Here are some common terms, acronyms and definitions related to healthcare transformation efforts in Washington. This is not a comprehensive list. This information comes from a variety of sources. In some cases, definitions may vary. For a more comprehensive list of terms, please CLICK HERE
1115 Waiver: 1115 waivers refer to section 1115 of the Social Security Act, which gives the Secretary of Health and Human Services authority to approve experimental, pilot, or demonstration projects that promote the objectives of the Medicaid and Children’s Health Insurance Program (CHIP) programs.
Oregon’s transition to coordinated care organizations was approved under an 1115 waiver.
These demonstrations give states additional flexibility to design and improve their programs and evaluate policy approaches such as expanding eligibility, providing services not typically covered by Medicaid, or using innovative service delivery systems that improve care, increase efficiency, and reduce costs. Provisions of the Social Security Act, or federal regulation for Medicaid managed care may be “waived” through the demonstration.
Accountable Community of Health (ACH): A model for improving health and health equity that uses regional, cross-sector collaboration to align resources and activities to address whole person health and wellness.
ACHs bring together leaders from multiple public and health sectors around the state with a common interest in improving health and health equity. ACHs work regionally to align resources and activities; they improve the delivery of whole-person health and wellness. Washington State has nine ACH regions.
Adverse Childhood Experiences (ACE’s): Refers to associations between childhood maltreatment and later-life health and well-being.
ACEs are categorized into three groups: abuse, neglect, and family/household challenges. Each category is further divided into multiple subcategories. The ACE score, a total sum of the different categories of ACEs reported by participants, is used to assess cumulative childhood stress. Study findings repeatedly reveal a relationship between ACEs and negative health and well-being outcomes – as the ACES score increases, so does the risk for multiple health issues including alcoholism/abuse, depression, heart disease, poor work or academic performance, smoking, etc.
Apple Health: The brand name for Medicaid in Washington State.
Bi-Directional Integration: Describes the integration of Physical and Behavioral Health. A flexible model of care intended to increase access to physical and behavioral health care through a “no wrong door” approach. Strategies may include: enhanced communication between practices and providers (care coordination), referrals and consultation; co-location, telehealth, routine use of evidence-based screening tools, cross-training between disciplines, and an interest in addressing all of an individual’s needs in the setting of their choice.
Clinical-Community Linkages: A priority focus in Healthier Washington of connecting health care providers, community organizations, and public health agencies so they can improve patients’ access to preventive and chronic care services.
Community Health Worker/Advocate (CHW/CHA): A frontline public health worker who is a trusted member of their communities.
Early Adopter: The Southwest Washington regional service area (Clark and Skamania Counties) opted to be an “early adopter” of fully integrated contracting for physical and behavioral health care beginning April 2016. It was the only region of the state to do so. State law calls for fully integrated managed care to be implemented for Apple Health (Medicaid) statewide by 2020.
Electronic Health/Medical Record (EHR/EMR): Computerized records of patient’s health information including medical, demographic and administrative data.
EHR are designed to reach out beyond the health organization that originally collects and compiles the information. They are built to share information with other health care providers, such as laboratories and specialists and contain information from all the clinicians involved in the patient’s care. The National Alliance for Health Information Technology stated that EHR data “can be created, managed, and consulted by authorized clinicians and staff across more than one health care organization.”
EMR are digital versions of the paper charts in the clinician’s office. An EMR contains the medical and treatment history of the patients in one practice. The information in EMRs does not travel easily out of the practice. In fact, the patient’s record might even have to be printed and delivered by mail to specialists and other members of the care team.”
Fee-For-Service (FFS): A method in which doctors and other health care providers are paid for each service performed. Examples of services include tests and office visits.
Fully Integrated Managed Care (FIMC): Washington’s terminology for regions that have consolidated physical health and behavioral health services into a single contract.
Health Care Authority (HCA): The Washington State Health Care Authority purchases health care for more than 2 million Washington residents through two programs — Washington Apple Health (Medicaid) and the Public Employees Benefits Board (PEBB) Program.
Health Information Technology (HIT): Information processing involving both computer hardware and software that deals with the storage, retrieval, sharing, and use of health care information, data, and knowledge for communication and decision making.
Healthier Washington: A state initiative aimed at transforming health care so that people experience better health and receive better, more affordable care by 2020. It is the operational work of the State Health Care Innovation Plan (SHCIP) developed to apply for a federal State Innovation Model (SIM) grant.
Managed Care Organization (MCO): A health care delivery system consisting of affiliated and/or owned hospitals, physicians and others which provide coordinated health services to assigned patients in return for a predetermined monthly fee or other shared risk or savings incentives.
Medicaid managed care provides for the delivery of Medicaid health benefits and additional services through contractual arrangements between state Medicaid agencies and managed care organizations (MCOs) that accept a set per member per month (capitation) payment for these services.
Medication Assisted Treatment (MAT): Medication Assisted Treatment for opioid use disorder. MAT is the use of FDA-approved medications, in combination with therapy and other “whole person” approaches, to treat substance use disorders (SUD).
Mid Adopter: Refers to ACH regions in Washington that will pursue financial integration for the region before 2020. ACHs that “go mid-adopter” are eligible for additional financial incentives from the state. Klickitat County will become a mid-adopter in 2019.
Opioid Use Disorder (OUD): Opioid use disorder is a medical condition characterized by a problematic pattern of opioid use that causes clinically significant impairment or distress. It often includes a strong desire to use opioids, increased tolerance to opioids, and withdrawal syndrome when opioids are abruptly discontinued. There is growing consensus that it is a chronic brain disease.
Patient-Centered Medical Home (PCMH): A model or philosophy of primary care that is patient-centered, comprehensive, team based, coordinated, accessible and focused on quality and safety.
Pay for Performance Measures (P4P): Also called “paying for value,” this is a strategy aimed at changing how we pay for health care. It moves away from the traditional fee-for-service approach to payment for how well providers perform. This can include patient satisfaction and a track record of helping people achieve health.
Quadruple Aim: “Developed by the Institute for Healthcare Improvement, the Triple Aim framework describes an approach to optimizing health system performance, under which health system transformation efforts should simultaneously pursue three dimensions:
· Improving patient experience of care (quality and satisfaction)
· Improving the health of populations
· Reducing the per capita cost of health care
· Improve the experience of health care workers.”
RHNI: Regional Health Needs Inventory – are an inventory by Accountable Communities of Health (ACHs) that takes a data-driven approach to project selection, design, and implementation. Under the Medicaid Transformation Demonstration, ACHs must gather, review, and interpret information about the health status, systems, and capacity of their region.
RSN: Regional Support Network (for Mental Health) – are entities responsible for the administration and purchase of public mental health services within their geographic region. As of April 1, 2016, the RSNs transitioned into BHOs.
Social Determinants of Health (SDOH): The complex, integrated and overlapping social structures and economic systems that are responsible for most health inequities. These social structures and economic systems include the social environment, physical environment, health services, and structural and societal factors. They are shaped by distribution of money, power, and resources.
Substance Use Disorder (SUD): Refers to the recurrent use of alcohol and/or drugs causing clinically and functionally significant impairment, such as health problems, disability, and failure to meet major responsibilities at work, school, or home.
Value Based Payment/Purchasing (VBP): A strategy used by health care purchasers to promote quality and value of health care services. The goal is to shift from volume-based payment (e.g., fee for service) to payments that are more closely related to outcomes (e.g., bundled payments, pay for performance, etc.). There are many types of VBP, which may also be referred to as Alternate Payment Methodology (APMs).
Whole-Person Care: Expanded health care delivery that links patients to comprehensive physical, behavioral and substance use disorder care. Examples of whole-person care can include nutrition, housing, child-care, neighborhood safety, chronic disease prevention, social supports, substance use, etc.