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Healthcare Reform

A Reference Guide for Healthcare Reform

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Ever find yourself bogged down in acronyms and jargon? Even experts can get lost in the language of the ever-changing healthcare landscape. Collected from all the leading sources, our continuously-updated glossary of terms breaks down the trending buzzwords so you don’t have to. This reference list will help you sift through the news of the day, from October 1 to January 1 and beyond.

 

ACA – Affordable Care Act; the comprehensive health care reform law. The Patient Protection and Affordable Care Act was enacted in two parts:  It was signed into law on March 23, 2010, then amended by the Health Care and Education Reconciliation Act on March 30, 2010. The name “Affordable Care Act” is used to refer to the final, amended version of the law. It is also known as “Obamacare.”

ACO – Accountable Care Organization; group of health care providers who give coordinated care, chronic disease management, and thereby improve the quality of care patients get. The organization’s payment is tied to achieving health care quality goals and outcomes that result in cost savings. More than 428 hospitals have signed up so far and serve about 14 percent of the U.S. population.

Attest – When you apply for health coverage through the Health Insurance Marketplace, you’re required to agree (or “attest”) to the truth of the information provided by signing the application.

CHIP – Children’s Health Insurance Program; an insurance program jointly funded by state and federal governments that provides health coverage to low-income children and, in some states, pregnant women in families who earn too much income to qualify for Medicaid but can’t afford to purchase private health insurance coverage.

Concierge medicine – Also called “direct pay” practices. Patients pay a monthly or annual fee for enhanced services, including same day appointments, 24/7 access to their doctor, e-mail consultations, and longer appointment times. Though some worry that most patients won’t have financial access to this model, there were 4,400 such physicians in the U.S. in 2012, and that number is expected to grow.

Co-op – A non-profit organization in which the same people who own the company are insured by the company. Cooperatives can be formed at a national, state, or local level, and may include doctors, hospitals, and businesses as member-owners. Co-ops will offer insurance through the Health Insurance Marketplace.

Coordinated Care – Organization of your treatment across several health care providers. Medical homes and Accountable Care Organizations are two common ways to coordinate care.

EHR – Electronic Health Record; a longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting. Included in this information are patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports.

Learn more about EHRs from our stories on their benefits, challenges and our tips on how to choose the right one for your practice when you finally make the switch from paper.

EPO – Exclusive Provider Organization plan; a managed care plan where services are covered only if you go to doctors, specialists, or hospitals in the plan’s network (except in an emergency).

Essential Health Benefits –ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care.

Starting in 2014, these health care service categories must be covered by all Medicaid state plans and any plan that will be offered in the Health Insurance Marketplace.

Group Health Plan – health coverage offered by employers.

HIE – Health Information Exchange; the electronic movement of health-related information among organizations according to nationally-recognized standards.

Health Insurance Marketplace – A resource where individuals, families, and small businesses can learn about their health coverage options; compare health insurance plans based on costs, benefits, and other important features; choose a plan; and enroll in coverage. Ins some states, the marketplace will be run by the state, in others by the federal government. Abbreviated HIX, for Health Insurance Exchange.

HITECH – Health Information Technology for Economic and Clinical Health Act; enacted in 2009, Department of Health and Human Services is spending upwards of $25 billion to 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 assure that healthcare workers are properly trained and equipped to be meaningful users of certified Electronic Health Records (EHRs).  

ICD-10 – code sets used to report medical diagnoses and inpatient procedures to insurance carriers and government databases, replacing the ICD-9 codes on October 1, 2014.

Interoperability – the ability of diverse systems and organizations to work together (inter-operate).

Managed Care – a type of health insurance in which Managed Care Organizations have contracts with health care providers and medical facilities to provide care for members at reduced costs. These providers make up the plan’s network. How much of your care the plan will pay for depends on the network’s rules.

Meaningful Use (MU) – set of standards defined by the Centers for Medicare & Medicaid Services (CMS) Incentive Programs that govern the use of electronic health records and allows eligible providers and hospitals to earn incentive payments by meeting specific criteria. MU stage 1 in 2011-2012, aimed to achieve basic data sharing and EHR adoption. Stage 2, planned for 2014, will advance clinical processes using EHRs. Stage 3, in 2016, will seek to actually improve patient outcomes with the new IT tools in place.

Navigator – An individual or organization that’s trained and able to help consumers, small businesses, and their employees as they look for health coverage options through the Marketplace, including completing eligibility and enrollment forms. These individuals and organizations are required to be unbiased. Their services are free to consumers.

ONC – Office of the National Coordinator; a government resource within the Department of Health and Human Services formed to support the adoption of health information technology, and the promotion of nationwide health information exchange to improve health care.

PCMH – Patient Centered Medical Home; team based health care delivery model led by a physician, physician assistant, or nurse practitioner, Medical Homes provide comprehensive and continuous medical care to patients with the goal of obtaining maximized health outcomes.

Precision medicine – integrates molecular and clinical research with patient data and outcomes and places the patient at the center of all elements. Genetic and environmental data are studied with patient information behavior to understand individual disease patterns, and to design preventive, diagnostic, and therapeutic solutions. Sometimes used interchangeably with “personalized medicine.”

Telemedicine – the remote diagnosis and treatment of patients by means of telecommunications technology or video conferencing.

 

 

 

 

 

 

 

 

 

SOURCES: MedCity News, WebMD, HealthCare.gov, Kaiser Health News, Forbes, HIMSS, HRSA, American College of Physicians

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