Glossary of Shared Accountability Terms
18 Shared Commitments. Providers who participate in Intermountain’s shared risk networks—such as the
SelectHealth Share networks and the Intermountain Align Network—agree contractually to “18 Shared
Commitments,” which support a high-value healthcare delivery model and Intermountain’s Shared
Accountability strategy. The commitments focus on:
1. Clinical excellence, integration, and improvement
2. Patient access
3. Accountability, operational commitment, and mutual respect
For example, providers agree to use evidence-based standards; refer within the shared risk panel when
clinically appropriate; accept accountability for performance on quality, service, and cost; participate in an
incentive compensation program; and share performance data with Intermountain and other providers.
ACA. See Patient Protection and Affordable Care Act (PPACA).
ACO. See “Accountable Care Organization.”
Accountable care. In healthcare delivery, the concept of providers (healthcare delivery organizations, hospitals,
clinics, physicians, other clinicians, etc.) assuming financial risk (“being accountable”) for the health
management and outcomes of a defined population. In the past, providers generally have been paid based on
services provided, and financial risk generally has been assumed by payers such as insurers. The assumption of
risk by providers typically is accomplished primarily through some form of prepayment (and/or capitated
payment) model, where the providers receive a prepayment to manage the health of a defined population and
retain, as income, monies in excess of expenses. See also “ACO,” “Population Health Management,” and
“Shared Accountability.”
Accountable Care Organization (ACO). An ACO is a provider organization that takes responsibility for managing
the health and care of a defined population of patients; the idea is to incentivize caregivers within the ACO to
provide effective, high-value care. The U.S. Centers for Medicare and Medicaid Services (CMS) certifies
Medicare ACOs that meet certain requirements for the care of Medicare patients; certification confers
obligations and benefits to the ACO. The term was coined by Dr. Elliot Fisher of Dartmouth in 2006 and was
subsequently included in the Patient Protection and Affordable Care Act (PPACA). The term is also used to refer
to similar models for Medicaid and private markets.
Alignment of incentives. Making sure that all parties involved in healthcare—including providers, payers, and
patients—are financially incentivized to seek high-value care: the highest quality care at the lowest sustainable
cost. The goal is to encourage health, prevention of illness and injury, and—when care is needed—the most
effective treatments.
Attribution. As used in the context of accountable care, “attribution” refers to the assigning of a patient to a
healthcare provider. The attributed provider is held accountable for the cost and quality of care provided to the
patient. (This can be problematic if the attribution is not accurate and the patient obtained care from a
different, non-attributed provider.)
Behavior Change Framework. Intermountain believes positive behavior change supports optimal health and
optimal clinical outcomes for patients. A team of Intermountain clinicians has developed a behavior change
framework to support patient choices that help them live the healthiest lives possible. Intermountain
caregivers use the framework—which applies to individuals, families, groups, and communities—to help plan
patient engagement communications, resources, and technology. The framework includes three direct
variables that can produce action: motivation, ability, and prompts. The model also shows how actions are
influenced by mindset, environment, and relationships.
Best practices. Medical and healthcare practices that have been demonstrated to be the most effective.
Researchers—notably those at the Dartmouth Institute for Health Policy and Clinical Practice, who undertake
the longitudinal study called The Dartmouth Atlas of Health Care—have shown that significant inappropriate
variation exists in the delivery of healthcare in the United States. A movement began in the 1980s to encourage
“continual quality improvement” in healthcare based on statistical quality control techniques developed in
other fields (such as manufacturing). As part of this focus on clinical quality, physicians and healthcare
organizations discover and then seek to implement medical best practices—care techniques that have been
demonstrated to be effective. See “Evidence-based medicine.”
Capitation. A term used to refer to a variety of payment arrangements generally based on a per-member-permonth (PMPM) dollar amount paid in advance. The term “capitation” was widely used in connection with
managed care plans in the 1990s and acquired some connotations that are inaccurate with respect to Shared
Accountability. At Intermountain, we prefer the term “prepayment.”
Care management. Programs that help patients manage their care, especially patients who have chronic health
conditions such as diabetes, asthma and other respiratory ailments, cardiovascular disease, etc. Care
management may also include programs for temporary conditions such as high-risk pregnancies. The term
“integrated care management” is sometimes used to describe care management efforts that are coordinated
or integrated operationally within an organization. The idea is to place the patient at the center of a range of
services and have all the different providers and services of care communicating and collaborating effectively in
a highly integrated and well-managed way. Integrated care management is designed to overcome the problems
associated with fragmented care delivery, in which patients typically had to become the integrators of their
own care, going from one service or physician to another. Such problems associated with fragmented care
delivery include poor communication among caregivers, redundant tests and consultations, other unnecessary
utilization, lower clinical quality, poorer medical outcomes, misdiagnoses, lower patient compliance with
treatment programs, and higher costs.
Centers for Medicare and Medicaid Services (CMS). The United States agency that oversees the Medicare and
Medicaid programs.
Clinical Programs: Intermountain’s Clinical Programs are the mechanism by which our experts in medical
science, operations, data analysis, and care delivery collaborate and advance clinical care. In each program,
multidisciplinary teams work together to review the medical literature, evaluate our own processes and data,
and develop evidence-based best practices and care process models. Our caregivers then apply these
standards, using judgment and flexibility, to tailor care to meet the unique circumstances of each patient.
Clinical Services. Within Intermountain, the term “Clinical Services” refers to system-wide services that support
the delivery of care. Intermountain Healthcare has 15 Clinical Services: Clinical Genetics Institute, Dialysis,
Environmental, Food and Nutrition, Imaging, Integrated Care Management, Laboratory, Nursing, Pain
Management, Patient and Provider Publications, Patient Flow, Patient Safety, Pharmacy, Rehabilitation, and
Respiratory Care.
CMS. See “Centers for Medicare and Medicaid Services.”
CPI + 1%. Intermountain's (and SelectHealth's) goal of being able to offer an average annual premium increase
to commercial large employer clients of the Consumer Price Index (CPI) plus about one percent. Note: For
clarity, we refer to this goal not as "CPI + 1%" but rather as "near the general inflation rate" (e.g., "achieving
average annual rate increases closer to the general inflation rate").
CPT Codes. See “Current Procedural Terminology (CPT) code set.”
Current Procedural Terminology (CPT) code set. A code set created by the American Medical Association and
maintained by the CPT Editorial Panel. CPT codes describe diagnostic, medical, and surgical services; the codes
are used for financial, administrative, and research purposes by the healthcare industry. New versions or
editions are issued each October and are named for the year of intended use (e.g., CPT 2014 was issued in
October 2013).
Diagnosis-Related Groups (DRGs). Categories of medical procedures or care established by the U.S.
government in the 1980s based on the ICD (see “ICD”) and used by Medicare as a basis for paying hospitals.
The idea was to identify standard services provided by hospitals. Examples include “normal newborn,” “vaginal
delivery,” etc.
Efficiency. “Efficiency” is used within Intermountain Healthcare to describe efforts to reduce the cost of units
of care or processes: e.g., reducing the cost of supplies, capital equipment, MRIs, lab tests, etc. In contrast,
Shared Accountability focuses on reducing the demand for services (see “Population Utilization”) and on
effective care processes (see “Intracase Utilization”).
Engaging patients. Involving patients in decisions about their health and healthcare. Patients are encouraged to
make lifestyle decisions that promote health and prevent illness and injury. They are also encouraged to use
healthcare resources wisely, taking advantage of prevention and care management programs and evaluating
the potential costs and benefits of various treatment options.
Evidence‐based medicine aims to apply the best available evidence gained from the scientific method to
clinical decision-making. One definition: “Making a conscientious effort to base clinical decisions on research
that is most likely to be free from bias, and using interventions most likely to improve how long or well patients
live” (Mark H. Evell, MD, MS, Professor, University of Georgia).
According to Brent James, MD, MStat, Intermountain’s Chief Quality Officer, a foundational document of the
evidence‐based medicine “movement” was a 1987 article by the U.S. Preventive Services Task Force in the
Journal of the American Medical Association (JAMA). This article described four levels of evidence‐base
medicine:
•
Level 4: Personal anecdote. This is the equivalent of an individual provider saying, “In my opinion . . . ”
and often reflects the training providers received or the influence of respected mentors. According to
Dr. James, this level doesn’t make the cut of evidence‐based medicine at all.
•
•
Level 3: Agreement among a group of respected authorities using formal consensus methods. Using
consensus in a decision‐making process implies that all people involved are united in the decision.
Level 2 has three sub‐levels:
o
o
o
•
Level 2‐A: Multiple‐time series (observational studies) or dramatic results.
Level 2‐B: Cohort or case‐control studies. This is a study that follows a group of people over
time.
Level 2‐C: Controlled trials without randomization (quasi‐experimental designs). This is an
experimental study in which people are allocated to different interventions using methods that
are not random.
Level 1: Using at least one randomized controlled trial. A randomized controlled trial is a clinical trial in
which the subjects are randomly distributed into groups that are either: 1) subjected to the
experimental procedure; or 2) controls (not subject to the experimental procedure). The results of the
two groups are then compared.
Intermountain uses the evidence-based medicine approach to create “best practices,” which are protocols that
indicate how care should be delivered. Following best practices helps clinicians provide excellent clinical care
without the variation and waste that reduce quality and drive up costs. Tracking the clinical outcomes and
other results helps us create a cycle of more evidence and continually improving care.
Fee-for-service (FFS). The payment arrangement between payers and providers—currently the most prevalent
in the U.S.—in which providers are paid for services they provide to patients; this payment is received after the
services are provided. This arrangement tends to encourage the provision of both necessary and unnecessary
services, because additional services result in additional payments. The trend toward accountable care is
sometimes described as a transition away from the fee-for-service model to a fee-for-value model or a
population health model.
Geographic Committees. Geographic Committees are groups of physician and administrative leaders in each
Intermountain region who are helping our physicians provide care in a population health model. The
committees strategize and support physician engagement, education, and communication efforts. They also
help track the quality, access, service, utilization, and costs of patients who are cared for in populations served
by specific health plans (although the committees don’t have operational responsibilities). Each committee is
co-chaired by a physician and an administrative leader, and committee members include leaders from
Intermountain hospitals, members of the Intermountain Medical Group, and affiliated physicians.
HDHP. See “High-Deductible Health Plan.”
HRAs. See “Health risk assessments.”
HSAs. See “Health Savings Accounts.”
Health literacy. The ability to understand healthcare information and instructions, especially in the context of
patients’ ability to understand and comply with treatment plans. When patients have low health literacy, they
often fail to follow their treatment plans. Studies have shown that many patients do have low health literacy
and that this is a factor contributing to disparate medical outcomes. Healthcare providers are increasingly
addressing this issue and can use various methods to improve the health literacy of the patients and
populations they care for.
Health Pathway. A standard framework for the development and organization of an all-inclusive compilation of
Care Process Models, analytical tools, care coordination services and reporting solutions that form
Intermountain’s defined care standard and recommended operations flow for the treatment and or
management of a designated clinical condition across the entire care continuum.
Health risk assessments (HRAs). These are questionnaires, completed by individuals, to help identify their
health status and health risks. Most HRAs seek information related to medical history, demographic
characteristics, physiological data, lifestyle, and attitudes. The idea is to provide individuals who complete the
HRA with information about their health risks, which can also be used to provide advice on how to improve or
optimize their health.
Health Savings Accounts (HSAs). Tax-advantaged medical savings accounts for people enrolled in a highdeductible health plan (HDHP). People can use the HSA funds to pay for qualified medical expenses at any time,
and spending the funds does not incur a penalty or federal tax liability. When deposited (e.g., when an
employer deposits funds in an employee HSA), contributions to the HSA are not considered taxable income. If
not spent, the funds accumulate in the HSA year after year (unlike flexible spending accounts, which must be
spent during the year). Individuals, not companies, own HSAs. HSAs encourage people to save for future
healthcare expenses.
High-Deductible Health Plan (HDHP). A health insurance plan with a deductible that is higher relative to the
deductibles typical of more traditional plans; the higher deductibles (e.g., typically in the range of $1,000 to
$5,000 for individuals) allow such plans to offer lower premiums. Participation in qualified High-Deductible
Health Plans is required for those enrolled in Health Savings Accounts (HSAs) and similar tax-advantaged
accounts. Compared to people covered by more traditional plans with lower deductibles, people enrolled in
HDHPs pay more out-of-pocket or out of their HSAs until their deductibles are reached and benefits are applied
(although spending against the higher deductible may be offset by lower spending on the premium, for a lower
net cost to the person insured). Higher deductibles tend to make those covered by HDHPs more sensitive to
utilizing healthcare.
Hot-spotting. Identifying patients in special need of care management or areas (geographic or clinical) of
higher-than-normal utilization. The term was popularized in an article by Atul Gawande, MD, in The New Yorker
(24 Jan 2011).
ICD-10 codes. See “International Statistical Classification of Diseases and Related Health Problems (ICD).”
IHI. The Institute for Healthcare Improvement (Cambridge, Mass.), founded in 1991 by Donald M. Berwick, MD,
and others with the mission to foster continual improvement in healthcare. The IHI defined the Triple Aim goals
(see below) of population health, care quality ("patient experience"), and cost management.
IOM. See “Institute of Medicine (IOM).”
Incentives. See “Alignment of incentives.”
Institute of Medicine (IOM). The IOM is an independent, not-for-profit organization that, although funded by
the U.S. government, works to provide unbiased advice about health policy to policymakers and the public.
Founded in 1970 as part of the National Academy of Sciences, the IOM is now considered part of the “National
Academies” (which include the National Academy of Sciences, the IOM, the National Academy of Engineering,
and the National Research Council). In a 1998 report, an IOM committee called the National Roundtable on
Health Care Quality defined three major categories of substandard care: overuse, underuse, and misuse.
Integrated Care Management. See “Care management.”
International Statistical Classification of Diseases and Related Health Problems (ICD). Created by the World
Health Organization (WHO), the ICD is a code set that classifies medical conditions such as symptoms, illnesses,
diseases, and causes of injuries. ICD-10 is the tenth iteration or edition of the ICD and was implemented
October 1, 2014, succeeding the previous edition called ICD-9.
LiVe Well. LiVe Well is Intermountain’s name for a host of prevention, wellness, and care management
programs offered to patients, health plan members, consumers (including children and teenagers), and
employees. See “Promoting health.”
MHI. See "Mental Health Integration."
Medicaid product. SelectHealth began to administer and operate a managed Medicaid plan in January 2013
called SelectHealth Community Care. The plan is available to Medicaid members in Weber, Davis, Salt Lake, and
Utah counties. The plan covers medical and pharmacy services; the Utah Department of Health Medicaid
program provides services for mental health, dental, long-term care, transportation, and chiropractic services.
Medical home. The “medical home” concept places the patient at the center of a team of caregivers, typically
led by the patient’s primary care physician. The idea is that the primary care setting can provide coordination of
services and care management to help patients stay as healthy as possible, prevent illness and injury, and
obtain access to effective and appropriate healthcare. Intermountain’s implementation of the medical home
concept is called “Personalized Primary Care” and is offered by the Intermountain Clinics (the Intermountain
Medical Group). SelectHealth also supports Personalized Primary Care in affiliated physician clinics.
Medicare Advantage. Licensed by the federal government, Medicare Advantage plans are privately operated
“managed Medicare” plans for Medicare-eligible enrollees. These plans are private alternatives to the public
Medicare health insurance program and offer certain advantages to Medicare patients who choose to enroll.
Intermountain began offering a Medicare Advantage plan in January 2013. Product features include: No
deductible; monthly reimbursement for gym memberships or approved wellness programs; $5 copays for
primary care provider visits; comprehensive prescription drug coverage; and a point-of-service option that
allows members to access healthcare out-of-network for an additional out-of-pocket cost. SelectHealth
Advantage plans are available to residents of seven Utah counties: Weber, Morgan, Davis, Salt Lake, Utah, Iron,
and Washington. Plans are also available to residents of seven Idaho counties: Boise, Ada, Canyon, Twin Falls,
Jerome, Cassia, and Minidoka.
Mental Health Integration. Mental Health Integration (MHI) is how Intermountain delivers evidenced-based
care and improved outcomes to people with mental and behavioral health needs who are served by
Intermountain Medical Group providers. Mental health integration helps primary care and mental health
providers collaborate to meet a patient’s physical and mental health needs during each patient visit, which they
do by focusing on prevention and early diagnosis, integrating care processes, enhancing information systems
and reporting methods, and partnering with community resources. Mental Health Integration is part of
Personalized Primary Care (Intermountain’s version of the patient-centered “medical home”) and supports the
lifestyle-focused best practices that lead to lower costs in a population health environment.
Misuse. One of the three major categories of substandard care identified by the Institute of Medicine. (The
other two categories are “overuse” and “underuse.”) “Misuse” refers to misuse of healthcare resources,
specifically in ways that negatively affect clinical quality and patient safety.
Overtreatment. See “overuse.”
Overuse. One of the three major categories of substandard care identified by the Institute of Medicine. (The
other two categories are “underuse” and “misuse.”) “Overuse” refers to providing unnecessary tests or
treatments to patients, which may be ineffective at best or harmful at worst. Also referred to as
“overtreatment.”
PHM. See “Population Health Management.”
PPACA. See “Patient Protection and Affordable Care Act.”
Patient engagement. One of the key component strategies within Shared Accountability is patient
engagement: engaging patients more effectively in choices related to their health and healthcare. This strategy
recognizes that patients have a vital role to play in optimizing their health, minimizing health risks, choosing
treatment options that reflect their values and preferences, and complying with treatment plans.
Intermountain offers a number of programs to help engage patients and plan members, including Shared
Decision-Making and LiVe Well.
Patient Protection and Affordable Care Act (PPACA or ACA) of 2010. Signed into law by President Obama in
March 2010, this act is considered the most far-reaching healthcare reform legislation since Congress created
the Medicare and Medicaid programs in 1965. Representatives of both political parties informally refer to the
PPACA as “Obamacare.”
Payers. Organizations that pay for healthcare. The term includes insurance companies, businesses that pay for
healthcare for their employees, and government health insurance programs such as Medicare, Medicaid,
CHAMPUS, state and local programs, etc. Payers may be categorized as “private payers” (i.e., non-government)
or “public payers” (i.e., government).
Personalized Primary Care. Intermountain Healthcare’s version of the patient-centered “medical home”
concept, in which a patient’s care is coordinated by the primary care physician and clinic staff. (See “Medical
Home.”)
Physician Payment Model. Intermountain has developed a new Physician Payment Model for physicians who
choose to participate in risk-sharing networks. The model continues to pay physicians for the volume of care
they provide, along with adding features that reward quality, patient experience, and help in managing the
overall cost of care.
Population Health. Population health is a healthcare delivery model that encourages improved outcomes and
better service and reduces overall healthcare costs. It replaces the fee-for-service system, which pays
healthcare providers based on the volume of services given, with a “fee-for-value” system that compensates
caregivers for providing evidence-based care, enhancing the patient experience, and helping people maintain
better health. In the population health model, hospitals and physicians are prepaid by health insurers and
government payers for taking care of a group of people (such as members of a health plan) for a fixed time,
with measures in place to ensure high-quality outcomes. At Intermountain, population health is supported by
our Shared Accountability programs, processes, and principles.
Population Health Management. Managing the health of a defined population. In the context of accountable
care, Population Health Management is undertaken primarily by providers who assume financial risk for the
health status and care outcomes of a patient and plan member population.
Population Health Operations Committee. Population Health Operations Committees are organized in each
Intermountain region to operationalize our transition to population health. They help manage the health and
the costs of the people in each region who are covered by population health insurance products. Members of
the committees include regional leaders from Intermountain’s hospitals, Medical Group, and SelectHealth, who
work closely and collaboratively with each region’s Geographic Committee. Key activities of the Population
Health Operations Committees:
1. Understanding the assigned populations in terms of health, budget performance, and utilization
2. Developing strategies and priorities for those populations
3. Providing operational support
4. Supporting Community Benefit plans, coordinating with Geographic Committees on physician
engagement, and overseeing population health plans, resources, and measurement.
Prepayment (to providers). A payment arrangement between payers and providers designed to encourage the
provision of high-value care (high quality at an affordable and sustainable cost). Instead of being paid after
services are provided, hospitals and physicians are prepaid by insurance companies and government payers for
taking care of a group of people for a fixed time, with measures in place to ensure high-quality outcomes.
Providers keep the difference between what is prepaid and what is spent, and quality metrics ensure providers
don’t withhold needed care. Prepayment takes away the incentive (under fee-for-service arrangements) for
providing more care and instead incentivizes more effective care. The idea is to provide care that is
demonstrated to help patients, which means avoiding things that don’t help and doing more of the things that
do help.
Promoting health. To help manage the need and demand for care, Intermountain is enhancing our prevention,
wellness, and care management programs. We’re providing a range of health programs under our “LiVe Well”
brand, and these include programs for weight management, fitness, smoking cessation, and mental and
behavioral health. For patients with chronic or high-risk conditions such as diabetes, asthma, hypertension,
cardiovascular disease, depression, or high-risk pregnancy, we’re strengthening our care management
programs. We’re also improving our benefit design in our health insurance plans to encourage patients to take
greater responsibility for their health.
Providers. People and organizations that provide care to patients. The term includes hospitals, physicians,
physician clinics, and advance practice professionals.
Risk. In the context of accountable care, “risk” means financial risk assumed for the health management of a
defined population. In accountable care, risk is assumed at least in part by providers. The assumption of risk by
providers typically is accomplished primarily through some form of prepayment model, where the providers
receive a prepayment to manage the health of a defined population and retain, as income, monies in excess of
expenses. (Intermountain does not anticipate having physicians in a shared-risk network receive capitated
payment.) See also “accountable care.”
Scientific method. The scientific method refers to a four-step process: 1) Defining a problem and hypothesis; 2)
collecting data through observation and experimentation; 3) testing the hypothesis; and 4) revising the
hypothesis. Thus, the method uses a combination of deductive and inductive reasoning.
SelectHealth Share. SelectHealth Share is SelectHealth’s first commercial health plan product that’s based on
Intermountain’s Shared Accountability principles. It’s been offered to large employers since January 2016. The
plan is a unique partnership between SelectHealth, providers, employers, and employees. It supports
predictable costs and lower premium increases; engaged, healthy employees; aligned financial incentives; and
a sustainable partnership that supports better, more affordable healthcare. The plan includes a three-year
contract with guaranteed premium rate increases of just 4 percent during years two and three.
SelectHealth Share follows a population health model, where Intermountain receives a prepayment from
SelectHealth to cover the costs of coordinating the health and the care of people covered by the plan.
Intermountain assumes financial accountability for the ongoing health and clinical outcomes of plan members.
Healthcare services for covered members are provided at Intermountain hospitals and by providers in a Shared
Accountability network—which includes both Medical Group and affiliated providers. Participating network
providers agree to 18 shared commitments designed to improve quality, enhance the patient experience, and
manage overall healthcare costs. Learn more at https://selecthealthshare.org/.
Shared Accountability. Shared Accountability is Intermountain Healthcare's approach to achieving population
health and fulfilling our mission of helping people live the healthiest lives possible. Shared Accountability is how
Intermountain improves people’s health—not just their healthcare—for the lowest sustainable costs in the
changing healthcare environment. In Shared Accountability, healthcare providers, payers, and consumers work
together to achieve three goals: 1) better health; 2) better care; and 3) more affordable costs. We use three
strategies to achieve these goals:
1. Providing evidence-based care that’s shown to result in optimal outcomes
2. Engaging patients
3. Aligning financial incentives for everyone who has a stake in healthcare
Shared Accountability Advocates. At Intermountain, regional planners and communications professionals
serve as Shared Accountability “champions” or advocates within their regions or areas. They are available to
promote and explain Shared Accountability in their regions, make or arrange presentations at the department
level, answer questions, and provide access to information resources.
Shared Decision-Making. Physicians in the Intermountain Medical Group are involved in a program called
Shared Decision-Making—a collaborative process involving the sharing of relevant, evidence-based information
on treatment options, eliciting informed patient preferences, and ensuring that these preferences are
integrated into treatment choices and care plans. As part of our Shared Decision Making efforts, the Medical
Group offers patients access to online decision aids through EMMI Solutions that can help facilitate the Shared
Decision Making process and involve patients in their care, set expectations, and increase knowledge and
understanding.
Shared Decision-Making can result in a number of patient benefits, including: higher patient satisfaction;
greater compliance with treatment plans; improved clinician efficiency; and appropriate use of health
resources.
Teleservices. The growing field of medicine in which healthcare is provided via electronic communication
channels such as the internet, mobile, and other links that allow the caregiver to be physically remote from the
patient.
Transparency: Healthcare transparency means providing access to information about clinical outcomes,
service, and costs to providers, patients, and other healthcare consumers. By improving transparency through
better communication of treatment options, details about how care is provided, expenses, and patient
experiences, Intermountain builds trust with patients and helps them make more informed decisions.
Intermountain has launched a robust initiative to support transparency. Consumers can now see patient
comments and star ratings of providers through the physician search tool on the intermountainhealthcare.org
website. Dashboards are bringing real-time data to providers related to population health, patient-care quality,
outcomes, and cost. Digital tools help patients engage in choices about treatment options and care details. For
the future, plans are underway to provide additional information to consumers about hospital and clinic
quality, costs, and patient experience ratings.
Triple Aim. The Triple Aim defines three goals or imperatives of healthcare: 1) Improve the health of the
defined population; 2) Enhance the patient care experience (including quality, access, and reliability); and 3)
Reduce, or at least control, cost increases. The idea is that, by focusing on these three goals simultaneously,
healthcare leaders and policymakers will develop more effective approaches to providing care. The “Triple
Aim” concept was developed by Donald M. Berwick, MD, and others at the Institute for Healthcare
Improvement (IHI) in 2007; it was described in an article by Berwick in Health Affairs (May/June 2008).
UM. See “Utilization Review/Utilization Management.”
Undertreatment. See “underuse.”
Underuse. One of the three major categories of substandard care identified by the Institute of Medicine. (The
other two categories are “overuse” and “misuse.”) “Underuse” refers to the failure to provide care that would
be beneficial to patients. Also referred to as “undertreatment.”
Utilization. “Utilization” refers to the use of healthcare services and products—generally, the amount of
healthcare used. Utilization can be categorized in many ways; in the context of Shared Accountability, we often
speak of two kinds of utilization:
1. Population utilization. This refers to the number of health episodes per patient: e.g., a hospitalization,
an outpatient surgery, etc.
2. Intracase utilization. This refers to the number of processes used within each health episode: e.g.,
imaging scans, lab tests, inpatient days, etc.
These types of utilization are represented in the following graphic:
Utilization is considered the main driver of healthcare spending. That is, Americans spend more on healthcare
because we use more. In general, the healthcare industry has succeeded in reducing the “unit cost” per process
over time by finding ways to increase efficiency—reducing, for example, the cost of x-rays, lab tests, inpatient
days, and other items or processes. However, healthcare spending has increased because Americans are using
more products and services.
Utilization Management (UM). “Utilization management” is the evaluation of the medical necessity,
appropriateness, and efficiency of the use of healthcare services, procedures, and facilities under applicable
evidence-based standards, conditions of participation, or compliance requirements. It may involve such
activities as pre-authorization of procedures and tests, care planning and discharge planning, and case appeals.
One of the techniques of utilization management is “utilization review,” which is a retrospective evaluation of
whether care was provided appropriately. (That is, utilization review is a function within utilization
management.)
Value. Value is generally defined as the relationship between, or ratio of, benefits to costs (Value = Benefits /
Costs). In the context of accountable care, providers are incentivized to increase value (i.e., to maximize
benefits while minimizing costs); this incentive generally is provided through some form of prepayment (and/or
capitated payment) model, where the providers receive a prepayment to manage the health of a defined
population and retain, as income, monies in excess of expenses. The trend toward accountable care is
sometimes described as a transition away from the fee-for-service model to a fee-for-value model or a
population health model.
Updated August 2016