Glossary of Terms

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. 

.

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”.

RESOURCES

Publications

Glossary of Terms

Links

Twitter

NHMH Salutes the Passing of American Scientist Dr. Paul Greengard, a Pioneer in Brain Research and Mental Health Treament. We owe Dr. Greengard a great debt for his incredible, break-through work, and his amazing life of service.

https://www.rockefeller.edu/news/25634-pioneering-neuroscientist-nobel-laureate-paul-greengard-dies-93/

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San Francisco's Fragmented Mental Health Services Are Literally Killing Its CitizensSan Francisco’s fragmented city services are harming – and killing – the most vulnerable,S.F. Chronicle, Michael Cabanatuan Sep. 27, 2022 “A small number of San Franciscans — almost all of them unhoused — are responsible for overly heavy use of both the city’s medical and legal systems — but the systems’ fragmented approach is failing, according to a new study. The study, from the nonpartisan California Policy Lab and the Benioff Homelessness and Housing Initiative at UCSF, shows that a small group of people are repeatedly cycling in and out of both the county’s health and criminal legal systems each year and represent a disproportionately high amount of utilization of these systems.The systems provide fragmented care that fails those who use it, the study’s authors said, and one finding backs that up: Nearly one in four of the people with heavy use of both systems in 2011 were dead by 2020, “reflecting how vulnerable these individuals are and how high the stakes are for improving the systems that support them,” said co-author Dr. Hemal Kanzaria, medical director at Zuckerberg San Francisco General Hospital and an associate professor of emergency medicine at UCSF.The study underscores what health care workers and public hospital officials told city leaders in July — that far too many people struggling with severe mental illness and addiction cycle through San Francisco’s overburdened emergency rooms, failing to get long-term help, and at a high cost to the city. For instance, just five people in the past five years accounted for 1,781 ambulance transports, possibly up to 2,000, at a cost of $4 million.The study’s authors called for a more coordinated approach, such as connecting people released from the emergency room or jail with housing and continued care. “Our research highlights the need for coordinated, evidence-based interventions to address these individuals’ complex needs, promote stable housing, and prevent poor health outcomes including untimely death,” said co-author Dr. Maria Raven, chief of emergency medicine at UCSF Medical Center and co-lead of the Benioff Homelessness and Housing Initiative program on adults with complex needs.The study looked at 10 years of data from 270,000 people who used the city’s acute medical care or legal systems between 2011 and 2020. It narrowed its focus to two groups of people who had interactions with both systems in the same year, one from 2011 and one from 2020, to investigate trends among frequent users of city services.The study is unusual, researchers say, because it links data from multiple agencies to see how people are using critical city services including mental and physical health care and housing over a several-year period.Among the study’s findings, according to the Policy Lab:• About 24% of the 2011 group continued their high use of both systems the following years but their use declined each of the following years. • Between 80% and 90% of the people in the 2011 and 2020 groups had substance use problems and many also had chronic mental and and physical health issues. • More than 90% of the individuals in both groups had been booked into jail for a felony and a misdemeanor. • The research team determined that many of the people in the 2020 group were in San Francisco in 2011 and had contact with both health and criminal legal systems in the prior 10 years. For example, 30% of the 2020 cohort was booked into jail in 2011.” Michael Cabanatuan is a San Francisco Chronicle staff writer, email: mcabanatuan@sfchronicle.com ... See MoreSee Less
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