Healthcare Reform: Terms You Should Know – Part 3

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June 21st, 2012
Categories: Healthcare Reform

Earlier we released two parts of our three part series of Health Reform Glossary Terms you should  know. If you didn't get a chance, take a moment to read parts one and two. Below, is the last and final hoorah, part 3.

Part 3 - Healthcare Reform Glossary Terms M through V


Meaningful Use – The 2009 Health Information Technology for Economic and Clinical Health Act (HITECH Act) is part of the American Recovery and Reinvestment Act (ARRA) which included funding for Medicare and Medicaid incentives for the ‘Meaningful Use” (MU) of certified electronic health records (EHRs). The intent of the legislation is to promote the use of EHR technology to:

  • Improve quality, safety, efficiency, and reduce health disparities
  • Engage patients and families in their healthcare
  • Enhance care coordination
  • Support population and public health

Medical Loss Ratio – This is the fraction of the collected insurance premium revenue dedicated to providing health services and improving the quality of care compared to the total revenue that includes expenditure for business administration, marketing, and profit.

Medicare Drug Coverage Gap/“Donut Hole” – This is a voluntary medication benefit program that started in 2006. Participants with a standard plan have 75 percent of their drug costs covered until they reach a cost of $2,830. Any expense higher than this is paid out of pocket until the cost reaches $4,550. Once costs reach this amount, 95 percent of costs are covered by Medicare.


Patient Registry – To deliver the most appropriate care to specific cohorts within a population, providers are encouraged to keep lists of patients who have common conditions or concerns. These registries can be paper-based or preferably computerized. With these lists, physicians and other providers can institute disease or condition management programs for patients with illness burdens or track others for their completion of appropriate screenings, for example.

Patient Safety – The domain dedicated to preventing and reducing the harm that may be caused during a patient’s interaction with the medical system. This can help improve healthcare outcomes while reducing costs.

Payment Integrity – Payment integrity is the process by which the correct payments for the correct covered lives, for the correct services are paid to the correct provider(s). This process involves detecting and minimizing fraud, waste, abuse, and misuse of healthcare dollars.

Personal Health Record – A personal health record (PHR) is a patient’s healthcare profile. Unlike an electronic medical record or electronic health record, these data are collected and maintained by the individual. In the future, PHRs will be electronically connected to provider EHRs for secure and private exchange of approved information.

Pre-existing Conditions – Pre-existing conditions are health concerns that exist prior to an individual’s enrollment in a health plan. Historically, illness burden has precluded an individual from qualifying for coverage or finding affordable rates.

Preventive Services – Preventive care services have a threefold purpose. They can reduce health risks by engaging in wellness promotion. They can promote screening or testing to ensure early detection and diagnosis of conditions, and they can provide interventions to prevent disabilities, mortality, and morbidity caused by disease.


Risk Pool – If individuals had to pay for their healthcare costs each year without insurance, some families would become bankrupt when faced with a catastrophic illness and a very large medical bill. The insurance industry was born to help large groups of people share the risk burden each year. Each participant bears only a fraction of the total risks and costs through premium insurance payments by joining the risk pool.


Telehealth – Telehealth is the practice of using electronic information systems with telecommunications technology to support the long-distance delivery of care. The practice of telehealth gives care providers the ability to diagnose, receive, and transfer appropriate health data, address questions, provide information, and oversee treatments and therapies for patients who are difficult to care for face to face (i.e., location).

The Accountable Care Organization – An Accountable Care Organization (ACO) is a care-delivery model in which physicians, specialists, and hospitals are aligned in providing efficient and effective care for a patient population. Instead of the present fragmented, fee-for-service delivery of care, this model emphasizes collaboration of providers accountable for the health status and outcomes of care provided to their panel of patients.

The Patient-Centered Medical Home – A Patient-Centered Medical Home (PCMH) is a model of care by which a personal primary care physician, who has an ongoing trusted relationship with a patient, provides comprehensive and continuous care with care coordination to meet the patient’s multiple care needs including: wellness, risk reduction, preventive services, as well as acute, chronic, and end-of-life care. This model focuses on improving accessibility, comprehensiveness, collaboration, record-keeping, patient safety, and the quality of care for the patients treated within them.


Value-Based Insurance Design – Recent studies demonstrate that health outcomes can be influenced by a patient’s insurance coverage and benefit policy. Therefore it is possible to design insurance packages that improve outcomes and add value. An example of this involves identifying effective clinical practices and reducing the financial barriers associated with those treatments and services encouraging greater adherence with care protocols.