCE

http://jointaccreditation.org/

IPCEIPCE

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now in the process of implementation. (ABMS, 2014)

CMS promotes MOC through its Physician Quality Reporting System (PQRS). The PQRS is a voluntary reporting program that provides incentive payments to identifi ed EPs who satisfactorily report data on quality measures for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-for-Service (FFS) benefi ciaries [See FFS].

Physicians who are incentive-eligible for 2014 PQRS can receive an additional 0.5% incentive payment when MOC Program Incentive requirements have been met. Physicians cannot receive more than 1 additional 0.5% MOC Program Incentive, even if they complete an MOC Program in more than one specialty. (CMS, 2014)

SOURCES

American Board of Medical Specialties (ABMS). (2014). Standards for the ABMS programs for maintenance of certifi cation. Retrieved from http://www.abms.org/media/1109/standards-for-the-abms-program-for-moc-fi nal.pdf

Centers for Medicare & Medicaid Services (CMS). (2014) Physician quality reporting system (PQRS): Maintenance of certifi cation program incentive made simple. Retrieved from http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/2014_MOCP_IncentiveMadeSimple_Final11-15-2013.pdf

MUMeaningful use

MU is the set of standards, defi ned by the Incentive Programs of the CMS, that governs the use of EHRs. The goal of meaningful use is to improve US healthcare by promoting the spread of EHRs. (HealthIT.gov 2014)

Using certifi ed EHR technology to: 1) improve quality, safety, and e© ciency and reduce health disparities, 2) engage patients and family, 3) improve care coordination [and population and public health], and 4) maintain privacy and security of patient health information. The overall mission of meaningful use is: better clinical outcomes, improved population health outcomes, increased transparency and e© ciency, empowered individuals, and more robust research data on health systems. (HITRC, 2013)

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The Joint Commission A nonprofi t organization that accredits more than 20,000 healthcare organizations and programs in the United States. Joint Commission accreditation and certifi cation is recognized nationwide as a symbol of quality and refl ects an organization’s commitment to meeting certain performance standards.

The mission of the Joint Commission is “to continuously improve healthcare for the public, in collaboration with other stakeholders, by evaluating healthcare organizations and inspiring them to excel in providing safe and e� ective care of the highest quality and value.” (The Joint Commission, 2015)

SOURCE

The Joint Commission. (2015). About The Joint Commission. Retrieved from http://www.jointcommission.org/about_us/about_the_joint_commission_main.aspx

MOCMaintenance of Certifi cation

The process of physicians keeping their certifi cation up to date through 1 of the 24 medical specialty boards of the ABMS [see ABMS], as well as some of the medical specialty boards of the American Osteopathic Association. In 2000, the Member Boards of ABMS agreed to evolve their recertifi cation programs to one of continuous professional development: the ABMS Maintenance of Certifi cation® (ABMS MOC®). The ABMS MOC ensures that a physician is committed to lifelong learning and competency in a specialty and/or subspecialty by requiring ongoing measurement of 6 core competencies adopted by the ABMS and the Accreditation Council for Graduate Medical Education in 1999. (ABMS, 2014)

The 6 core competencies are measured in a variety of ways, some of which vary according to specialty, using a 4-part process that is designed to keep certifi cation continuous. The ABMS MOC program plans were approved in 2006, and the boards are

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The benefi ts of the meaningful use of EHRs include:

■ Complete and accurate information. EHRs give providers the information they need to deliver the best possible care. They will know more about their patients and their health history before they enter the examination room.

■ Better access to information. EHRs facilitate greater access to the information that providers need to diagnose health problems earlier and improve the outcomes of their patients. EHRs also allow information to be shared more easily among doctors’ o© ces and hospitals, and across health systems, leading to better coordination of care.

■ Patient empowerment. EHRs will help empower patients to take a more active role in their health and in the health of their families. Patients can receive electronic copies of their medical records and share their health information securely over the Internet with their families. (HealthIT.gov, 2014)

The HITECH Act establishes incentive payments under the Medicare and Medicaid programs that can be earned by EPs, EHs, and critical access hospitals that demonstrate that they meaningfully use certifi ed EHR technology. (CMS, 2013)

SOURCES

Centers for Medicare & Medicaid Services (CMS). (2013). Defi nition stage 1 of meaningful use. Retrieved from http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/2013Defi nition_Stage1_MeaningfulUse.html


HealthIT.gov. (2013). How to optimize patient portals for patient engagement and meet meaningful use requirements- Fact sheet. Retrieved from http://www.healthit.gov/providers-professionals/implementation-resources/how-optimize-patient-portals-patient-engagement-and

MAPMeasure Applications Partnership

A public-private partnership convened by the NQF to provide input to the HHS on the selection

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MMM MMof quality and e© ciency measures for use in public reporting and performance-based payment programs. The MAP initiative is the fi rst of its kind, blending the views of diverse groups in order to provide recommendations to the federal government in advance of the regulatory rule-making process. The MAP collaboration represents a variety of interests, including consumers, businesses and purchasers, labor, health plans, clinicians and providers, communities and states, and suppliers, in an e� ort to promote fair and balanced input to HHS on performance measure selection. (NQF, 2013)

SOURCES

National Quality Forum (NQF). (2013). The measure applications partnership (MAP): Frequently asked questions. Retrieved from http://www.qualityforum.org/WorkArea/linkit.aspx?LinkIdentifi er=id&ItemID=69492

MLRMedical Loss Ratio

A basic fi nancial measurement used in the ACA to encourage health plans to provide value to enrollees.

SOURCE

https://www.healthcare.gov/glossary/medical-loss-ratio-MLR/

MACRAMedicare Access and CHIP Reauthorization Act

MACRA, signed into law on April 16, 2015, reforms Medicare reimbursement to providers. It ended the sustained growth rate formula that had been in place since 1997 to control the growth of Medicare. MACRA creates a new framework that reimburses providers based on quality, use of electronic health records, and value of care provided. MACRA relies on provider participation in APMs or MIPS and moves Medicare payments from healthcare providers’ volume metrics to value/quality metrics.

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Medicare Star Ratings are found on the CMS Nursing Home Compare website, with a quality rating system that gives each nursing home a rating of between 1 and 5 stars. Those with 5 stars are considered to have quality much above average, and those with 1 star are considered to have quality much below average. There is 1 overall 5-star rating for each nursing home, and a separate star rating for each of the following 3 sources of information (CMS, 2015):

■ Health Inspections, which determine the extent to which a nursing home has met Medicare’s minimum quality requirements. More than 200,000 onsite reviews are used in the health inspection scoring nationally.

■ Sta� ng, which has information about the average number of hours of care provided to each resident each day by nursing sta� . This rating considers di� erences in the level of need of care of residents in di� erent nursing homes.

■ QMs, which have information on 9 di� erent physical and clinical measures for nursing home residents—for example, the prevalence of pressure sores, or changes to a resident’s mobility. This information is collected by the nursing home for all residents. More than 12 million assessments of the conditions of nursing home residents are used in the Five-Star rating system. (CMS, 2015)

SOURCES

Centers for Medicare & Medicaid Services (CMS). (2015). Five-Star Quality Rating System. Retrieved from http://www.cms.gov/Medicare/Provider-Enrollment-and-Certifi cation/Certifi cationandComplianc/FSQRS.html

Centers for Medicare & Medicaid Services (CMS). (2015). Nursing home compare. Five star rating. Retrieved from http://www.medicare.gov/NursingHomeCompare/About/HowWeCalculate.html

MTMMedication therapy management

A term used to describe a broad range of healthcare services provided by pharmacists, the medication experts on the healthcare team. (This is the American Pharmacists Association defi nition, but the CMS has further guidance on its website.)

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MLNMedicare Learning Network

A free Medicare education and information resource. (CMS, 2015)

SOURCE

Centers for Medicare & Medicaid Services (CMS). (2015). Medicare Learning Network. Retrieved from http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNGenInfo/index.html?redirect=/MLNGenInfo

MSSPMedicare Shared Savings Program

Established by the ACA, the MSSP encourages and incentivizes providers to work collaboratively through an ACO to improve quality of care and reduce costs.

SOURCE

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/index.html

Medicare Star RatingCenters for Medicare & Medicaid Services (CMS, 2015) created the Five-Star Quality Rating System (Medicare Star Rating) to help consumers, their families, and caregivers compare nursing homes more easily and to help identify areas about which consumers may have questions.

QIEproviders, communities and states, and suppliers, in an e� ort to promote fair and balanced input to HHS

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QIEMACRA, signed into law on April 16, 2015, reforms

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SOURCE

http://www.pharmacist.com/mtm

MIPSMerit-Based Incentive Programs

MIPS is intended to integrate and simplify several of the current CMS quality programs; namely, the Base EHR portion of MU, the PQRS, and the Value Based Payment Modifi er. It is 1 of 2 pathways by which healthcare providers can submit QPP data. The other pathway is called the APM.

SOURCE


Merit-Based Incentive Programs Composite ScoreCalculated from QPP data; healthcare provider payments are based on MIPS composite score. Score is based on 4 QPP data categories: QMs (50%), Advancing Care Information (25%), Clinical Practice Improvement Activities (15%), and Resource Use (10%).

Minimally disruptive medicineA type of patient care that focuses on goal achievement, while also minimizing the burden of treatment.

SOURCE

http://www.mdpi.com/2227-9032/3/1/50

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and 5 stars. Those with 5 stars are considered to have quality much above average, and those with 1 star are

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MM NNMultidisciplinary team approachAn approach that encompasses all members of the treatment and/or care team, allowing coordination of all relevant aspects of a patient’s healthcare needs. These team members consider every facet involved with the patient’s care, treatment planning, and disease or symptom management, resulting in more e� ective communication among the full healthcare team and the patient. (PHYTEL, 2012; Truesdell, 2012)

SOURCES

PHYTEL (2012). Provider-based patient engagement: An essential strategy for population health. Retrieved from http://www3.phytel.com/Libraries/Whitepaper-PDFs/Provider-Based-Patient-Engagement---An-Essential-Strategy-for-Population-Health.sfl b.ashx


Narrow-network planA limited provider network health plan to control cost. (McKinsey & Company, 2014)

SOURCE

McKinsey & Company. (2014). Hospital networks: Updated national view of confi gurations on the exchanges. Retrieved from http://healthcare.mckinsey.com/sites/default/fi les/McK%20Reform%20Center%20-%20Hospital%20networks%20national%20update%20(June%202014)_0.pdf

NAMNational Academy of Medicine

An independent, nonprofi t organization that works outside the US government to provide unbiased

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SOURCES

National Committee for Quality Assurance (NCQA). (2015a). Home page. Retrieved from http://www.ncqa.org/HomePage.aspx

National Committee for Quality Assurance (NCQA). (2015b). Health plan report card. Retrieved from http://reportcard.ncqa.org/plan/external/Plansearch.aspx

NLCNational Learning Consortium

Represents a centralized hub for training tools and resources designed to aid healthcare professionals in identifying and disseminating best practices during the implementation, adoption, and support of EHR systems. (HealthIT, 2014)

SOURCE

HealthIT.gov. (2014b). National Learning Consortium: About the National Learning Consortium (NLC). Retrieved from http://www.healthit.gov/providers-professionals/national-learning-consortium

NPPNational Priorities Partnership

A partnership of 52 national organizations with a shared goal of achieving “better health, and a safe, equitable, and value-driven healthcare system” (NQF, 2015, para 1). The NPP was convened by the NQF [see NQF] as part of its overall mission to improve the healthcare system.

The NPP member organizations collaborated to create the NQS, which sets clear goals to help the public focus its e� orts on improving the quality of health and healthcare. All 52 NPP member organizations worked together to advocate for the creation of the NQS and continue to shape its direction by o� ering annual input to the US Secretary of HHS. (NQF, 2015)

Together, the NPP member groups:

■ Identify national goals that correspond to the priorities put forth in the NQS;

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and authoritative health advice to decision makers and the public. Formerly known as the IOM, or Institute of Medicine, the NAM administers fellowships, scholarships, and awards; hosts workshops, expert meetings, and symposia; and conducts programs to enrich the broader work of the academies. NAM is the health arm of the National Academies, which also includes the National Academy of Sciences, the National Academy of Engineering, and the National Research Council. The purpose of the NAM is to provide independent advice on issues relating to biomedical science, medicine, and health. Their initiatives respond to current and emerging priorities in health and medicine, such as the Global Health Risk Framework, Grand Challenges in Health and Medicine, Human Gene Editing, and Vital Directions for Health and Health Care.

SOURCE

(https://nam.edu/)

NCQANational Committee for Quality Assurance

A private, nonprofi t organization dedicated to improving healthcare quality in the United States. Its governing board includes employers, consumer and labor representatives, health plans, quality experts, regulators, and representatives from organized medicine. (NCQA, 2015a)

The NCQA’s quality improvement e� orts are primarily organized around accreditation and performance measurement. The organization manages voluntary accreditation programs for individual physicians, medical groups, and health plans. Health plans seek accreditation through the administration and submission of HEDIS, which consists of a set of performance measures that compare how well a healthcare plan performs across several domains of care.

Consumers can compare health plans on NCQA’s Health Plan Report Card, which rates plans in 5 categories: Access and Service, Qualifi ed Providers, Staying Healthy, Getting Better, and Living with Illness. (NCQA, 2015)

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■ Provide input on measures for tracking national progress toward the goals; and

■ O� er guidance on strategic opportunities to accelerate improvement. (NQF, 2013)

SOURCES

National Quality Forum (NQF). (2013). National priorities partnership fact sheet. Retrieved from http://www.qualityforum.org/npp/

National Quality Forum (NQF). (2015). National Priorities Partnership. Retrieved from http://www.qualityforum.org/npp/

Department of Health and Human Services (HHS). (2012). Annual progress report to congress. National Strategy for Quality Improvement in Health Care. Retrieve from http://www.ahrq.gov/workingforquality/nqs/nqs2012annlrpt.pdf

NQFNational Quality Forum

A nonprofi t, nonpartisan membership organization created to develop and implement a national strategy for healthcare quality measurement and reporting. The NQF reviews, endorses, and recommends the use of standardized healthcare performance measures. These performance measures, also called quality measures, are essential tools used to evaluate how well healthcare services are being delivered. (NQF, 2015)

NQF performance measures are intended to:

■ Make our healthcare system more information-rich;

■ Point to actions physicians, other clinicians, and organizations can take to make healthcare safe and equitable;

■ Enhance transparency in healthcare;

■ Ensure accountability of healthcare providers; and

■ Generate data that help consumers make informed choices about their care. (NQF, 2015)

The NQF operates under a 3-part mission to improve the quality of healthcare by:

■ Building consensus on national priorities and goals for performance improvement, and working in partnership to achieve them;

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NN NN■ Endorsing national consensus standards for

measuring and publicly reporting on performance; and

■ Promoting the attainment of national goals through education and outreach programs. (NQF, 2015)

SOURCE

National Quality Forum (NQF). (2015a). Home page. Retrieved from http://www.qualityforum.org/

NQF measuresNational Quality Forum measures

Standards that are evaluated through the Consensus Development Process for measuring and publicly reporting on the performance of di� erent aspects of the healthcare system. Standards endorsed by NQF are widely viewed as the “gold standard” for the measurement of healthcare quality. (NQF, 2012)

SOURCE

National Quality Forum (NQF). (2012). Critical paths for creating data platforms: Care coordination. Final report. Retrieved from http://www.qualityforum.org/Publications/2012/11/Critical_Paths_for_Creating_Data_Platforms__Care_Coordination.aspx

NQMCNational Quality Measures Clearinghouse

A public resource consisting of a database and website that provide information on specifi c evidence-based healthcare quality measures and measure sets. Sponsored by AHRQ to promote widespread access to quality measures by the healthcare community and other interested individuals.

The mission is to “provide practitioners, health care

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■ Working with communities to promote wide use of best practices to enable healthy living; and

■ Making quality care more a� ordable for individuals, families, employers, and governments by developing and spreading new healthcare delivery models. (AHRQ, 2014)

SOURCES

Agency for Healthcare Research and Quality (AHRQ). (2011). National strategy for quality improvement in health care: Report to congress. Retrieved from http://www.ahrq.gov/workingforquality/nqs/nqs2011annlrpt.pdf Agency for Healthcare Research and Quality (AHRQ). (2014b). National Quality Strategy: Overview. Retrieved from http://www.ahrq.gov/workingforquality/nqs/overview.htm#s1

Navigator/patient navigator/patient navigationAn individual focused on guiding the patient through stages of care to reduce barriers and ensure compliance.

SOURCE

http://www.patientnavigation.com/what-is-patient-navigation

Next generation Next generation refers to the most current or soon-to-be-released use of technology to engage patients in their healthcare. “Next generation” can apply to developments in topics such as: e-visits, e-consults, health evaluation, coaching, interoperability across organizations/platforms, and patient goals and outcomes.

SOURCE

http://www.intersystems.com/assets/PatientEngagement-HIMSSAnalyticsStudy.pdf

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providers, health plans, integrated delivery systems, purchasers, and others an accessible mechanism for obtaining detailed information on quality measures, and to further their dissemination, implementation, and use in order to inform health care decisions.” (AHRQ, 2013)

The NQMC builds on AHRQ‘s previous initiatives in quality measurement, including the Computerized Needs-Oriented Quality Measurement Evaluation System, the Expansion of Quality of Care Measures project, the Quality Measurement Network project, and the Performance Measures Inventory. (AHRQ, 2014)

SOURCE

Agency for Healthcare Research and Quality (AHRQ). (2014a) National quality measures clearinghouse. About NQMC. Retrieved from http://www.qualitymeasures.ahrq.gov/about/index.aspx

NQSNational Quality Strategy

This term is shorthand for the National Strategy for Quality Improvement in Health Care, a nationwide e� ort to align public and private interests to improve the quality of health and healthcare. Part of the ACA, the NQS is guided by 3 aims: to provide better care, to facilitate healthy people/healthy communities, and to provide a� ordable care.

To achieve these aims, the NQS applies 6 priorities that address the range of quality concerns that a� ect most Americans. These aims and priorities have the potential to rapidly improve health outcomes and increase the e� ectiveness of care for all populations. (AHRQ, 2011)

The 6 NQS priorities are:

■ Making care safer by reducing harm caused in the delivery of care;

■ Ensuring that each person and family are engaged as partners in their care;

■ Promoting e� ective communication and coordination of care;

■ Promoting the most e� ective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular disease;

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OCM Oncology Care Model

A voluntary physician payment performance program focused on the total cost of care for patients with cancer receiving chemotherapy during a 6-month period, with payments tied to quality metrics.

SOURCE

https://innovation.cms.gov/initiatives/oncology-care/

OPPE Ongoing Professional Practice Evaluation

A screening tool used to identify clinicians who are treating patients with an unacceptable quality of care.

SOURCE

http://www.jointcommission.org/jc_physician_blog/oppe_fppe_tools_privileging_decisions/

Outcome vs impact “Outcome” is a predefi ned, specifi c, measurable change resulting from an intervention of some sort.

■ Example: Twenty-three percent more physicians were able to answer a question correctly after participation in our educational intervention

■ Example: Thirty-one percent of individuals were able to reach target A1C level <7% after being educated by 1 or more members of the care team

“Impact” is the extension of the outcome to a broader arena; “impact” is something that happens as a result of an outcome.

■ Example: A newly educated patient is now

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OOO PPempowered to participate in the shared decision-making process; in this case, the outcome in which a patient learns more about therapeutic options leads to the impact that the patient participates in SDM

■ Example: A physician learns more about early identifi cation and treatment of drug-related adverse e� ects (outcome) and applies that knowledge to 50 patients (outcome), who then experience improved quality of life as a result (impact)

Outcomes research Research that includes the collection of real-world data allowing for the analysis of the impact of healthcare interventions on patient well-being including clinical, economic, and patient-centered outcomes.

Also refers to the analysis of the e� ect and impact of healthcare interventions on healthcare provider knowledge and competence, as well as on patient well-being; includes focus on clinical, economic, and patient-centered outcomes and impact.

SOURCE

http://www.ispor.org/about-ispor.asp

Patient activationAn individual’s knowledge, skill, and confi dence for managing his/her own health and healthcare. (Health A� airs, 2014; Hibbard, Greene & Overton, 2013)

SOURCES

Health A� airs. (2014). Health policy briefs: Patient engagement. Health A� airs, February 14, 2013. Retrieved from http://www.healtha� airs.org/

Hibbard, J. H., Greene, J., & Overton, V. (2013). Patients with lower activation associated with higher costs; Delivery systems should know their patients’ ‘scores’. Health A� airs, 32(2), 216-222.

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Patient-centered careActive involvement of patients and their families and respecting individual and cultural values, needs, and choices/decisions in care delivery and decision-making. (PHYTEL, 2012; Truesdell, 2012)

SOURCES



PCMHPatient-Centered Medical Home

The PCMH is not a place: it is a promising model for transforming the organization and delivery of primary care. The PCMH o� ers a way to organize primary care that emphasizes care coordination and communication in order to transform primary care in fundamental ways that can lead to higher quality and lower costs and can improve patients’ and providers’ experience of care.

The PCMH is a team-based model of care led by a personal physician who provides continuous and coordinated care throughout a patient’s lifetime to maximize health outcomes. (ACP, 2015)

The PCMH has become a widely accepted model for how primary care should be organized and delivered throughout the healthcare system and is intended to ensure that patients are treatedwith respect, dignity, and compassion and to enable strong and trusting relationships with providers and sta� .

The PCPCC describes PCMH as:

■ Patient-centered: A partnership among practitioners, patients, and their families that

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IPCEPatient-Centered Medical Home

The PCMH is not a place: it is a promising model

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PAMPatient Activation Measure

An assessment tool designed to measure knowledge, skills, and abilities of patients in managing their own health and healthcare decisions. There are 4 stages that a patient must take to be activated in their care (starting to take a role, building knowledge and confi dence, taking action, and maintaining behaviors). (Hibbard & Green, 2013; Nursing Alliance for Quality Care, 2011)

SOURCES

Hibbard, J. H., & Green, J. (2013). What the evidence shows about patient activation: Better health outcomes and care experiences: Fewer data on costs. Health A� airs, 2, 207–214.

Nursing Alliance for Quality Care. (2011). Guiding principles for patient engagement. Retrieved from http://www.gwenrn.com/uploads/1/8/3/6/18362263/patient_engagement_guiding.pdf

Patient advocacyAn individual or organization acting as a liaison between the patient and provider to ensure the needs (medical, social, psychological, community support, and others) of patients are addressed as part of an integrated and comprehensive patient-centered care approach. (Gilkey & Earp, 2009)

SOURCES

Gilkey, M. B., & Earp J. L. (2009). Defi ning patient advocacy in the post-Quality Chasm era. NC Medical Journal, 70(2), 120-124. Retrieved from http://nciom.org/wp-content/uploads/NCMJ/Mar-Apr-09/Gilkey.pdf

Patient Advocate Foundation. (2015). Home page. Retrieved from http://www.patientadvocate.org

Professional Patient Advocate Institute. (2015). Home page. Retrieved from http://www.patientadvocatetraining.com/

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ensures that decisions respect patients’ wants, needs, and preferences, and that patients have the education and support they need to make decisions and participate in their own care.

■ Comprehensive: Delivered by a team of care providers who are wholly accountable for a patient’s physical and mental healthcare needs, including prevention and wellness, acute care, and chronic care.

■ Coordinated: Care is organized across all elements of the broader healthcare system, including specialty care, hospitals, home healthcare, community services, and supports. (ACP, 2015)

The AHRQ website has an online resource website that provides policymakers and researchers with evidence-based resources about the PCMH approach and its potential to transform primary care and improve the quality, safety, e© ciency, and e� ectiveness of US healthcare. (AHRG, n.d.)

SOURCES

Agency for Healthcare Research and Quality (AHRQ). (n.d.) Patient centered medical home resource center. Defi ning the PCMH. Retrieved from http://pcmh.ahrq.gov/page/defi ning-pcmh

American College of Physicians (ACP). (2015). Understanding the patient-centered medical home. Retrieved from http://www.acponline.org/running_practice/delivery_and_payment_models/pcmh/understanding/index.html

National Committee for Quality Assurance (NCQA). (2015). Patient-centered medical home recognition. Retrieved from http://www.ncqa.org/Programs/Recognition/Practices/PatientCenteredMedicalHomePCMH.aspx

Patient-Centered Primary Care Collaborative (PCPCC). (2015). Defi ning the medical home. A patient-centered philosophy that drives primary care excellence. Retrieved from http://www.pcpcc.org/about/medical-home

PCORIPatient-Centered Outcomes Research Institute

A US-based nongovernmental institute created as part of a modifi cation to the Social Security Act by clauses in the Patient Protection and ACA.

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PP PPAuthorized by Congress to conduct research to provide information about the best available evidence to help patients and their healthcare providers make more informed decisions. The aim of PCORI’s research is to give patients a better understanding of the prevention, treatment, and care options available, and the science that supports those options. (PCORI, 2013a)

The institute is responsible for setting priorities for national clinical comparative e� ectiveness research; its ultimate purpose is to improve healthcare delivery and outcomes by producing and promoting high-integrity, evidence-based information that comes from research guided by patients, caregivers, and the broader healthcare community. (PCORI, 2013b)

SOURCES

Patient-Centered Outcomes Research Institute (PCORI). (2013a). About us. Retrieved from http://www.pcori.org/about-us/landing/ Patient-Centered Outcomes Research Institute (PCORI). (2013b). Mission and vision. Retrieved from http://www.pcori.org/about-us/mission-and-vision/

PCPCCPatient-Centered Primary Care Collaborative

The collaborative works to advance an e� ective and e© cient health system built on a strong foundation of primary care and the Patient-Centered Medical Home through delivery reform, payment reform, patient engagement, and employee benefi t redesign. (PCPCC, 2015)

SOURCES

Patient-Centered Primary Care Collaborative (PCPCCb). (2015). Home page. Retrieved from http://www.pcpcc.org

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The Beryl Institute. (2015). Home page. Retrieved from http://www.theberylinstitute.org/

Worden, I. (2012). Patient experience vs. patient engagement. Retrieved from http://www.betterpatientengagement.com/2012/07/15/patient-experience-vs-patient-engagement/

Patient engagement The use of a set of principles and strategies for empowering patients to actively participate in actions related to their own health. The concept of engagement takes into account the need for continuous and regular interaction between patients and providers throughout healthcare delivery. (Barello, Gra© gna & Vegni, 2012; Canadian Foundation for Healthcare Improvement, 2015; Coulter, 2012; Gamble, 2014; Health A� airs, 2014; Health Research and Education Trust, 2013)

SOURCES

Barello, S., Gra© gna, G., & Vegni, E. (2012). Patient engagement as an emerging challenge for healthcare services: Mapping the literature. Nursing research and practice (2012). Volume 2012.

Canadian Foundation for Healthcare Improvement. (2015). Patient & family engagement. Retrieved from http://www.cÁ i-fcass.ca/WhatWeDo/PatientEngagement.aspx

Coulter, A. (2012). Patient engagement —What works? Journal of Ambulatory Care Management, 35(2), 80-89.

Gamble, M. (2014). It’s not easy to engage patients—even for ACOs. Becker’s Hospital Review, January 16, 2014. Retrieved from http://www.beckershospitalreview.com/accountable-care-organizations/it-s-not-easy-to-engage-patients-even-for-acos.html

Health A� airs. (2014). Health policy briefs: Patient engagement. Health A� airs, February 14, 2013. Retrieved from https://www.healtha� airs.org/healthpolicybriefs/brief.php?brief_id=86

Health Research and Education Trust (HPOE, HRET, AHA). (2013). A leadership resource for patient and family engagement strategies. Retrieved from http://www.hpoe.org/resources/hpoehretaha-guides/1407

Agency for Healthcare Research and Quality (AHRQ). (n.d.) Patient decision aids. Retrieved from http://e� ectivehealthcare.ahrq.gov/index.cfm/tools-and-resources/patient-decision-aids/

Agency for Healthcare Research and Quality (AHRQ). (n.d.) Patient engagement. Retrieved from http://integrationacademy.ahrq.gov/content/Patient%20Engagement

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PGHDPatient-generated health data

The health-related data created, recorded, or gathered by or from patients (or family members or other caregivers) to help address a health concern. (Deering, 2013; HealthIT.gov, 2015)

SOURCES

Deering, M. J. (2013). Issue brief: Patient-generated health data and health IT. Retrieved from http://www.healthit.gov/sites/default/fi les/pghd_brief_fi nal122013.pdf

HealthIT.gov. (2015) Consumer eHealth: Patient-generated health data. Retrieved from http://www.healthit.gov/policy-researchers-implementers/patient-generated-health-data

Patient education A planned, systematic, sequential, and logical process of teaching and learning provided to patients and clients in all clinical settings. (Jones and Bartlett, n.d.)

SOURCE

Jones and Bartlett Publishers, LLC. (n. d.) Basic concepts of patient education. Retrieved from http://www.jblearning.com/samples/0763755443/55447_CH01_Dreeben.pdf

Patient empowerment Allowing patients access to choices that a� ect health outcomes. (Center for Advancing Health, 2010; Nursing Alliance for Quality Care, 2011)

SOURCES

Center for Advancing Health. (2010). A new defi nition of patient engagement: What is engagement and why is it important? Washington, DC: Author.

Nursing Alliance for Quality Care. (2011). Guiding principles for patient engagement. Retrieved from http://www.gwenrn.com/uploads/1/8/3/6/18362263/patient_engagement_guiding.pdf

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Robert Wood Johnson (RWJF). (2014). A multidimensional framework for patient and family engagement in health and health care. Retrieved from http://www.rwjf.org/en/library/research/2014/02/a-multidimensional-framework-for-patient-and-family-engagement-i.html

Patient Engagement FrameworkThe Patient Engagement Framework is a model created to guide healthcare organizations of all sizes in developing and strengthening their patient and family engagement strategies through the use of eHealth tools and resources, designed to assist in implementing of their patient engagement strategies. (RWJF, 2014)

SOURCE

Robert Wood Johnson (RWJF). (2014). A multidimensional framework for patient and family engagement in health and health care. Retrieved from http://www.rwjf.org/en/library/research/2014/02/a-multidimensional-framework-for-patient-and-family-engagement-i.html

Patient/family outreach Proactive e� orts to understand and reach out to the patient and family to ensure adherence to treatment, with the goal of sustaining new healthy behaviors or for prevention screening outreach.

SOURCES


Truesdell, N. (2012). Practical strategies to engage patients with integrated health care. Retrieved from http://www.mehaf.org/blog/2012/09/11/practical-strategies-engage-patients-integrated health-care/

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PPP PPPatient health literacyThe degree to which an individual has the capacity to obtain, communicate, process, and understand basic health information and services available to be able to make appropriate health decisions. (The Joint Commission, 2007)

SOURCE

The Joint Commission. (2007). “What did the doctor say?” Improving health literacy to protect patient safety. Retrieved from http://www.jointcommission.org/assets/1/18/improving_health_literacy.pdf

Patient-oriented researchA continuum of research, conducted by multidisciplinary teams in partnership with relevant stakeholders, that engages patients as partners, focuses on patient-identifi ed priorities, and improves patient outcomes. (Canadian Institutes of Health Research, 2014)

SOURCE

Canadian Institutes of Health Research. (2014). Strategy for patient-oriented research: Putting patients fi rst. Retrieved from http://www.cihr-irsc.gc.ca/e/documents/spor_framework-en.pdf

Patient portalA secure online website that gives patients convenient 24-hour access to personal health information to either communicate with healthcare providers and/or gain access to portions of their medical record and other services. (HealthIT.gov, 2013)

SOURCE

HealthIT.gov. (2013). How to optimize patient portals for patient engagement and meet meaningful use requirements. Retrieved from http://www.healthit.gov/providers-professionals/implementation-resources/how-optimize-patient-portals-patient-engagement-and

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been implemented by both Medicare and private insurers. The CMS has numerous demonstration projects underway to pilot P4P programs in a range of care settings, from primary care clinics to hospitals. The goal is to improve the transparency and accountability of the quality improvement process as a complement to other incentives. (CMS, 2005)

There are fi nancial incentives attached to P4P created explicitly to improve the quality and e� ective management of clinical care objectives. Using quantitative metrics, a percentage of physician compensation can be tied to achieving specifi c clinical benchmarks in the care they provide. The key di© culty in establishing a P4P program is in choosing appropriate benchmarks. In general, stressing adherence to evidence-based guidelines for care (e.g., ordering of pneumonia vaccines for all patients over the age of 65 years) should be preferred over patient outcomes (e.g., number of diabetic patients with an HbA1c less than 7.0%), because patient outcomes often depend on factors outside the provider’s control. (CMS, 2005; Health A� airs, 2012; Integrated Healthcare Association, 2014)

SOURCES

Centers for Medicare & Medicaid Services (CMS). (2005). Pay-for-performance/quality incentives. Retrieved from http://www.cms.gov/Regulations-and-Guidance/Guidance/FACA/downloads/tab_H.pdf

Health A� airs. (2012). Health policy briefs: Pay for performance. Retrieved from http://www.healtha� airs.org/

Integrated Healthcare Association. (2014). Pay for performance overview. Retrieved from http://www.iha.org/p4p_california.html

PMPMPer member per month

A type of capitation payment model for healthcare, in which a provider organization is given a set amount of money each month to provide an agreed-upon range of services for the patients enrolled in the program for the period of time covered by the agreement. Depending on the contract, the types of services provided to patients enrolled in the program may vary. The PMPM payments are meant to incentivize providers to implement wellness

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PRO Patient-reported outcome

PROs are defi ned as “any report of the status of a patient’s (or person’s) health condition, health behavior, or experience with healthcare that comes directly from the patient, without interpretation of the patient’s response by a clinician or anyone else.” NQF, with funding from the US Department of Health and Human Services, brought together a diverse set of stakeholders who could facilitate the groundwork for developing, testing, endorsing, and implementing PRO performance measures.

SOURCES

http://www.qualityforum.org/Publications/2012/12/Patient-Reported_Outcomes_in_Performance_Measurement.aspx

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3227331/

Patient technology competenceThe skills, competence, and use of technology that a patient may have to access his or her own health information or electronic personal health record. (Rogers & Mead, 2004)

SOURCE

Rogers, A. & Mead, N. (2004). More than technology and access: Primary care patients’ views on the use and non-use of health information in the Internet age. Health Social Care Community, 12(2), 102-110.

P4PPay for performance

An emerging movement in health insurance, in which providers are compensated by payers for meeting certain preestablished measures for quality and e© ciency. P4P programs have

PEPE

PEfocuses on patient-identifi ed priorities, and improves

PE

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strategies that keep their patients healthier and reduce the need for expensive acute care services. (Alguire, 2015)

Managed care organizations use capitation payments to control healthcare costs, through controlling the use of healthcare resources by putting the physician at fi nancial risk for services provided to patients. In order to ensure that patients do not receive suboptimal care through underutilization of healthcare services, managed care organizations measure (and report on) rates of resource utilization in physician practices. These reports are made available to the public as a measure of healthcare quality and can be linked to fi nancial rewards, such as bonuses. (Alguire, 2015)

Capitation is a fi xed amount of money per patient per unit of time (per year in the case of PMPM), paid in advance to the physician for the delivery of healthcare services. The amount of money paid is determined by the services provided, the number of patients involved, and the period of time during which the services are provided. Capitation rates are developed using local costs and average utilization of services, and so can vary from 1 region to another. When the primary care provider signs a capitation agreement, a list of specifi c services that must be provided to patients is included in the contract. (Alguire, 2015)

SOURCES

Alguire, P. C. (2015). Understanding capitation. Retrieved from http://www.acponline.org/residents_fellows/career_counseling/understandcapit.htm

National Quality Measures Clearinghouse. (2015). Cost of care: Total cost of care population-based per member per month (PMPM) index. Retrieved from http://www.qualitymeasures.ahrq.gov/content.aspx?id=38363

Performance improvementPositive changes in capacity, process, and outcomes within an organization. (CDC, 2011; HealthIT.gov, 2013)

SOURCES

Centers for Disease Control and Prevention (CDC). (2011). Performance management and quality improvement. Retrieved from http://www.cdc.gov/stltpublichealth/performance/

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PPP PPHealthIT.gov. (2013a). How to optimize patient portals for patient engagement and meet meaningful use requirements. Retrieved from http://www.healthit.gov/providers-professionals/implementation-resources/how-optimize-patient-portals-patient-engagement-and

PI CME Performance Improvement Continuing Medical Education

CME that includes outcomes that are focused on quality improvement.

SOURCE

https://cme.medicine.iu.edu/cme-activities/performance-improvement/

Performance managementThe practice of actively using performance data to improve patient health. This involves the strategic use of performance standards, measures, progress reports, and ongoing quality improvement e� orts to ensure an organization achieves desired results. (CDC, 2011; HITRC, 2013)

SOURCES

Centers for Disease Control and Prevention (CDC). (2011). Performance management and quality improvement. Retrieved from http://www.cdc.gov/stltpublichealth/performance/Health Information Technology Research Center (HITRC). (2013). Continuous quality improvement (CQI) strategies to optimize your practice. Retrieved from http://www.healthit.gov/sites/default/fi les/tools/nlc_continuousqualityimprovementprimer.pdf

Performance recordingThe use of video cameras and microphones for educators to use during a learning activity and o� er

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Pharmaceutical outcomes-based contractingPharmaceutical contracts between payers and pharmaceutical companies that are based on predefi ned outcomes attained by a pharmaceutical company. With the implementation of risk-based payment models and the rapid growth of specialty pharmacy spending, opportunities exist to establish collaborative and outcomes-focused specialty pharmacy contracts and related programs with regional third-party payers.

SOURCE

http://tinyurl.com/j4r6qgp

Pharmaco-economicsAn area of health economics that compares pharmaceutical products and treatment strategies.

SOURCE

http://onlinelibrary.wiley.com/doi/10.1111/j.1468-3083.2005.01285.x/abstract

Pharmaco-genomicsPharmacogenomics, a part of precision medicine, refers to the study of how genes a� ect a patient’s response to particular drugs. This new and expanding fi eld combines the science of drugs (pharmacology) and the study of genes and their functions (genomics) to develop e� ective, safe medications and doses that will be tailored to variations in a person’s genes.

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feedback to participants. Learners also have the opportunity to watch recordings of their learning activities to observe their performance and identify opportunities for improvement. (Patow, 2005)

SOURCE

Patow, C. A. (2005). Advancing medical education and patient safety through simulation learning. Retrieved from http://psqh.com/marapr05/simulation.html

PHRsPersonal health records

An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards that can be drawn from multiple sources while being managed, shared, and controlled by the individual. (HITRC, 2013; HealthIT.gov, 2013)

SOURCES


HealthIT.gov. (2013). What is a personal health record? Retrieved from http://www.healthit.gov/providers-professionals/faqs/what-personal-health-record

Personalized medicineAn evolving fi eld, benefi cial to both patients and health systems, involving the use of diagnostic testing combined with data from a patient’s medical history, circumstances, and values. Healthcare professionals can develop targeted treatment and prevention plans resulting in optimal treatment regimens.

SOURCE

http://www.personalizedmedicinecoalition.org/

PEContinuing Medical Education

PE

PEPerformance management and quality improvement. Retrieved from PE

SOURCE

https://www.nih.gov/precision-medicine-initiative-cohort-program

PQAPharmacy Quality Alliance

A 501(c)3 designated nonprofi t alliance with more than 100 member organizations. The mission is to improve the quality of medication management and use across healthcare settings, in order to improve patients’ health. The PQA undertakes this e� ort through a collaborative process to develop and implement performance measures and to recognize examples of exceptional pharmacy quality. (PQA, 2015)

As a multistakeholder, consensus-based membership organization, PQA collaboratively promotes appropriate medication use and develops strategies for measuring and reporting performance information related to medications. (PQA, 2015)

SOURCE

Pharmacy Quality Alliance (PQA). (2015). PQA mission and strategic objectives. Retrieved from http://pqaalliance.org/about/default.asp

PCPIPhysician Consortium for Performance Improvement

A national, physician-led program convened by the American Medical Association (AMA) and dedicated to enhancing healthcare quality and patient safety. The organization seeks to accomplish aligning patient-centered care, performance measurement, and quality improvement. The PCPI develops, tests, implements, and disseminates evidence-based measures that refl ect the best practices and best interest of medicine. (AMA, 2015)

The PCPI focuses on improving patient health and safety by:

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QIEhttp://onlinelibrary.wiley.com/doi/10.1111/j.1468-3083.2005.01285.x/

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PPP PPPPP■ Promoting the implementation of e� ective and

relevant clinical performance improvement activities;

■ Identifying and developing evidence-based clinical performance measures and measurement resources that enhance the quality of patient care and foster accountability;

■ Promoting the implementation of e� ective and relevant clinical performance improvement activities; and

■ Advancing the science of clinical performance measurement and improvement. (AMA, 2015)

The PCPI is nationally recognized for measure development, specifi cation and testing of measures, and enabling the use of measures in EHRs. The PCPI’s measure development resources include a measure testing protocol, a position statement on the evidence base required for measure development, a composite framework, specifi cation and categorization of measure exceptions, and an outcomes measure framework. (AMA, 2015)

SOURCE

American Medical Association (AMA). (2015). About the PCPI. Retrieved from http://www.ama-assn.org/ama/pub/physician-resources/physician-consortium-performance-improvement/about-pcpi.page

PQRSPhysician Quality Reporting System

A reporting program run by CMS that uses a combination of incentive payments and payment adjustments to promote reporting of quality information by EPs. The PQRS provides an incentive payment to practices with EPs identifi ed on claims by their individual National Provider Identifi er and Tax Identifi cation Number. EPs qualify for the payments by satisfactorily reporting data on quality measures for covered PFS services furnished to Medicare Part B FFS benefi ciaries (including Railroad Retirement Board and Medicare Secondary Payer). Beginning in 2015, the PQRS also applies a payment adjustment to

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Precision medicine A medical model that focuses on identifying specifi c medical approaches will be e� ective for an individual patient based on genetic, environmental, and lifestyle factors in order to customize an individual’s healthcare. This allows for the tailoring of medical decisions, practices, and/or products. Often used interchangeably with personalized medicine, precision medicine has recently become the preferred term, as it is less likely to imply that treatments and preventions are being developed uniquely for each individual.

SOURCE

https://www.nih.gov/precision-medicine-initiative-cohort-program

Predictive analytics The use of technology and statistical and analytic methods to search through massive amounts of information and predict patient outcomes and behaviors. (Winters-Miner, 2014)

SOURCE

Winters-Miner, L. A. (2014). Seven ways predictive analytics can improve healthcare. Retrieved from http://www.elsevier.com/connect/seven-ways-predictive-analytics-can-improve-healthcare

PCIPPrimary Care Bonus Incentive Payment Program

This program allows physicians in primary care practices a 10% bonus regardless of which Zip code they practice in. The 10% will be paid quarterly and will be based on the actual amount paid, not the allowed amount. If the EPs practice in

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EPs who do not satisfactorily report data on quality measures for covered professional services. The PQRS reporting set pulls data from the PCPI, HEDIS, and other measures, but is primarily vetted by the NQF. (CMS, 2015)

SOURCES

Centers for Medicare & Medicaid Services (CMS). (2015f). Physician quality reporting system. Retrieved from http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/index.html

American Medical Association (AMA). (2015b). 2015 Physician Quality Reporting System. Retrieved from http://www.ama-assn.org/ama/pub/physician-resources/clinical-practice-improvement/clinical-quality/physician-quality-reporting-system.page

Pioneer ACO Model CME that includes outcomes that are focused on quality improvement.

SOURCE

https://innovation.cms.gov/initiatives/Pioneer-aco-model/

Population health A term used to describe the “potent opportunity for health care delivery systems, public health agencies, community-based organizations, and many other entities to work together to improve health outcomes in the communities they serve” (Stoto, 2013). One of the 3 elements in the IHI's Triple Aim for improving the US healthcare system.

SOURCE

Stoto, M. A. (2013). Population health in the A� ordable Care Act era. Retrieved from http://www.academyhealth.org/fi les/AH2013pophealth.pdf

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IPCE

development, a composite framework, specifi cation

CME that includes outcomes that are focused on quality improvement.

development, a composite framework, specifi cation

IPCE

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a Health Professional Shortage Areas (HPSA) area, they will qualify for both the PCPI and HPSA bonus payments. (ACP, 2015)

SOURCES

American College of Physicians (ACP). (2015a). Medicare primary care bonus payment program: Bonus payment program overview. Retrieved from http://www.acponline.org/running_practice/payment_coding/bonus.htm

Centers for Medicare & Medicaid Services (CMS). (2011a). Incentive payment program for primary care services, Section 5501(a) of the ACA. Retrieved from http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads//R2161CP.pdf

Provider/physician engagementThe process of bringing together healthcare professionals and other stakeholders in an e� ort to improve outcomes and address quality-of-care gaps.

SOURCE

https://hbr.org/2014/06/engaging-doctors-in-the-health-care-revolution

Public health Public health refers to all organized measures (whether public or private) to prevent disease, promote health, and prolong life among the population as a whole. Its activities aim to provide conditions in which people can be healthy, and focus on entire populations, not on individual patients or diseases. Thus, public health is concerned with the total system, and not only the eradication of a particular disease. According to WHO (2015), the 3 main public health functions are:

■ The assessment and monitoring of the health of communities and populations at risk to identify health problems and priorities.

■ The formulation of public policies designed to solve identifi ed local and national health problems and priorities.

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IPCEThe process of bringing together healthcare professionals and other stakeholders in an e� ort to

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PEconnect/seven-ways-predictive-analytics-can-improve-healthcare PE

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PP QQ■ To ensure that all populations have access to

appropriate and cost-e� ective care, including health promotion and disease prevention services.

SOURCE

World Health Organization (WHO). (2015). Public health. Retrieved from http://www.who.int/trade/glossary/story076/en/

QCDRQualifi ed Clinical Disease Registry

A new reporting mechanism available for the PQRS for the purpose of patient and disease tracking to foster improvement in the quality of care provided to patients. (CMS, 2015)

SOURCE

Centers for Medicare & Medicaid Services (CMS). (2015g). Qualifi ed clinical data registry reporting. Retrieved from http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Qualifi ed-Clinical-Data-Registry-Reporting.html

QHPQualifi ed health plan

An insurance plan that is certifi ed by the Health Insurance Marketplace, provides essential health benefi ts, follows established limits on cost-sharing, and meets other requirements. (Healthcare.gov, n.d.)

SOURCE

Healthcare.gov (n.d.). Qualifi ed health plan. Retrieved from http://www.healthcare.gov/glossary/qualifi ed-health-plan/

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QIOsQuality Improvement Organizations

A CMS-coordinated group of health quality experts and clinicians that assist Medicare providers with quality improvement and review of quality concerns. There is 1 QIO for each US state territory and the District of Columbia. (QIOs, 2015)

SOURCE

Quality Improvement Organizations (QIOs). (2015). About the QIO Program. Retrieved from http://qioprogram.org/about

Quality measuresTools that help quantify healthcare processes, outcomes, patient perceptions, and organizational structures and/or systems. A method for quantifying patient healthcare in comparison with baseline criteria (such as using evidence-based recommendations as baseline for cholesterol measurement). (CMS, 2015)

SOURCES

Centers for Medicare & Medicaid Services (CMS). (2011). Performance management and quality improvement. Retrieved from http://www.cdc.gov/stltpublichealth/performance/

Centers for Medicare & Medicaid Services (CMS). (2015h). Quality measures. Retrieved from https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures/index.html

Cosgrove, D. M., Fisher, M., Gabow, P., Gottlieb, G., Halvorson, G.C., James, B.C., Kaplan, G.S., & Toussaint J. S. (2013). Ten strategies to lower costs, improve quality, and engage patients: The view from leading health system CEOs. Health A� airs, 32(2), 321-327.

Health Research and Education Trust (HPOE, HRET, AHA). (2013). A leadership resource for patient and family engagement strategies. Retrieved from http://www.hpoe.org/resources/hpoehretaha-guides/1407

Hibbard, J. H., & Green, J. (2013). What the evidence shows about patient activation: Better health outcomes and care experiences: Fewer data on costs. Health A� airs, 2, 207-214.

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Quality and safetyQuality care is safe, e� ective, patient-centered, timely, e© cient, and equitable. Safety is the foundation upon which all other aspects of quality care are built. (Hibbard & Green, 2013)

SOURCE

Hibbard, J. H., & Green, J. (2013). What the evidence shows about patient activation: Better health outcomes and care experiences: Fewer data on costs. Health A� airs, 2, 207-214.

QIQuality improvement

Systematic and continuous actions that lead to measurable improvement in healthcare services and the health status of targeted patient groups. Also, the process of continuous e� ort to achieve measurable improvements in the e© ciency, e� ectiveness, performance, accountability, outcomes, and other indicators of quality services or processes that achieve equity and improve the health of individuals or communities. (American Telemedicine Association, 2012; HITRC, 2013; Riley et al., 2010)

SOURCES



Riley, W. J., Moran, J. W., Corson, L. C., Beitsch, L. M., Bialek, R., & Cofsky, A. (2010). Defi ning quality improvement in public health. Journal of Public Health Management & Practice, 16(10), 5-7.

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QPPQuality Payment Program

The value-based reimbursement system implemented by MACRA, using both a MIPS and APM path.

SOURCES

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/Quality-Payment-Program.html

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/NPRM-QPP-Fact-Sheet.pdf

Real-world dataData that are not collected during random controlled trials; instead, the data come from the real-life practice of clinicians, hospitals, and social settings.

SOURCE

http://www.rand.org/content/dam/rand/pubs/research_reports/RR500/RR544/RAND_RR544.pdf

RMDsRemote monitoring devices

Mobile medical devices used to perform a routine test and send the test data, such as blood pressure or weight, to a healthcare professional in real-time. These data are sent directly to a healthcare professional for instant feedback.

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PEInitiatives-Patient-Assessment-Instruments/QualityMeasures/index.

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RRRR SSSDMShared decision-making

A process in which healthcare providers and patients collaboratively discuss and select tests, interventions, management, and next steps that are based both on evidence-based research and patient preferences. (Barello, Gra© gna, & Vegni, 2012; Gamble, 2014; Hibbard, Greene, & Overton, 2013; PHYTEL, 2012; Truesdell, 2012)

An approach to clinical decision making in which both the provider and the patient are recognized as having unique expertise relevant to care decisions. (AHRQ, n.d.; Gamble, 2014)

SOURCES

Agency for Healthcare Research and Quality (AHRQ). (n. d.) Patient engagement. Retrieved from http://integrationacademy.ahrq.gov/content/Patient%20Engagement

Barello, S., Gra© gna, G., & Vegni, E. (2012). Patient engagement as an emerging challenge for healthcare services: Mapping the literature. Nursing Research and Practice (2012). http://dx.doi.org/10.1155/2012/905934

Gamble, M. (2014). It’s not easy to engage patients—even for ACOs. Becker’s Hospital Review, January 16, 2014. Retrieved from http://www.beckershospitalreview.com/accountable-care-organizations/it-s-not-easy-to-engage-patients-even-for-acos.html

Hibbard, J. H., Greene, J., & Overton, V. (2013). Patients with lower activation associated with higher costs; Delivery systems should know their patients ‘scores’. Health A� airs, 32(2), 216-222



SimulationAn interactive teaching method that allows the learner to practice techniques and apply knowledge in scenarios that would be

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to improve a patient’s health status. (American Telemedicine Association, 2012)

SOURCES


Association of Standardized Patient Educators (ASPE). (2015a). About HIMSS. Retrieved from http://www.himss.org/aboutHIMSS/

Transition and continuityInformation that will help patients care for themselves away from a clinical setting, and the follow-up coordination, planning, and support to ease transitions in care. (Chen et al., 2013; Truesdell, 2012)

SOURCES

Chen, W. T., Wantland, D., Reid, P., Corless, I. B., Eller, L. S., Iipinge, S., et al. (2013). Engagement with health care providers a� ects self-e© cacy, self-esteem, medication adherence and quality of life in people living with HIV. Journal of AIDS & Clinical Research. 4(11), 256.Truesdell, N. (2012). Practical strategies to engage patients with integrated health care. Retrieved from http://www.mehaf.org/blog/2012/09/11/practical-strategies-engage-patients-integrated-health-care/

TOCTransition of care

The movement of a patient from 1 setting of care (hospital, ambulatory primary care practice, ambulatory specialty care practice, long-term care, home health, rehabilitation facility) to another.

SOURCE

https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/8_Transition_of_Care_Summary.pdf

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QIE TOCTransition of care

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IPCETransition of care

The movement of a patient from 1 setting of care (hospital, ambulatory primary care practice,

Transition of care IPCE

experienced in the real world, in a controlled and safe environment. (Abdolrasulnia & Roy, n.d.)

SOURCES

Abdolrasulnia, M., & Roy, K. (n. d.). Simulation: A proven but underutilized education method. Retrieved from http://m-consultingllc.com/wp-content/uploads/2014/01/Simulation.pdf

SSHSociety for Simulation in Healthcare

A society that studies the use of simulation to improve performance in healthcare and reduce errors in patient care.

SOURCE

http://www.ssih.org/About-SSH

Standardized patientA layperson or actor hired and trained to portray the role of actual patient, presenting a faculty-defi ned clinical scenario with patient history and physical symptoms for teaching and assessment purposes. (Anderson, n.d.)

SOURCES

Anderson, D. (n. d.). Standardization patients (SP): Tip sheet. Retrieved from http://www.womenshealth.gov/heart-truth/pdf/SPTips.pdf

Association of Standardized Patient Educators (ASPE). (2015). Home page. Retrieved from http://www.aspeducators.org/

TelemedicineThe use of medical information exchanged from 1 site to another via electronic communications

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QIEGamble, M. (2014). It’s not easy to engage patients—even for ACOs.

www.beckershospitalreview.com/accountable-care-organizations/

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PEPE

US Department of Health & Human Services The US Department of Health and Human Services, or HHS (2014), is the US government’s principal agency for protecting the health of Americans and delivering essential human services. The HHS has 11 separate divisions, including 8 public health agencies and 3 human services agencies, which conduct research and provide a variety of health and human services. The 11 divisions include:

■ Administration for Children and Families (ACF),■ Administration for Community Living (ACL),■ Agency for Healthcare Research and Quality

(AHRQ),■ Agency for Toxic Substances and Disease

Registry (ATSDR),■ Centers for Disease Control and

Prevention (CDC),■ Centers for Medicare & Medicaid Services (CMS),■ Food and Drug Administration (FDA),■ Health Resources and Services Administration

(HRSA),■ Indian Health Service (IHS),■ National Institutes of Health (NIH), and■ Substance Abuse and Mental Health Services

Administration (SAMHSA).

The HHS administers more than 300 programs covering a broad spectrum of activities. Some of the agency’s chief responsibilities include administration of the Medicare and Medicaid programs, health and social science research, preventing disease, ensuring food and drug safety, substance abuse treatment and prevention, and improving maternal and infant health. (HHS, 2014)

SOURCE

US Department of Health and Human Services (HHS). (2014). About HHS. Retrieved from http://www.hhs.gov/about/index.html

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UU VVUSHIKUS Health Information Knowledgebase

An online registry and portal for meaningful use. Designed as a 1-stop shop for publically accessing the components of meaningful use quality measures, providing technical specifi cations including defi nitions, measure computation logic, data elements, context, version comparisons, and value (code) sets. This registry is funded and directed by the AHRQ. (AHRQ, n.d.)

SOURCE

AHRQ. (n. d.) United States health information knowledgebase. Retrieved from https://ushik.ahrq.gov/help/faq?system=mdr

URACUtilization Review Accreditation Commission

An independent nonprofi t organization that promotes healthcare quality and e© ciency through its accreditation, education, and measurement programs. This organization is independent of any single stakeholder group. The governing board of directors was founded with representatives from all a� ected constituencies: consumers, providers, employers, regulators, and industry experts. The URAC o� ers a wide range of quality benchmarking programs and services through which organizations can validate their commitment to quality and accountability. Through its broad-based governance structure and an inclusive standards-development process, URAC ensures that all stakeholders are represented in its e� orts to establish meaningful quality measures for the entire healthcare industry. (URAC, 2013)

SOURCE

Utilization Review Accreditation Commission (URAC). (2013). About URAC. Retrieved from http://www.urac.org/about-urac/about-urac/

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The program’s 2 primary components for accomplishing this are Quality and Resource Use Reports (also known as Physician Feedback Reports) and development and implementation of the value-based payment modifi er. (CMS, 2016)

SOURCES

Chien, A.T. & Rosenthal, M. B. (2013). Medicare’s physician value-based payment modifi er—Will the tectonic shift create waves? New England Journal of Medicine, 369, 2076-2078. Retrieved from http://www.nejm.org/doi/full/10.1056/NEJMp1311957

https://www.acponline.org/running_practice/payment_coding/medicare/vbp_program.htm

https://www.cms.gov/medicare/medicare-fee-for-service-payment/physicianfeedbackprogram/

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/2016-VM-Fact-Sheet.pdf

Virtual procedure stationsA computer-controlled simulation device available for teaching such as bronchoscopy, colonoscopy, blood-drawing, puncture technique, and generates a report that helps track the student’s progress over time and helps identify areas for improvement. (Patow, 2005)

SOURCE

Patow, C. A. (2005). Advancing medical education and patient safety through simulation learning. Retrieved from http://psqh.com/marapr05/simulation.html

Wireless and wearable health technologyMobile devices that monitor health conditions in real time and automatically import those data into health information systems, allowing for quicker assessments and care interventions.

SOURCE

Health Tech Insider. (2015). Home page. Retrieved from http://healthtechinsider.com/

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VBPValue-based payment

An approach to paying for healthcare that fi nancially rewards physicians who provide healthcare that is high value—that is, high in quality while also low in cost. CMS implemented a VBP for Medicare and Medicaid providers in 2015, as mandated by the ACA. To accomplish this, CMS has begun applying a value modifi er under the Medicare Physician Fee Schedule that will factor cost and quality data into the calculations for payments for physicians. (CMS, 2016)

The reward formula is a simple system: performance is assessed in 2 dimensions (quality and cost), and payments go to physicians who have above-average performance in 2 dimensions. Physicians who perform worse than average or choose not to be involved are paid less, and there will be no change for physicians with average performance. The maximum bonus is about 2% of Medicare fees, and the maximum penalty is approximately 1%. Scoring physicians relative to one another achieves budget neutrality for CMS. For physicians, it eliminates the e� ects of common shocks to performance, such as an infl uenza epidemic or vaccine shortage. The disadvantage of this incentive structure is the uncertainty for physicians about the amount of improvement that will be necessary to receive a bonus or avoid a penalty. (Chien & Rosenthal, 2013; CMS, 2015)

The CMS implemented VBP in 2 stages. Groups of 100 or more physicians who submit claims to Medicare under a single tax identifi cation number were subject to the value modifi er in 2015. All physicians who participate in FFS Medicare will be a� ected by the value modifi er by January 1, 2017. (CMS, 2016)

The ACA directs the CMS to provide information to physicians and medical practice groups about their resource use and the quality of care provided to their Medicare patients, including patterns of resource use/cost among di� erent healthcare providers, as part of Medicare’s e� orts to improve the quality and e© ciency of clinical care. (ACP, n.d.) This actionable information is intended to help physicians improve the care they furnish, as the CMS moves toward physician reimbursement that rewards value rather than volume. (CMS, 2016)

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healthcare reform: a lexicon for...

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