Healthcare Reform: Terms You Should Know – Part 2

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May 31st, 2012
Categories: Healthcare Reform

Earlier this month we released part one of Health Reform Glossary Terms you should  know. If you didn't get a chance to take a look at part one, click here to get up to speed. Below, is part two; part three will be coming soon!

Part 2 - Healthcare Reform Glossary - Terms E through I

E

Early Retiree Reinsurance Program – The Early Retiree Reinsurance Program (ERRP) is a temporary $5 billion program established by the Patient Protection and Affordable Care Act. Its purpose is to help businesses and unions cover the healthcare costs of Medicare-ineligible early retirees, their spouses, and other dependents. It provides 80 percent of claims costs for benefits between $15,000 and $90,000 starting with the 2010 calendar year.

Electronic Medical Record/Electronic Health Record – Electronic medical records (EMRs) and electronic health records (EHRs) are computerized records maintained centrally by a medical practice or health center to keep track of patient care. EMRs are electronic versions of a patient’s paper medical chart and maintain a patient’s medical history over time, including patient demographics, clinical notes, prescriptions and registries, web applications, and connection to personal health records kept by patients. They are usually constructed so the data can be part of other systems such as clinical workflow and decision support and possess the ability to safely exchange health information between entities such as collaborating providers.

Employer Mandate/Pay or Play – This Patient Protection and Affordable Care Act mandate requires employers to either offer minimal levels of health insurance coverage to their employees or pay a fine, which in turn will subsidize health insurance for those without access. This part of the health reform law will go into effect for plan years beginning on or after 1/1/2014 and for employers with 50 or more full-time employees who choose not to provide group coverage and have at least one employee obtaining federally subsidized coverage through a health insurance exchange.

E-prescribing – According to the Centers for Medicare and Medicaid, e-prescribing is, “a prescriber’s ability to electronically send an accurate, error-free and understandable prescription directly to a pharmacy from the point-of-care.” Studies have demonstrated that replacing handwritten prescriptions with this electronic transmission greatly reduces medication errors.

Evidence-Based Medicine – Much of the care delivered today has been simply based on expert opinion. Evidence-Based Medicine’s (EBM)’s charge is to deliver care that has strong scientific validation. Ideally this term refers to the synthesis of individual, first-hand clinical experience with evidence garnered by external systematic research to create best practices in care delivery. It involves the interested clinician or organization asking a specific care question and then proceeding to systematically review published research to find practices backed by concrete data.

Expanded Coverage – A significant goal of the Affordable Care Act is near universal coverage. To accomplish this, a mandate requiring most U.S. citizens and legal residents to have health insurance is included. There are individual regulations that support this initiative by:

  • Expanding Medicaid coverage
  • Removing bans on coverage of individuals with pre-existing conditions
  • Setting required groundwork for the formation of state-based health insurance exchanges
  • Supplying assistance for individuals to procure insurance
  • Expanding coverage of dependents up to age 26

G

Global Payments (Global Capitation) – Global payments (global capitation) are fixed payments for which providers are given a pre-specified amount per patient (dependent on demographic data and other considerations) for a time period such as a month or a year. This payment schema places the burden of risk on the provider who will be responsible for delivering comprehensive acute, chronic, and preventive care during that time period for that all-inclusive payment.

H

Health Information Exchange and Interoperability – A Health Information Exchange (HIE) is an initiative focused on the electronic exchange of healthcare data between healthcare stakeholders. The exchange typically includes clinical, administrative, and financial data across a medical care and coverage area. Interoperability refers to the ability to connect to two or more disparate systems, for example, a disease registry and a payer claims database, for the sharing of permissible secure information via standardized protocols and exchanges.

Hospital Value-Based Purchasing/Pay for Performance – These programs are established to reward providers of care for better results. They require the care-providing organizations have a system of accurate measurements to gauge performance (i.e., a hospital measuring readmission rates). If the organization achieves established goals set by a program sponsor, the organization receives an incentive payment. Organizations can also receive lower remunerations for poor outcomes.

I

Individual Coverage Market – For people unable to receive health coverage through their employer or the government, the Affordable Care Act legislation will create a competitive marketplace for buying coverage from insurers at the state-specific level.

Integrated Healthcare Delivery System – An integrated delivery system (IDS) is a network of healthcare providers and organizations that provide or arrange to provide a coordinated continuum of services. Services provided by an IDS can include a fully equipped community and/or tertiary hospital, home healthcare and hospice services, primary and specialty outpatient care and surgery, social services, rehabilitation, preventive care, and health education (Washington Hospital Association).