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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.

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.

Quadruple Aim
Quadruple Aim

Quadruple Aim

Definition: Quadruple Aim is the expansion of the Triple Aim (enhancing patient experience, improving population health, and reducing costs) to include an additional goal of improving the work life of health care providers.1 Organizations view this expansion in different ways, but the Institute for Healthcare Improvement calls this new aim “Joy in Work.”1 Many health care organizations have adopted the framework of the Triple Aim, but the stressful work life of clinicians and staff has proven to play a large role in the ability to achieve and maintain the 3 aims. In primary care, the adoption of the Triple Aim has enhanced the patient experience, but resources are lacking to help providers and staff maintain these overarching goals. Professional burnout and reduced job satisfaction have hindered the ability of providers and staff to provide quality care.2 Therefore, a fourth aim focusing on the improvement in work life of clinicians and staff has been proposed to create a more symbiotic relationship between patients and health care providers.

Social Determinants of Health (SDOH)

Social Determinants of Health (SDOH)

According to CDC, SDOH are “conditions in the places where people live, learn, work, and play that affect a wide range of health and quality-of-life-risks [sic] and outcomes.”1 These factors can impact patient access to and understanding of health care. They may also impact the extent to which a patient or population is able to engage in their health care and healthy living.

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