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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.

Medicare Shared Savings Program

Medicare Shared Savings Program

The Medicare Shared Savings Program (Shared Savings Program or MSSP) is a program developed by CMS in 2012 that enables providers and suppliers of health care such as physicians and hospitals to set up an accountable care organization (ACO). The Shared Savings Program is a novel Medicare payment model which shifts away from the focus on volume-based reimbursement metrics and toward improved patient outcomes and increased value (value-based care). Under the MSSP, the ACO is charged with serving an assigned FFS Medicare beneficiary population, with a focus on improving patient outcomes while reducing cost of care. The Shared Savings Program holds ACOs accountable to certain standards while providing patient care, including quality, cost, and patient experience. These metrics are tied to the ACO’s reimbursement for services provided.

Patient-Centered Medical Home (PCMH)

Patient-Centered Medical Home (PCMH)

According to the Agency for Healthcare Research and Quality (AHRQ), a PCMH is a model of the organization of primary care that delivers the core functions of primary health care.1 They are also often called medical homes, primary care medical homes, medical neighborhoods, advanced primary care practices, and patient-centered health care homes. In adopting the PCMH model, primary care practices transform their practice to integrate the following functions.

Population Health

Population Health

Population Health refers to the outcomes of a group of individuals with similar characteristics—including the distribution of such outcomes within the group—and the role of health determinants. These health determinants can include medical care, public health, social environment, genetics, and individual behavior.1 According to the Centers for Disease Control and Prevention (CDC), population health allows for health care organizations to collaborate and improve outcomes in the community.

Primary Care First/Seriously Ill Population

Primary Care First/Seriously Ill Population

Primary Care First is a set of payment model options that aims to financially incentivize value and quality of care for Medicare beneficiaries seen in the primary care setting, especially those with complex medical conditions.1 The principles of this model are similar to those of current Comprehensive Primary Care Plus (CPC+) models, especially in terms of prioritizing the primary care provider–patient relationship, financially rewarding improvement in health outcomes, and reducing administrative burden.

Public Health

Public Health

Public health is defined as “the science and art of preventing disease, prolonging life, and promoting health through the organized efforts and informed choices of society, organizations, public and private communities, and individuals”.1 Health determinants (the personal, economic, social and environmental factors that affect health) can play a role in public health due to certain populations potentially being more predisposed to particular conditions due to genetics, health behaviors, social or societal characteristics, and availability and quality of health services or medical care.2 The aims of public health are prevention and health promotion. Prevention is aimed at reducing the risk of disease, such as modifying risk factors, using screenings to find disease in its early stages, and immunizations, while health promotion is directed at modifying behaviors of individuals at risk.

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