Glossary
Do you get lost and confused when your doctor starts talking about things like "health care initiatives" and "incentive-based programs?" Don't worry... we do too.
That's why we've come up with this list of terms you might hear when talking about accountable care organizations (ACOs) and what they really mean.
| Term | Definition |
|---|---|
| Accountable Care Organization (ACO) | Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers, who come together to provide coordinated high quality care to patients. The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. OSF HealthCare is participating in the Medicare Shared Saving Program ACO. |
Advocate |
A person, inside or outside of the health care system, who speaks for the patient and makes certain that the patient receives the necessary services. |
| Aligned Beneficiaries | In the Medicare Shared Saving Program ACO, Medicare beneficiaries are "aligned" with the ACO, based on where they have been receiving their primary care. If a beneficiary does not have a primary care physician, they may be aligned to the ACO based on specialty care services they have received. |
| Care Gaps | The difference between what health care services the patient should have received and what the patient actually received. Care gaps are often focused on preventive services such as flu shots, immunizations, and screenings but data analysis can also uncover gaps in care for patients with chronic conditions such as diabetic retina exams or diabetic foot exams. |
| Care Coordination | Care Coordination is the process of taking care of a patient with a chronic or complex condition and helping them coordinate their health over their lifetime. |
| Care Coordinator | A health care professional, typically a nurse or social worker, who arranges, monitors or coordinates services throughout a patients lifetime. Care Coordinators accomplish this by combining a working knowledge of health and psychology, human development, family dynamics, public and private resources and funding sources, while advocating of the patients through the continuum of care. |
| Chronic Illness | A condition that will not improve, that lasts a lifetime, or recurs. Examples of chronic illnesses include asthma, Alzheimer's disease, diabetes, epilepsy and some mental illnesses. |
| Clinical Pathway | A health care management tool that suggests the best way to treat a disease. Clinical pathways are designed to reduce the variations in health care through the use of standardized treatment. |
| Discharge Planning | 一种决定病人从一个护理级别顺利转移到另一个护理级别所需的过程。只有医生才能授权患者出院，但出院计划的实际流程可以由社会工作者、护士、病例管理员或其他人完成。理想情况下，特别是对于最复杂的医疗条件，出院计划是由团队方法完成的。In general, the basics of a discharge plan are:
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| Disease Management | Refers to the process of assisting a patient in the ongoing management of their disease (such as asthma or epilepsy), rather than treating a single episode. Disease management is intended to improve both the patients' condition and manage the cost of care while focusing on the patient's quality of life. |
| E-Prescribing | E-prescribing is the act of electronically sending an accurate, error-free, and understandable prescription directly to a pharmacy. |
| Electronic Medical Record (EMR) | 电子病历(EMR)是一种计算机化的病历。它能够在医院和其他卫生保健办公室之间共享。EMR可能包括病史、药物和过敏、免疫状况、实验室测试结果、放射图像、生命体征、个人数据(如年龄和体重)以及账单信息。电子医疗记录(EMR)也被称为电子健康记录(EHR)。 |
| Evidence-Based Medicine | Evidence-based medicine aims to apply the best evidence available from science to patient care decision making. It seeks to assess the evidence against the risks and benefits of treatment (or lack of treatment). |
| Medical Home | See Patient-Centered Medical Home (PCMH). |
| Medication Reconciliation | The process of reviewing patient medication orders in order to avoid inconsistencies. A health care professional reviews the patient's current medication and compares it with the medication being recommended for the new setting of care (home or nursing home). |
| Outcomes | 测量治疗的结果和效果。结果通常以成本、死亡率、健康状况、生活质量和/或患者功能来衡量。 |
| Patient-Centered Medical Home (PCMH) | The Medical Home serves as the central point of contact for the patient and is focused on providing comprehensive and continuous medical care, working to maximize health outcomes. The Primary Care Physician (PCP) office serves as the center of the Patient's Medical Home. Using a team approach, the staff within the PCP office (physicians, nurses, care managers, etc.) have the responsibility of assessing the physical, social and emotional needs of the patient, providing the care to meet those needs, or arranging for the care to be provided outside the PCP office, when necessary. PCP将把患者转诊给其他OSF提供者，但在必要时也将转诊和协调OSF交付系统之外的患者护理。 |
| Population Health Management | An approach designed to improve the health of an entire population. Population health management looks beyond the individual. Instead, it focuses on mainstream medicine and public health by addressing a broad range of factors such as environment, social structure, and resource distribution. |
| Referral Management | 初级保健医生(pcp)决定是否需要将病人转诊给专家进行咨询或在办公室外进行服务的过程。This may include diagnostic tests, outpatient surgery, home health care, etc. |
| Transforming Health Care | OSF HealthCare is "Transforming Health Care" from a fee-for-service environment to one where the patient is at the center of care. We are changing our focus from treating acute episodes of care (when a patient comes to us), to a focus of caring for the person over his or her lifetime. We are broadening care to include the physical, emotional and social needs of the patient and including health, wellness, and patient outreach, throughout the patient's life. |
| Value-Based Purchasing | Value-based purchasing (VBP) is a pay-for-performance program. It reduces payment to poorly performing hospitals and redistributes those dollars to high performers. |