Health jargon: A glossaryThe latest era of health reform has produced a lexicon of jargon only a health-policy geek could love. But some of those strange acronyms and terms actually affect what happens when we visit the doctor or check in at the hospital.
By: News Tribune staff, Duluth News Tribune
ACOs. PCMH. Triple Aim.
The latest era of health reform has produced a lexicon of jargon only a health-policy geek could love. But some of those strange acronyms and terms actually affect what happens when we visit the doctor or check in at the hospital.
Here’s a partial glossary of terms that are in vogue:
Accountable Care Organizations (ACO) — Health systems set up to provide improved health in the area they serve, improved quality and service for patients, and lowered costs. Rather than a health system being compensated by Medicare and other insurers on the basis of the volume of services it performs, an ACO seeks to be compensated on the basis of the value of its work, such as its ability to reduce emergency room visits. Two sections of the Affordable Care Act address ACOs. One sets up a demonstration project for pediatric care and the other provides for “shared savings” when ACOs result in lowered Medicare costs. See “Triple Aim.”
Fee for Service — The traditional way health providers have been paid by Medicare and other insurers, also referred to as volume-based care. The more procedures and services the provider performs, the more it is compensated.
Health Maintenance Organization (HMO) — Established by an act of Congress in 1973, HMOs were designed to improve preventive care rather than just pay to treat the sick, Smylie said. That might sound like the same thing as ACOs. “Someone said, ‘Is this HMOs in drag?’ ” said John Smylie, CEO of Essentia Health. One of the differences, he said, is that patients keep their freedom of choice. They can switch to a different provider if they wish.
Patient-Centered Medical Home (PCMH) — They began as “Primary-Care Medical Homes,” about four or five years ago, Smylie said. A PCMH places responsibility for a patient’s care with a team led by a doctor and including nurse practitioners, physician assistants, nurses, medical assistants and specialists. It gives the patient a single place to look for recommendations about care.
Triple Aim — The three objectives of Accountable-Care Organizations. Dr. Hal Teitelbaum, CEO of Crystal Run Healthcare in Middletown, N.Y., put it in the simplest possible terms: better care, better health, lower cost.
Value-based care — The model of care that’s sought by ACOs. Health providers are rewarded for producing better health for their patients and for the populations they serve, not for the number of procedures they perform.