Glossary of Terms

Care delivery system 

The entire system of how health care is delivered to you; currently the U.S. has two separate systems for health care: one for medical care and another for behavioral health care. Doctors in both systems do not now routinely coordinate and collaborate with each other, nor have access to each other records, treatment plans etc. Yet most national surveys have shown that more Americans receive behavioral health care from primary care doctors than from mental health specialists. Most patients would prefer an integrated approach in which primary care and behavioral health providers work together to address both medical and behavioral needs in a coordinated way.

Stakeholders 

Patients, families, communities, providers and facilities, payers, purchasers.

Population health

Not just an individual, but a whole large group, e.g. a community, a state, a group of employees, a country

Providers 

People who provide you with H/C services, e.g. doctors, nurses, physician assistants, hospitals, clinics, nursing homes, rehab centers, etc

Primary care 

The care you receive from your local family doctor, usually focused on common medical, and now behavioral, health problems, who refers patient to a specialist if needed.

PCP 

Primary care physician; your local doc

Payers 

Insurance companies who reimburse doctors, hospitals, etc for H/C services provides; they are NOT themselves the “payers” of those services!

Purchasers 

Government, employers, and in some cases, individuals; they actually pay for all H/C services delivered

Parity 

On an equal basis; in H/C context, medical care management and behavioral health care management must now be done on an equal basis

Value 

Interaction of quality and cost; in H/C contest, value is best quality H/C at most cost-effective price

Gain sharing 

Doctors et al sharing in savings of providing high-value care

Shared savings program 

A Government program under Medicare, effective January 2012 that allows doctors et al to share in savings of accountable care, with coordinated services, investment in practice infrastructure, improved improved processes for high-value, high-quality care

Quality 

Health care services delivered according to best available evidence in medicine, in a efficient, accountable, way

Outcomes 

The results of your treatment; are you getting better or not?

Quality metrics 

Measurements of what is quality care, e.g. percentage of population receiving quality interventions and their outcomes

Evidence-based care

Medical and behavioral health care practiced according to and based on latest findings, research and knowledge in medicine and science

EHR

Electronic health records; this will be a game-changer, new information re: diagnosis, treatments, risks, etc available via digital platforms, new ways to handle and exchange this information, track population health trends.

HIT 

High information technology, the larger IT system for EHRs. The Federal Government’s Stimulus law (see The Three Acts) gives doctors $40K each to install HIT systems.

Patient-centered 

A health care delivery means where patient is part of, and at center of, a health care team, coordinated by the PCP; the patient/family and primary care team are the hub of a care delivery system

Accountable care 

A care delivery model where doctors must accept responsibility for the outcomes (health, cost and services) of the population under their care

Collaborative Care 

An integrated approach to health care delivery in primary care, where medical and behavioral health providers work together to address the patients medical and behavioral health needs.

Integration of health systems 

Bringing the medical health care system and the behavioral healthsystem together to provide integrated, cost-effective care with better health outcomes.

Integrated care model 

Treating the patient’s medical/physical and behavioral (mental health and substance use) conditions in an integrated, coordinated fashion in primary care, with the PCP coordinator of the care team

Medical cost offset

Savings from less unnecessary medical care due to behavioral health interventions

Stepped care 

Part of integrated care model, where treatments are systematically adjusted with consultations from specialists if patients are not improving as expected

Registry

A clinical tracking system that helps identify patients who are falling through the cracks and supports effective stepped care.

CER 

Comparative effectiveness research, studies and results providing evidence of effectiveness, harms, benefits, etc of different options for treatment, e.g. studies on drugs, devices, tests, surgeries, delivery models, etc. CER is an emerging field which tries to determine where a drug, procedure, a test or a therapeutic strategy fits into what is already available and being used.

Behavioral health 

Mental health plus substance use disorders

SUDs 

Substance use disorders, i.e. chemical dependency disorders, usually alcohol and/or drugs.

Screen 

Can be used as a verb or noun! A survey, questionnaire or way to help identify, and begin to diagnose, a condition

PHQ-9 

Patient Health Questionnaire with 9 questions, a structured rating scale for common mental disorders, in this case depression, should be part of routine office visit to PCP; this questionnaire completed by the patient.

IMPACT 

A model of integrated medical and behavioral health care delivery developed at the University of Washington, involving consultations with Behavioral health consultants and care managers tracking patients progress

Care manager

A care professional, usually a RN or physician’s assistant, working under the supervision of the PCP, performing proactive outreach and tracking of treatment adherence, medication side effects, referrals if appropriate to other health care specialists and coordination of visits.

Acute condition

Episodic condition treated and usually resolved, e.g heart attack.

Chronic condition

On ongoing medical or behavioral health condition persisting over time, e.g. diabetes, asthma, congestive heart failure, COPD, cancer, etc

Complex patients

Patients who have both chronic medical conditions and co-existing behavioral health conditions such as depression and/or anxiety.

Telemedicine 

Care team of providers consulting, reviewing records and interacting with the patient via video conferencing technology, especially useful to serve rural locations with specialists, reducing hospitalizations, travel costs.

Reimbursement 

How insurance companies pay health care providers such as doctors, hospitals, etc, payments to doctors for services they perform

Fee for service 

A reimbursement method in which doctor is paid for every service performed, i.e. for volume. This is the old paradigm.

Capitation 

A modified FFS payment method in which doctors receive a set amount per patient per month (PMPM), e.g. if a doctor has 400 diabetes patients, insurance firm may set a reimbursement rate of $50 per patient per month, regardless of quantity/quality services performed

ACA 

Affordable Care Act, the federal law on health care enacted in 2010

(also known as the Patient Protection Affordable Care Act).

ACO 

Established throught the 2010 federal health care law (ACA), accountable care organizations are networks of doctors, hospitals and clinics that collaborate to provide quality care at lower cost, with the idea of keeping a portion of the savings they deliver, to Medicare and private insurers. 

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PCMH 

Patient centered medical home, advanced primary care, that is team-based with care managers to track patient progress, and with doctors accountable for the health outcomes of all members of the organization population, and reimbursed in a new reimbursement payment method that rewards the high-value, high-quality care.

Health Homes 

Is a health care delivery approach. It is NOT a physical location; it is a provider, or team of professionals, that delivers integrated health care, including primary care, dental, and behavioral health services.

Operating under the “whole person” philosophy, a health home offers not only services for an individual’s health needs, it also offers expanded services including long-term community services necessary for individuals to achieve and maintain wellness and recovery.

CMS 

Center for Medicare and Medicaid Services, part of the U.S. Dept of Health and Human Services (HHS), responsible for administering government health care programs such as Medicare, Medicaid and CHIPS.

AHRQ 

Agency for Healthcare Research and Quality, part of HSS, that tracks and publishes new findings on quality health care innovations and results.

NCQA 

National Committee for Quality Assurance, a private nonprofit which sets out measurement systems to define and describe what constitutes high quality care. Doctor’s offices, hospitals etc earn Level I, II or III status rankings if they qualify as high-quality under NCQA standards.

HEDIS data 

Healthcare Effectiveness Data and Information Set, a tool used by insurance companies to assess and measure performance of health care services, part of NCQA. Consumers use HEDIS data to help them select the best health plan for their needs.

CCRN

Collaborative Care Research Network, evaluates models of medical and behavioral health care physicians working together.

SAMHSA 

Substance Abuse and Mental Health Services Admin, part of HHS, provides research findings on mental health and substance use findings.

PCORI 

Patient-Centered Outcomes Research Institute, an independent entity created by the Affordable Care Act to fund research into comparative effectiveness research and distribute results.

DCoE 

Defense Centers of Excellent, part of Dept of Defense, has group devoted to Psychological Health & Traumatic Brain Injury

The Three Acts

Three federal laws enacted in the past three years that collectively are transforming the way health care is delivered, aiming for high-value, high-quality care, with resultant lowered costs and better health outcomes.

Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) – “Parity”;

American Recovery and Reinvestment Act of 2009 (ARRA) – “Stimulus”;

Patient Protection and Affordable Care Act (PPACA or ACA) “Reform”.