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Learn The Lingo

Learn the Lingo: Key Terms for Navigating the Value Based Care World

With the shift toward value-based payment models, pharmacists are seizing new opportunities to improve patient care in medical homes, accountable care organizations, and other innovative care models. This resource includes acronyms and terminology commonly used when practicing in or discussing innovative practice models. Each term includes a short description and references so you can further your practice in a value based care world. This is the first of multiple volumes that will be published by the Medical Home/ACO SIG.

Consumer Assessment of Healthcare Providers and Systems (CAHPS)

Consumer Assessment of Healthcare Providers and Systems (CAHPS)

Consumer Assessment of Healthcare Providers and Systems (CAHPS) is an Agency for Healthcare Research and Quality (AHRQ) program that has conducted research and developed standardized surveys to gather information about patients’ experiences with health plans, providers, and facilities.1,2 CAHPS surveys are designed with standardized questions to ensure valid comparison of data across health care settings.3 These surveys collect patients’ perceptions of various aspects of health care including, but not limited to, communication with doctors, ability to schedule appointments in a timely manner, level of coordinated care and ease of access to information, etc.1

Patients are asked to complete the surveys either through mail or online, with additional follow-up by telephone for individuals who do not initially respond. On average, surveys take 15 minutes to complete.

Incident to Services

Incident to Services

“Incident to” services are defined as services that are furnished as an integral, although incidental, part of a physician’s professional services in the physician’s office (whether located in a separate office suite or within an institution) or in a patient’s home.1,2 In the Medicare program administered by the Centers for Medicare and Medicaid Services (CMS), auxiliary personnel such as pharmacists; nurses; and nonphysician practitioners (NPPs) like physician assistants, nurse practitioners, or clinical nurse specialists can provide some services traditionally performed by physicians in certain practice settings under incident to services arrangements.1,2 These services must be part of a patient’s normal course of treatment and are billed by the CMS-recognized provider under that provider’s National Provider Identifier (NPI).1,2

Medicare Administrative Contractor (MAC)

Medicare Administrative Contractor (MAC)

A Medicare Administrative Contractor (MAC) is a private health care insurer responsible for managing policies and processing Medicare Part A, Medicare Part B, and durable medical equipment (DME) claims for Medicare Fee-For-Service (FFS) beneficiaries.1

NCQA Patient-Centered Medical Home Recognition

NCQA Patient-Centered Medical Home Recognition

The National Committee for Quality Assurance (NCQA) establishes quality standards and guidelines for health plans, providers, and practices with a mission of improving the quality of health care. NCQA conducts various programs, including but not limited to measure development for the Healthcare Effectiveness Data Information Set (HEDIS), accreditation, credentialing, and recognition programs. One of the most well-known recognition programs distinguishes a practice as a patient centered medical home (PCMH). There are 3 PCMH level designations. 

Pharmacy Quality Alliance (PQA)

Pharmacy Quality Alliance (PQA)

The Pharmacy Quality Alliance (PQA) is an independent, nonprofit national organization dedicated to improving medication safety, adherence, and appropriate use. A measure developer, researcher, educator and convener, PQA’s quality initiatives support better medication use and high-quality care.

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