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”.

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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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Schizophrenia Second Only To Age as Greatest Risk Factor for COVID-19 Death25-Jan-2021 7:00 PM EST, by NYU Langone Health Contact Patient ServicesNewswise — People with schizophrenia, a mental disorder that affects mood and perception of reality, are almost three times more likely to die from the coronavirus than those without the psychiatric illness, a new study shows. Their higher risk, the investigators say, cannot be explained by other factors that often accompany serious mental health disorders, such as higher rates of heart disease, diabetes, and smoking.Led by researchers at NYU Grossman School of Medicine, the investigation showed that schizophrenia is by far the biggest risk factor (2.7 times increased odds of dying) after age (being 75 or older increased the odds of dying 35.7 times). Male sex, heart disease, and race ranked next after schizophrenia in order. “Our findings illustrate that people with schizophrenia are extremely vulnerable to the effects of COVID-19,” says study lead author Katlyn Nemani, MD. “With this newfound understanding, health care providers can better prioritize vaccine distribution, testing, and medical care for this group,” adds Nemani, a research assistant professor in the Department of Psychiatry at NYU Langone Health. The study also showed that people with other mental health problems such as mood or anxiety disorders were not at increased risk of death from coronavirus infection.Since the beginning of the pandemic, experts have searched for risk factors that make people more likely to succumb to the disease to bolster protective measures and allocate limited resources to people with the greatest need. Although previous studies have linked psychiatric disorders in general to an increased risk of dying from the virus, the relationship between the coronavirus and schizophrenia specifically has remained unclear. A higher risk of mortality was expected among those with schizophrenia, but not at the magnitude the study found, the researchers say.The new investigation is publishing Jan. 27 in the journal JAMA Psychiatry. Researchers believed that other issues such as heart disease, depression, and barriers in getting care were behind the low life expectancy seen in schizophrenia patients, who on average die 15 years earlier than those without the disorder. The results of the new study, however, suggest that there may be something about the biology of schizophrenia itself that is making those who have it more vulnerable to COVID-19 and other viral infections. One likely explanation is an immune system disturbance, possibly tied to the genetics of the disorder, says Nemani.For the investigation, the research team analyzed 7,348 patient records of men and women treated for COVID-19 at the height of the pandemic in NYU Langone hospitals in New York City and Long Island between March 3 and May 31, 2020. Of these cases, they identified 14 percent who were diagnosed with schizophrenia, mood disorders, or anxiety. Then, the researchers calculated patient death rates within 45 days of testing positive for the virus.They note that this large sample of patients who all were infected with the same virus provided a unique opportunity to study the underlying effects of schizophrenia on the body.“Now that we have a better understanding of the disease, we can more deeply examine what, if any, immune system problems might contribute to the high death rates seen in these patients with schizophrenia,” says study senior author Donald Goff, MD. Goff is the Marvin Stern Professor of Psychiatry at NYU Langone.Goff, also the director of the Nathan S. Kline Institute for Psychiatric Research at NYU Langone, says the study investigators plan to explore whether medications used to treat schizophrenia, such as antipsychotic drugs, may play a role as well.He cautions that the study authors could only determine the risk for patients with schizophrenia who had access to testing and medical care. Further research is needed, he says, to clarify how dangerous the virus may be for those who lack these resources. Goff is also the vice chair for research in the Department of Psychiatry at NYU Langone.Study funding was provided by NYU Langone.In addition to Nemani and Goff, other NYU Langone researchers included Chenxiang Li, PhD; Esther Blessing, MD; PhD; Narges Razavian, PhD; Ji Chen, MS; and Eva Petkova, PhD. Another study investigator was Mark Olfson, MD, MPH, at Columbia University in New York. ... See MoreSee Less
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