Accountable Care Collaborative (ACC) Colorado’s Medicaid primary health care program is designed to improve health and health patients access the services needed to stay health. The ACC model is based on clinicians sharing information across the continuum to coordinate care, applying evidence-based medicine, manage patient populations, and collaborate to align incentives while patients are encouraged to take an active role in their own care.
Accountable Care Organization (ACO) A health care organization characterized by a payment and care delivery model that seeks to tie the provider reimbursements to quality metrics and reductions in the total cost of care for as assigned population of patients. The goal of coordinated care is to ensure that patients, especially the chronically ill, receive the right care, at the right time, while avoiding unnecessary duplication of services and preventing medical errors.
Affordable Care Act (ACA) ACA is used to refer collectively to two pieces of legislation – the Patient Protection and Affordable Care Act of 2018 (P.L. 111-148) and the Health Care Education Reconciliation Act of 2010 (P.L. 111-152). The ACA was enacted to increase the quality and affordability of health insurance, lower the uninsured rate by expanding public and private insurance coverage, and reduce the costs of health care for individuals and the government.
Behavioral Health Organization (BHO) An organization that arranges for a member to get medically necessary behavioral health services. The community behavioral health services in Colorado is statewide and provides mental health and substance abuse disorder services to all Colorado Medicaid members. Each Medicaid member is assigned to a BHO based on where they live.
Behavioral Health Provider (BHP) A mental health or substance abuse treatment provider such as a psychiatrist, social worker, psychologist, licensed chemical dependency counselor or psychiatric nurse.
Bi-directional Integration – Addressing the need for primary care services in behavioral health settings as well as the need for behavioral health services in primary care settings.
Care Coordination Care coordination is the deliberate organization of patient care activities between two or more participants (including the patient) involved in a patients care to facilitate the appropriate delivery of health care services. Organizing care involves the arranging of resources needed to carry out all required patient activities, and is often managed by the exchange of information amongst participants responsible for different aspects of care.
Care Management A set of evidence based integrated care practices in which patients are educated about behavioral health and/or physical health and regularly monitored for their response and treatment adherence.
Clinical Health Information Technology Advisor (CHITA) An expert in data capture and data reporting. The CHITA becomes familiar with the electronic health record (EHR) platform in each practice to understand how best to report clinical data that document measures that matter to the practice. The CHITA supports practice workflow as it relates to effective data capture in the HER, provide oversight and analysis is of consistent data entry across practices to enhance the ability to accurately measure and report on key metrics. The CHITA and the practice facilitator/coach work together closely to optimize their respective skills for the benefit of the practice.
The CHITA and the practice facilitator/coach work together closely to optimize their respective skills for the benefit of the practice.
Co-location or Colocation An integrated healthcare approach in which both physical and mental health providers are located in the same building or the same premises in which both physical and mental health providers are located in the same building or on the same premise to increase access to those services and to reduce the stigma of seeking mental health treatment.
Colorado Health Extension Service (CHES) A collaborative, multi-stakeholder organization that seeks to improve health and health across Colorado through: 1) supporting redesign and innovation in primary care practices, improving their readiness for new payment models through practice transformation support and infrastructure development; 2) promoting local collaboration among healthcare providers, community groups, patient advisory groups, local public health offices, and public health agencies; and 3)facilitating local or regional efforts to improve healthcare to meet the Triple Aim of improving quality, improving experience of healthcare, and reducing costs.
Colorado Regional Health Information Organization (CORHIO) A nonprofit organization that provides secure health information exchange (HIE) services, as well as the convener of the Colorado Regional Extension Center (REC) to support the meaningful use and adoption of EHRs. CORHIO operates as one of two HIEs for the state of Colorado.
Community Health Center (CHC) See Federally Qualified Health Center (FQHC) definition.
Comorbidity The co-existence of two or more illnesses at the same time.
Coordinated Care Integrating the efforts of medical, behavioral health, and social service providers while addressing an individual’s health and wellness.
Federally Qualified Health Center (FQHC) Organizations that receive grants, or qualify to receive grants (FQHC look-alikes), under section 330 of the Public Service Act (PHS). FQHCs qualify for specific reimbursement systems from Medicare and Medicaid, as well as other benefits. FQHCs must offer services to all persons, regardless of ability to pay, serve an underserved area or population, offer a sliding fee scale, provide comprehensive primary care services, have an ongoing quality assurance program, and have a governing board of directors that is made up of at least 51 percent consumers. In Colorado, the terms FQHC and Community Health Center are used interchangeably.
Health Information Exchange (HIE) A system that allows doctors, nurses, pharmacists, other healthcare providers and patients to appropriately access and securely share a patient’s vital medical information electronically.
Health Information Technology (HIT) The umbrella framework to describe the comprehensive management of health information across computerized systems and its secure exchange between consumers, providers, government and quality entities, and insures.
Health Information Technology for Economic and Clinical Health (HITECH) Act The HITECH Act, enacted as part of the American Recovery and Reinvestment Act of 2009, was signed into law on February 17, 2009, to promote the adoption and meaningful use of health information technology.
Institute for Healthcare Improvement (IHI) An independent nonprofit organization that is a leading innovator, convener, partner and driver or health care improvement worldwide. They developed the Triple-Aim-a framework within which a health system's performance is optimized.
Integrated Healthcare The care that results from a practice team of primary care and behavioral health clinicians, working together with patients and families, using a systematic and cost-effective approach to provide patient-centered care for a defined population. This care may address mental health and substance abuse conditions, health behaviors (including their contribution to chronic medical illnesses), life stressors, and crises, stress-related physical symptoms, and ineffective patterns of health care utilization.
Integrated Practice Assessment Tool (IPAT) A tool that uses a decision tree to determine the readiness of a practice to enter into collaboration/integration. The tool rates a practice on a scale of 1 (pre-coordinated care) to 6 (fully integrated care).
Learning Collaborative A group of practice teams who collectively agree to work together to achieve a specific aim for the group as a whole. In order to reach the aim, all members of the collaborative gather in “learning sessions” to share what has worked and not worked. Sometimes, Learning Collaborative is used to refer to the gathering of practice teams to engage in peer-to-peer learning and sharing.
Learning Session An identified meeting or period of time dedicated to particular activity aimed at convening members of a group who share what has worked and not worked related to a specific aim.
Meaningful Use (MU) The measureable benchmarks providers must meet to qualify for incentive payments under the Health Technology of Economic and Clinical Health (HITECH) Act.
Mental Health A state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.
Mental Illness Refers to disorders generally characterized by dysregulation of mood, thought, and/or behavior, as recognized by the diagnostics and Statistical Manual (DSM-currently 5th edition) of the America Psychiatric Association.
Patient Centered Medical Home (PCMH) According to the American College of Physicians (ACP) a Patient-Centered Medical Home is a team-based model of care led by a personal physician who providers comprehensive, continuous and coordinated care throughout a patients’ lifetime to maximize health outcomes.
Patient Registry A log or database of all patients in a clinic or practice who have a particular illness or condition.
Practice Facilitator/Quality Improvement Advisor/Quality Improvement Coach/Quality Improvement Specialist A person who works with practice teams to facilitate practice change that includes many aspects of care delivery: team-based care, population management, coordination and care management, patient engagement, building medical neighborhoods, and others. These teams are often used inter changeable in Colorado.
Practice Support Practice facilitator provide support in the areas of HIT/HIE, medical home transformation, help with business processes, qulity0improvement initiatives. Practice support varies significantly in pace, intensity, duration and content.
Practice Transformation Substantive change in how care is delivered in preparation for substantive change in how care is compensated. Evolving payment models will be based on demonstrated value of care, not activities of care. These changes include evolving to a model of practice, planned care, as opposed to episodic, reactive care; using registry functionality to identify gaps in care, outreach to patients to address gaps in care; using registry functionality to identify gaps in care; using data to improve processes of care; and developing patient panels assigned to practice care teams to enhance continuity of care. Other changes may include new roles and responsibilities, different workflows, and new positions within the practice such as care managers of behavioral health professional.
Practice Transformation Organization (PTO) An organization that provides support services to medical practices in the area of practice facilitation, HIT/HIE support, change management, and quality-improvement activities.
Primary Care The basic, entry-level health care provided by physicians or non-physician health care practitioners that is generally provided in an outpatient setting.
“Comprehensive primary care”, at a minimum, includes providing or arranging for the provision of the following services on a year-round basis: Primary health care; maternity care, including prenatal care; preventive developmental, and diagnostic services for infants and children; adult preventive services, diagnostic laboratory and radiology services; emergency care for minor trauma; pharmaceutical services; and coordination and follow up for hospital care.
Based on Comprehensive Primary Care definition from Colorado Indigent Care Program (CICP) from 25.5-3-203 (1) C.R.S.
Primary Care Medical Provider (PCMP) PCMPs are doctors, nurses, nurse practitioners and physician assistants that act as the “medical home” to patients participating in the Colorado ACC.
Quality Health Network A quality-improvement organization that provides secure electronic health information exchange (HIE) services to support the meaningful use and adoption of EHRs. QHN operates as one of two HIEs for the state of Colorado, with its focus on the Western Slope.
Quality Improvement (QI) QI consists of systematic and continuous actions that lead to measureable improvement in health care services and the health stats of targeted patient groups.
Quality Improvement Initiative Process improvement projects for a defined, limited scope objective; for example, breast cancer screening.
Regional Care Collaborative Organization An organization that provides coordinated care of Colorado Medicaid clients by connecting them PCMPs and other community-based services.
Regional Health Connector (RHC) previously referred to as Health Extension Agent. A person who provides as essential connector for function among health-related organizations in the region to promote improvement of the health of the community; builds ongoing supportive relationships with primary care practices including assessing practice needs and connecting the practice to appropriate resources that may include practice facilitation, HIT support, local public health agencies, and community resources to support patients.
State Innovation Model (SIM) A nationwide effort to build an innovative and integrated system of health care services. Colorado is one of a number of states to receive SIM funding. The initial award of $2 million in 2013 supported preliminary efforts to develop a system of physical and behavioral health integration. In December 2014, the State was awarded $64 million over four years to “create coordinated, accountable system of care that gives Coloradoans access to integrated primary care and behavioral health.”
Triple Aim A framework developed by the Institute for Healthcare Improvement (IHI) that describes an approach to optimizing health system performance. Its IHI’s belief that new designs must be developed to simultaneously pursue three dimensions, which they call the “Triple Aim”: 1) improving the patient experience of care (including quality and satisfaction); 2) improving the health of populations; and 3)reducing the per capita cost of health care.
Value-Based Payment A strategy used by purchasers to promote a quality and value of health care services with the goal of shifting from volume-based payment to payments aligned with outcomes.