DP13-1305 Domain 3
Resource Guide

A healthcare organization characterized by a payment and care delivery model that seeks to tie provider reimbursement to quality metrics and reductions in the total cost of care for an assigned population of patients.

A federal statute signed into law in March 2010 as a part of the healthcare reform agenda of the Obama administration.

As one of 12 agencies within the Department of Health and Human Services, AHRQ supports research that helps people make more informed decisions and improves the quality of health care services.

A national program of the Robert Wood Johnson Foundation (RWJF) designed to help communities across the country improve the quality of health care for patients with chronic conditions such as diabetes, asthma, depression and heart disease.

America's Health Insurance Plans is the national association representing nearly 1,300 member companies providing health insurance coverage to more than 200 million Americans.

Representing more than 110,600 family physicians, residents, and medical student members, the AAFP is committed to helping family physicians improve the health of Americans by advancing the specialty of family medicine. Their focus is to help family physicians spend more time doing what they do best: providing quality and cost-effective patient care.

A division of HHS that administers the Medicare program and some aspects of state Medicaid programs.

Tools that help us measure and track the quality of healthcare services provided by eligible professionals (EPs), eligible hospitals (EHs), and critical access hospitals (CAHs) within our health care system.

The Community Care Team is a multidisciplinary team that partners with primary care offices (certified health care homes), the hospital, and existing health and social service organizations. The goal is to provide citizens with the support they need for well-coordinated preventive health services and coordinated linkages to available social and economic support services.

A frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community served. This trusting relationship enables the CHW to serve as a liaison/link/intermediary between health/social services and improve the quality and cultural competence of service delivery.

A process of electronic entry of medical practitioner's instructions for the treatment of patients (particularly hospitalized patients) under his or her care.

The Consumer Assessment of Healthcare Providers and Systems (CAHPS) develops and supports the use of a comprehensive and evolving family of standardized surveys that ask consumers and patients to report on and evaluate their experiences with health care.

Education for medical professionals (i.e., a physician learns new medical techniques or technologies).

A hospital certified under a set of Medicare Conditions of Participation (CoP), which are structured differently than the acute care hospital CoP. Some of the requirements for CAH certification include having no more than 25 inpatient beds; maintaining an annual average length of stay of no more than 96 hours for acute inpatient care; offering 24-hour, 7-day-aweek emergency care; and being located in a rural area, at least 35 miles drive away from any other hospital or CHA.

The Department of Health and Human Services is the U.S. government's principal agency for protecting the health of all Americans and providing essential human services, especially for those who are least able to help themselves.

A patient classification system adopted on the basis of diagnosis consisting of distinct groupings.

The Electronic Health (Medical) Record is a computerized medical file that contains the history of a patient's medical care, commonly abbreviated as "EHR," in contrast to "PHR," which stands for personal health record. An EHR or EMR enables patients to transport their health care information with them at all times.

An integrated, federally assisted system of health manpower, facilities, and equipment providing all necessary emergency care in a defined geographic area.

Providers who are eligible for covered professional services paid under or based on the Medicare Physician Fee Schedule (PFS). Medicare Eligible professionals include: doctor of medicine or osteopathy, doctor of dental surgery or dental medicine, doctor of podiatry, doctor of optometry, chiropractor. Medicaid Eligible professionals include: physicians (primarily doctors of medicine and doctors of osteopathy), nurse practitioner, certified nurse-midwife, dentist, physician assistant who furnishes services in a Federally Qualified Health Center or Rural Health Clinic that is led by a physician assistant. Medicaid EPs must meet one of the following criteria: have a minimum 30% Medicaid patient volume; have a minimum 20% Medicaid patient volume, and is a pediatrician; practice predominantly in a Federally Qualified Health Center or Rural Health Center and have a minimum 30% patient volume attributable to needy individuals.

Includes all organizations receiving grants under Section 330 of the Public Health Service Act. Must serve an underserved area or population, offer a sliding fee scale, provide comprehensive services, have an ongoing quality assurance program, and have a governing board of directors.

Also known as EHR (Electronic Health Record) or EMR (Electronic Medical Record), a computerized medical file that contains the history of a patient's medical care.

Computer-based tools developed specifically for health care delivery.

A set of health care quality measures designed to help purchasers and consumers determine how well health plans follow accepted care standards for prevention and treatment.

The Health Resources and Services Administration is an agency of the U.S. Department of Health and Human Services and is the primary federal agency for improving access to health care services for people who are uninsured, isolated or medically vulnerable.

A lab test that shows the average level of blood sugar (glucose) over the previous 2 to 3 months. It shows how well you are controlling your diabetes.

A standardized survey instrument and data collection methodology for measuring patients' perceptions of their hospital experience.

A common condition in which the force of the blood against your artery walls is high enough that it may eventually cause health problems, such as heart disease. It is usually indicated by an adult systolic blood pressure of 140mm Hg or greater or a diastolic blood pressure of 90mm HG or greater.

Informed decision-making is a term to describe a process designed to help patients understand the nature of the disease or condition being addressed; understand the clinical service being provided including benefits, risks, limitations, alternatives and uncertainties; consider their own preferences and values; participate in decision-making at the level they desire; and make decisions consistent with their own preferences and values or choose to defer a decision until a later time.

An independent not-for-profit organization based in Cambridge, Massachusetts, IHI is a leading innovator in health and health care improvement worldwide.

An independent, non-profit organization that works outside of government to provide unbiased and authoritative advice to decision makers and the public.

An independent, not-for-profit group in the United States that administers accreditation programs for hospitals and other healthcare-related organizations.

The Recovery Act specifies the following 3 components of Meaningful Use: use of certified EHR in a meaningful manner (e.g., e-prescribing), use of certified EHR technology for electronic exchange of health information to improve quality of health care, use of certified EHR technology to submit clinical quality measures (CQM) and other such measures selected by the Secretary.

A national organization that accredits quality assurance programs in prepaid managed health care organizations.

The National Institutes of Health (NIH) is a part of the U.S. Department of Health and Human Services, the primary federal agency for conducting and supporting medical research.

A not-for-profit membership organization created to develop and implement a national strategy for health care quality measurement and reporting.

The Office of the National Coordinator for Health Information Technology is a government organization that coordinates nationwide efforts to promote and implement the use of health information technology and electronic health records.

Care that considers patients' cultural traditions, their personal preferences and values, their family situations and their lifestyles.

A way of organizing primary care that emphasizes care coordination and communication to transform primary care into "what patients want it to be." Medical homes can lead to higher quality and lower costs, and can improve patients' and providers' experience of care.

The Patient Protection and Affordable Care Act is the full title of the comprehensive health care reform law enacted in March 2010.

Pay-for-performance (P4P) is a method for paying hospitals and physicians based on their demonstrated achievements in meeting specific health care quality objectives. The idea is to reward providers for the quality - not the quantity - of care they deliver.

In health care, PI refers to the use of concurrent systems to improve quality. PI programs usually use tools such as task forces, statistical studies, cross-functional teams, process charts, etc.

A physician-hospital organization (PHO) is a joint venture between one or more hospitals and a group of physicians. It acts as the single agent for managed care contracting, presenting a united front to payers. In some cases, the PHO provides administrative services, credentials physicians and monitors utilization.

A program that provides a financial incentive to physicians and other eligible professionals who successfully report quality data related to covered services provided under the Medicare Physician Fee Schedule.

A component of the Model for Improvement which involves testing changes on a small scale before full implementation, a quality improvement tool.
Plan - a specific planning phase
Do - a time to try the change and observe what happens
Study - an analysis of the results of the test
Act - devising next steps based on the analysis

Designated by CMS, QIOs work with consumers, physicians, hospitals, and other caregivers to refine care delivery systems to make sure patients get the right care at the right time, particularly among under-served populations.

An organization that has received funding under the Health Information Technology for Economic & Clinical Health Act to assist health care providers with the selection and implementation of electronic health record technology.

RVUs are a measure of value used in the United States Medicare reimbursement formula for physician services.

A return on investment (ROI) is the amount of improvement in care brought about by a certain investment. ROI can also refer to the theory that if you invest in health care quality now, then the quality of care for patients will improve in the future.

The State Innovation Models Initiative is providing up to $300 million to support the development and testing of state-based models for multi-payer payment and health care delivery system transformation with the aim of improving health system performance for residents of participating states.

The use of electronic communication networks for the transmission of information and data focused on health promotion, disease prevention, and the public's overall health including patient/community education and information, population-based data collection and management, and linkages for health care resources and referrals.

The practice of health care delivery, diagnosis, consultation, treatment, transfer of medical data, and health education, using interactive audio, video, or data communications.

Contains the annual reporting requirements for recipients of the cluster of primary care grants funded by the Health Resources and Services Administration (HRSA).

One of the major operating components of the Department of Health and Human Services. Its mission is to collaborate to create the expertise, information, and tools that people and communities need to protect their health.

Value-based purchasing is a broad strategy used by some large employers to get more value for their health care dollars by demanding that health care providers meet certain quality objectives or supply data documenting their use of best practices and quality treatment outcomes.