Groups of providers organized under a unified governance system to provide coordinated, high-quality care to patients. Successful ACOs will then share in the savings they achieve.
Adjuvant therapy –
Therapy that is provided after primary treatments (such as surgery) in order to completely remove cancer cells (e.g., chemotherapy, hormone therapy, and radiation therapy).
Advanced practice nurse –
Professionals who, in addition to a basic nursing degree, have advanced degrees or other certification to perform more specialized, often independent work (e.g., nurse practitioners, nurse midwives, and nurse anesthetists).
Alameda County Study –
Large-scale longitudinal study that focused on the behavioral and social correlates of mortality.
Allopathic –
Modern science-based medicine that treats disease with drugs, surgery, radiation, and other professionally accepted mainstream interventions.
Ambulatory care –
Outpatient services, encompassing diagnosis, observation, consultation, treatment, intervention, and rehabilitation services provided outside a hospital setting.
Ambulatory care-sensitive condition –
Medical conditions where appropriate management, treatment, and interventions in a clinical setting may prevent hospitalization.
Backward-bending labor supply curve –
A concept in labor economics suggesting that people will reduce their contributions to the market (such as hours worked or patients seen) once they have achieved a particular income target.
Balance billing –
The practice by which a health care provider charges patients the difference between the compensation paid by an insurance company or government program and a higher rate that the provider considers justified.
Behavioral Risk Factor Survey (BRFS) –
A continuous data-gathering effort by the CDC that helps to detect trends in the risk behavior of Americans.
Benchmarking –
The practice of comparing business processes and key performance indicators relative to competitors and leading organizations in an industry.
Bias –
In statistics, a metric representing the difference between an observed value and the true value of a population characteristic.
Board certification –
A credential granted to a physician usually requiring successful completion of an examination by a specialty board certifying that the physician is qualified to practice a particular specialty.
Built environment –
Characteristics of the community’s infrastructure – for example, buildings, streets, roadways – that may either enhance or restrict opportunities for exercise and socialization.
Candidate vaccine –
A vaccine being tested in comparison with another vaccine for safety and efficacy.
Capitation –
Payment by an insurer or other sponsor to an individual health care provider or organization on the basis of a flat fee for each individual enrolled.
Case fatality rate –
The percentage of fatalities from a certain disease among the entire population diagnosed with the disease.
Case study –
An in-depth examination of an individual, group, or situation.
Case-control –
A research design comparing individuals exposed to an experimental intervention or having a known disease with individuals selected from the population who have had no such exposure but have characteristics (such as demographic features) that are the same as of those exposed.
Centers for Medicare and Medicaid Services (CMS) –
The federal agency tasked with administering the Medicare and Medicaid programs.
Certificate of Need (CON) –
A legal document required in some states for proceeding with a new health care facility, expansion of an existing facility, or the acquisition of a health care facility.
Children’s Health Insurance Program (CHIP) –
A government-sponsored health insurance program that provides low-cost health coverage to children in families whose income is too high to qualify for Medicaid. Every U.S. state offers CHIP coverage, but each state has its own rules regarding who qualifies.
Cobweb feedback cycle –
A concept in labor economics that captures fluctuations in prices of goods and services based on delayed impact of periodic oversupply and undersupply.
Coinsurance –
The percentage of the cost a policyholder must cover after paying a deductible.
Comorbidity –
The existence of two or more diseases or medical conditions in a patient.
Competitive contracting –
A process in which a payer engages multiple vendors in a bidding process to obtain a favorable price. Also called “selective contracting.”
Complementary and alternative medicine (CAM) –
Nonstandard and traditional forms of medicine (such as meditation, homeopathy, and acupuncture).
Concierge practice –
A physician practice offering on-call services to patients directly in exchange for a prospective (usually monthly) fee (also known as “retainer medicine”).
Control –
The nontreatment group used as a standard of comparison in an experiment.
Copayment –
A fixed amount that an insured person is charged for a service after paying the required deductible.
Corporate practice of medicine –
The practice of medicine as an employee of an organization owned or controlled by individuals who are not physicians.
Cost sharing –
Any of several arrangements under which an insured individual is required to pay a portion of the costs associated with a unit of health care (such as a doctor visit); familiar examples of cost sharing are deductibles and copayments.
Cost-benefit –
A positive or negative number obtained by subtracting the cost of providing an intervention from the value of its outcome expressed in monetary terms (such as posttreatment income of an individual able to retain employment due to the intervention).
Cost-effectiveness –
The financial cost of a desired health or health-related outcome; formally, a ratio of successful outcomes achieved (such as cases of measles avoided or quality-adjusted years of life obtained) to dollars spent.
Coverage gap –
Also known as the “donut hole,” a gap in Medicare Part D coverage after initial plan coverage limits have been reached, but before catastrophic coverage becomes operative.
Cultural competence –
The ability to understand and interact with individuals from different cultures.
Data dredging –
Also known as “data mining,” this process involves searching for statistically significant patterns in data without the prior development of a hypothesis.
Deductibles –
A form of cost sharing under which an insured person receives no benefits in a given year until his/her medical expenses have exceeded a specified amount.
Delaney Clause –
A section of the Food Additives Amendment of 1958 that prohibits cancer-causing agents from being deliberately added to or found as a contaminant in food.
Denial –
A rejection of the sick role or failure to accept likely consequences of an illness.
Diagnostic and Statistical Manual of Mental Disorders(DSM) –
The American Psychiatric Association’s authoritative guide to the diagnosis of mental disorders.
Diagnosis Related Group (DRG) –
A classification system for different illnesses that is used by the Centers for Medicare and Medicaid Services (CMS) to standardize reimbursements and promote efficiency. Also called “Diagnostic Related Group.”
Effective reproduction number –
Designated as “R0,” (pronounced “R naught”), the average number of infections in other people generated by one individual with the disease.
Elective surgery –
A nonemergency surgery that is scheduled in advance.
Electronic Health Record (EHR) –
A digital record of the patient’s physical chart (sometimes called “Electronic Medical Record,” or EMR).
Endemic –
A disease that becomes permanently present in a certain population or region.
Ethics –
The moral principles expected to guide a person’s behavior.
Etiology –
The causes and origins of a disease.
Exchanges –
Online marketplaces established by the ACA enabling consumers to choose among qualified health insurance plans.
Fecal occult blood test (FOBT) –
A type of colorectal cancer screening tool that searches for small amounts of blood in the stool that may have been produced by tumors.
Federally Qualified Health Center (FQHC) –
Federally funded community health centers that provide primary care services in underserved areas.
Fee-for-Service (FFS) –
A payment method where the provider charges the patient based on each additional service provided.
Flexner Report –
Landmark report published in 1910 finding that a substantial portion of U.S. medical schools were inadequate, resulting in the closure of numerous medical schools and greater standardization of medical education.
Formal organization –
A structure through which individuals operate under specific rules, processes, task assignments, and relationships to attain recognizable goals and objectives.
Free clinic –
Nonprofit walk-in facilities that provide medical care to economically disadvantaged patients at cost or free of charge.
Global Influenza Surveillance and Response System (GISRS) –
A WHO-organized influenza surveillance, monitoring, and response system that shares epidemiological and public health information across 123 countries.
Gross Domestic Product (GDP) –
The total value of the final goods and services produced within a country.
Harvard Alumni Health Study –
A large-scale longitudinal study that followed the health in later life of Harvard alumni who matriculated between 1916 and 1950.
Health care marketing –
Outreach and communication intended to attract consumers to providers of health care goods and services.
Health literacy –
The ability to understand and use health care information to make appropriate decisions regarding one’s health.
Health Maintenance Organization (HMO) –
A type of managed care plan where patients pay a predetermined fee in exchange for a wide range of integrated medical services from providers registered with the parent organization.
Health promotion –
Programs that aim to influence and empower individuals to engage in healthy behaviors.
Health risk appraisal –
Also known as “health risk assessment,” a statistical means of identifying an individual’s health risks and life expectancy based on her/his heredity, disease history, and behavior.
Healthcare Effectiveness Data and Information Set (HEDIS) –
A set of standardized performance measures developed by the National Committee for Quality Assurance (NCQA) to measure, report, and compare quality across health plans. It is a widely employed tool by U.S. health insurers to measure performance on important dimensions of care and service.
Homeopathy –
A branch of alternative medicine that uses small dosages of drugs (or toxins) not conventionally believed to effectively treat disease.
Iatrogenic –
A disease or complication caused by medical treatment or examination.
Incidence –
The number of new cases of a disease identified over a specific period of time.
Income transfer –
A redistribution of income/wealth via government.
Incrementalism –
A theory of public policymaking that advocates gradual change and a focus on concrete issues, rather than the pursuit of large-scale or abstract objectives.
Index case (“Patient Zero”) –
The first individual to become infected in an epidemic.
Indian Health Service (IHS) –
A division within the U.S. Department of Health and Human Services that is responsible for providing direct medical and public health services to Native Americans and Inuit.
Indirect rate –
A percentage of the direct cost of proposed research that is built into organizations’ grant funding proposals.
International Classification of Disease (ICD) –
Globally used classification system for billing codes, admission and discharge records, death certificates, and other purposes.
International Health Regulations (IHR) –
A set of international regulations coordinated by the WHO that require countries to have the ability to detect, assess, report, and respond to public health situations.
Joint Commission –
A nonprofit organization involved in accrediting health care organizations and programs (formerly JCAHO).
Liquid biopsy –
A type of blood test that is capable of detecting circulating free DNA or entire cells shed by cancerous tumors.
Logic model –
A visual tool that displays the relationships among the resources, activities, outputs, outcomes, and impact for public health and community interventions.
Magnetic resonance imaging (MRI) –
An imaging tool that uses a magnetic field and computer-generated images of organs and tissues.
Mammography –
An X-ray of the breast that can be used to detect potential breast cancer.
Managed care –
A system in which administrative personnel, structures, or processes are placed between the consumer and provider of health services to ensure that the patient receives only care that is beneficial, to restrain costs, or both.
Market sector –
A portion of the economy that encompasses organizations and personnel offering similar goods or services (such as hospitals, ambulatory care facilities, pharmaceutical manufacturers, and medical devices).
Market segment –
A subcategory of individuals who have been grouped together because they share at least one common characteristic (e.g., age, geography, gender, and taste for particular products or services).
Mass market –
Products and services that are intended for a wide range of consumers.
Medicaid –
Jointly funded health insurance program by the federal government and states for low-income individuals who are elderly, disabled, pregnant, or have families with dependent children.
Medi-Cal –
California’s Medicaid program.
Medicare –
Federally funded national health insurance program for individuals over age 65, as well as disabled individuals regardless of income or age.
Medicare (A, B, C, D) –
Part A covers hospital care; Part B covers outpatient care; Part C provides an alternative route to receiving Medicare coverage through private plans (Medicare Advantage); Part D covers prescription drugs.
Medicare administrative contractor (MAC) –
A private health insurance provider that has been assigned a geographic area to process Medicare claims or Durable Medical Equipment claims for Medicare fee-for-service beneficiaries (formerly known as “Medicare Intermediary”).
Medicare Trust Fund –
A fund that is set aside to pay for current and future Medicare beneficiaries comprising two separate trust funds (the Hospital Insurance fund and the Supplementary Medical Insurance fund).
Merit-Based Incentive Payment System (MIPS) –
A program that determines Medicare payment adjustments by assigning clinicians a composite performance score.
Meritocracy –
A belief system based upon the idea that individuals who work the hardest and possess the most valuable skills should be differentially rewarded.
Meta-analysis –
An examination of multiple independent studies determining a conclusion based on the strongest of these studies.
Monopsony –
A market structure in which there is one dominant buyer.
Myocardial infarction (MI) –
Also known as a heart attack, in which one or more areas of the heart is deprived of oxygen.
National Committee for Quality Assurance (NCQA) –
A U.S.-based nonprofit organization that is focused on improving health care quality through reviews, accreditation, certification of managed care organizations, utilization review organizations, and several other types of health care organizations.
National Institutes of Health (NIH) –
A group of agencies within the U.S. Department of Health and Human Services that conducts biomedical research and funds extramural scientists.
Naturopathy –
A branch of alternative medicine that subscribes to the belief that diseases can be treated with natural remedies, rather than conventional pharmaceutical drugs.
Net cost of health insurance –
The expense of managing risk and providing financial services to the health care system’s operating units, including costs of operating an insurance entity (such as rents, employee salaries, and taxes) as well as an insurance company’s profits from underwriting.
Niche market –
Specialized products and services that are marketed and sold to consumers with unusual interests or needs.
Noncompliance/nonadherence –
Not adhering to medical advice, for example, deliberately failing to take medications or undergo diagnostic or therapeutic procedures.
Nosocomial –
An infection that occurs in a hospital (at least 48 hours after admission).
Null hypothesis –
A research hypothesis stated as the belief that there will be no difference between an experimental and a control group.
Nurses’ Health Study –
A large-scale longitudinal study that has followed several thousand nurses for the purpose of investigating lifestyle-related causes of disease.
Osteopathy –
A branch of medicine that uses manipulation of certain parts of the body to improve range of motion in joints.
Overinterpretation –
Drawing conclusions from a study for which there is some but not fully sufficient evidence.
Pandemic –
A worldwide or nearly worldwide epidemic.
Papanicolaou (Pap) test –
A screening tool used to detect the presence of cervical cancer or precancerous lesions.
Pathogen –
An organism that produces disease.
Pay for performance (P4P) –
A payment model with incentives for favorable provider performance.
Per-member per-month (PMPM) –
A monthly fixed payment for every enrollee covered by a contract.
Placebo effect –
The perceived impact of an inert substance or procedure known to have no physiological effects on a patient.
Pluralism –
The presence in a society of many distinct repositories of power and centers of decision-making or the belief that society should be organized in this fashion.
Point of service (POS) –
A type of managed care plan that offers enrollees the option of treatment by providers outside the plan.
Political culture –
The shared attitudes, beliefs, and normative judgments that characterize a society regarding the political system and political process.
Practice acts –
Laws passed at the state level that specify procedures that members of a particular profession may carry out and the areas of the body that they may treat.
Practice profiling –
A process used by insurers to measure the costs incurred by individual providers relative to others.
Preferred Provider Organization (PPO) –
A type of managed care allowing patients the option of choosing from a list of approved providers who offer services on a discounted basis.
Prevalence –
The number of individuals within a population who have (or had) a certain illness, condition, or risk factor.
Primary care –
Routine diagnostic, therapeutic, and referral services usually obtained from a family practitioner, internist, pediatrician, or advanced practice nurse in the patient’s community.
Primary prevention –
Intervention aimed at preventing disease or injury before it occurs through, for example, education, immunization, or government safety mandates.
Professionalism –
An adherence to a community’s set of standards, code of conduct, and accepted practices.
Program evaluation –
An assessment of the efficacy of organization or community investments intended to prevent illness or improve delivery of services.
Prospective payment –
A method of reimbursement where payment is fixed and predetermined, as in a managed care PMPM contract or under DRGs.
Provider –
A health professional providing direct patient care, usually empowered to make independent decisions and deliver billable services; includes physicians, advanced practice nurses, and physical/occupational/speech therapists, though not nurses.
Quality-Adjusted Year of Life (QALY) –
A statistic used to capture the value and benefit of health outcomes encompassing both life expectancy and function.
Quasi-experimental –
A type of nonrandomized study that aims to measure cause-and-effect relationships through longitudinal data, nonequivalent experimental and control groups, and other means.
Quitline –
A telephone-based health intervention that provides counseling and support to individuals trying to quit tobacco.
R0 –
Effective reproduction number (see above).
RAND Health Insurance Experiment (HIE) –
An experiment conducted by the RAND Corporation to measure the effects of cost sharing and managed care on health care costs and patient outcomes.
Randomization –
A component of experimental procedure that randomly assigns subjects to specific arms of the study.
Randomized controlled trial (RCT) –
An experimental procedure characterized by randomization of subjects to specific interventions (sometimes including a placebo group) and statistical comparison of outcomes assessed according to standard measures.
Relative risk –
A ratio of the probability of an outcome in an exposed group versus the probability of an outcome in an unexposed group.
Reliability –
In research methodology, the likelihood that the same information obtained by one method or individual will be obtained by another individual or method.
Reportable disease –
A type of disease that is required by law to be reported to local public health authorities upon diagnosis.
Reservoir (of disease) –
Any area where a pathogen lives and reproduces naturally.
Safety net provider –
An organization or individual who provides care for uninsured, underinsured, or otherwise disadvantaged to people.
Screening –
An early detection technique testing for the potential presence of disease or premorbid condition.
Secondary care –
Health services obtained from community-based specialists or hospitals, such as routine surgery.
Secondary prevention –
Medical intervention that aims to reduce the impact of a disease or injury that has already occurred (e.g., prompt treatment of existing disease).
Self-efficacy –
An individual’s belief that he/she can be effective in pursing improvements in conditions of life or human relationships.
Seroprevalence –
The proportion of people in the population who have antibodies in their blood serum indicative of disease or disease exposure.
Sick role –
The characteristics and behavior society expects from an ill person (such as avoiding social interaction and seeking medical care).
Social capital –
Networks of relationships that link individuals and facilitate working relationships among organizations and institutions.
Social insurance –
A government-run insurance program that provides coverage for everyone in a jurisdiction.
Statin –
A class of drugs prescribed to lower cholesterol, as well as reduce the risk of heart attack/stroke.
Structure –
The established patterns of command and control, information exchange, and resource allocation that provide the foundation of an organization.
Study arm –
Each group/subgroup in a clinical trial that receives a specific treatment or placebo.
Target income –
A level of income that an individual aims to earn in a certain profession.
Tertiary care –
Highly specialized or scientifically advanced interventions usually unavailable outside large, regional medical centers or university-operated facilities.
Tertiary prevention –
Medical intervention that aims to reduce the impact of an ongoing illness or injury that has lasting effects (such as chronic disease management programs, support groups, and vocational rehabilitation).
Third-party payers –
An entity (public or private) that pays medical claims on behalf of policyholders or beneficiaries.
Triage –
A process in which patients are sorted and queued according to the seriousness or urgency of their condition.
Tricare –
A health insurance program employed by the Department of Defense for active servicemembers, military retirees, and their families.
Tuskegee –
The location of a U.S. Public Health Service/CDC sponsored program from 1932 to 1972 to study untreated syphilis in Black men.
U.S. Preventive Services Task Force (USPSTF) –
A federally sponsored body of physicians, scientists, and experts tasked with integrating research findings related to prevention and developing recommendations for clinical preventive services.
Underinsurance –
A situation in which individuals possess health insurance that does not offer adequate financial protection.
Underwriting –
A process where a bank, insurance company, or investment firm assumes financial risk of entities or individuals (e.g., financial risk associated with illness, injury, or death).
Uninsurance –
Lack of health insurance coverage.
Upstream determinants of health –
Issues that can affect the health of a community in the long run, such as public safety, access to health care, employment opportunity, education, and housing.
Upstream resources allocation –
A government regulation or restriction on the deployment of new technology or resources for the purpose of controlling system costs.
Utilization review (UR) –
A review of the health care services provided, which is then used by payers to manage costs and quality of care.
Vaccine hesitancy –
Delaying or refusing vaccines despite the availability of vaccination services.
Validity –
The ability of a research design to definitively test a hypothesis or of a metric to accurately reflect a phenomenon of interest, such as physical function.
Value-based health care –
A health care delivery model that compensates providers based on indicators and correlates of patient health and well-being.
Vector –
A carrier of a pathogen, parasite, or adverse genetic material.
Veterans Affairs (U.S. Department of) –
A federal agency providing health care services and other benefits to military veterans.
Vital status –
The body temperature, pulse rate, respiration rate, and blood pressure of the patient.
Voluntary hospital –
Also known as community hospitals, facilities historically funded through voluntary donations rather than government or private industry.
Wholistic –
A view of health care that takes into consideration the “whole” individual, such as the physical, emotional, and mental health of the patient, into account; often designating unconventional or “alternative” practice.
World Health Organization (WHO) –
An agency within the United Nations that is tasked with overseeing international public health and health promotion.
Zoonotic –
An infectious disease that is transferred from animals to humans.
ABBREVIATIONS
ACA
Affordable Care Act (also, “Patient Protection and Affordable Care Act”)
ACO
Accountable Care Organization
BRFS
Behavioral Risk Factor Survey
CAM
Complementary and Alternative Medicine
CHIP
Children’s Health Insurance Program
CMS
Centers for Medicare and Medicaid Services
CON
Certificate of Need
DRG
Diagnosis Related Group (also, “Diagnostic Related Group”)
DSM
Diagnostic and Statistical Manual of Mental Disorders
EHR
Electronic Health Record
FFS
Fee-for-Service
FOBT
Fecal Occult Blood Test
FQHC
Federally Qualified Health Center
GDP
Gross Domestic Product
GISRS
Global Influenza Surveillance and Response System
HEDIS
Healthcare Effectiveness Data and Information Set
HIE
Rand Health Insurance Experiment
HMO
Health Maintenance Organization
ICD
International Classification of Diseases
IHR
International Health Regulations
IHS
Indian Health Service
JCAHO
Joint Commission on Accreditation of Healthcare Organizations (now “Joint Commission”)