NYCAF Learning Lab Glossary
Accountable Care Organization (ACO)
A network of health providers that work together to,
and are held accountable for, providing quality care.
Advanced Primary Care (APC)
Leading model for efficient management and delivery
of quality health care services that builds on the
principles embodied by the NCQA-certified medical
home. An APC practice utilizes a team approach, with
the patient at the center. The care model emphasizes
prevention, health information technology, care
coordination and shared decision-making among
patients and their providers. The APC model is designed
to leverage the strengths of New York State’s emerging
NCQA-certified medical homes while laying out a
graduated path for all practices to advance toward
integrated care.
Agency for Healthcare Research and Quality (AHRQ)
Federal agency charged with improving the quality,
safety, efficiency, and effectiveness of and effectiveness
of health care.
Articles 28, 31 and 32 of NYS Public Health Law
Licensure to provide primary care, mental health
outpatient services and outpatient substance use
treatment services, respectively.
Affordable Care Act (ACA or Obamacare, technically
The Patient Protection and Affordable Care Act)
Health reform legislation signed into law in 2010 that
aims to significantly expand access to insurance
coverage and overhaul the regulation of the US health
care system.
Avoidable Hospital Use
Designates all avoidable hospital service use including
avoidable emergency department use, avoidable
hospital admissions and avoidable hospital
readmissions within 30 days. This can be achieved
through better aligned primary care and community
based services, application of evidence based guidelines
for primary and chronic disease care, and more efficient
transitions of care through all care settings.
Behavioral Health Organization (BHO)
An organization with expertise and demonstrated
experience with managing care for individuals with
substance abuse, serious mental illness, and/or chronic
physical disease.
Certified Health Home Agency (CHHA)
A care provider for high need individuals, responsible
coordinating patient care, improving health outcomes,
and reducing unnecessary health costs.
Clinical Laboratory Improvement Amendment (CLIA)
Federal regulations with quality standards for
laboratory testing to insure the accuracy, reliability and
timeliness of patient test results regardless of where
the test is performed.
Community Health Center (CHC)
A federally designated health center that serves
medically underserved areas and populations.
Consumer Directed Personal Assistance Program
(CDPAP)
A Medicaid program that allows participants to have
more control in who provides their home care and how
this care is provided, including all eligible for services
provided by a CHHA, long-term home healthcare
(waiver) program, AIDS homecare program or personal
care (home attendant).
Delivery System Reform Incentive Payment Program
(DSRIP)
As part of New York’s Medicaid Redesign Team (MRT)
Waiver Amendment, DSRIP’s purpose is to
fundamentally restructure the health care delivery
system by reinvesting in the Medicaid program, with
the primary goals stabilizing the safety-net system and
reducing avoidable hospital use by 25% over 5 years.
DSRIP is the largest piece of the MRT Waiver
Amendment with a total allocation of $6.9 billion.
Dual Eligible
An individual who qualifies for both Medicare and some
level of Medicaid.
DSRIP Project
Individual method created by a Performing Provider
System to transform the delivery of care that support
Medicaid beneficiaries and uninsured as well as address
the broad needs for the population the performing
provider system serves. DSRIP projects will be designed
to meet and be responsive to community needs while
meeting three key elements: appropriate infrastructure,
integration across settings and assumes responsibility
for a defined population.
Federal Poverty Level (FPL)
The federal government's definition of poverty used to
determine eligibility for government programs and
subsidies. In 2014, the FPL is $11,670 for an individual
and $23,850 for a family of 4.
Federally Qualified Health Center (FQHC)
A community based organization that provides primary
and preventive care services to individuals regardless of
insurance status or ability to pay.
Fully Integrated Dual Advantage (FIDA)
A NYS program focusing on integrating and improving
care for those eligible to enroll in both Medicare and
Medicaid.
Health and Recovery Plan, Special Needs (HARP)
The term for a behavioral health Special Needs Plan.
Health Home (HH)
A patient-centered care management model that
provides comprehensive, team-based care and
integrates physical and mental health. The goal of HHs
is to reduce unnecessary ER visits and hospitalizations.
Health Insurance Exchange/Marketplace (HIX or HIE)
A system established by the ACA through which insurers
offer health plans to individuals and employers starting
in 2014.
Integrated Delivery System (IDS)
An organized, coordinated, and collaborative network
of various healthcare providers that care connected
with the aim to offer a coordinated, continuum of
services to a particular patient population or
community. A goal of an efficient IDS is to be
accountable, both clinically and fiscally, for the clinical
outcomes and health status of the population or
community served, and has systems in place to manage
and improve them.
Managed Care Organization (MCO)
An organization of providers that coordinate health care
services for beneficiaries in the network.
Managed Long Term Care (MLTC)
A type of health plan designed for the chronically ill or
those who need long term services.
Meaningful Use (MU)
The American Recovery and Reinvestment Act of 2009
authorizes the Centers for Medicare & Medicaid
Services (CMS) to provide incentive payments to eligible
professionals (EPs) and hospitals who adopt,
implement, upgrade, or demonstrate meaningful use of
certified electronic health record (EHR) technology.
Meaningful Use is defined by the use of certified EHR
technology in a meaningful manner (for example
electronic prescribing); connected in a manner that
provides for the electronic exchange of health
information to improve the quality of care; and the
provider must submit to the Secretary of Health &
Human Services (HHS) information on quality of care
and other measures.
Medicaid Redesign Team (MRT)
A team of experts brought together to reform NYS
Medicaid and reduce its cost.
Medicaid Waiver
Authority granted by the Secretary of Health and
Human Services for states to test new coverage
approaches with Medicaid.
National Committee of Quality Assurance (NCQA)
A not-for-profit organization that develops quality
standards and performance measures for a broad range
of health care entities, as well as serves as an
accrediting body and tracks the quality of care delivered
in the US across several metrics.
New York State of Health (NYSOH)
The official website of the NYS health insurance
exchange.
Patient-Centered Medical Home (PCMH)
A way of organizing primary care that emphasizes care
coordination and communication to provide patients
with timely, well-organized and integrated care, and
enhanced access to teams of providers within a health
care organization.
Pay-for-Performance (P4P)
Payment model that rewards providers for meeting
certain pre-established performance targets or
measures for quality and efficiency.
Performing Provider System (PPS)
DSRIP eligible providers, which include both major
public general hospitals and safety net providers,
collaborating together, with a designated lead provider
for the group.
Potentially Preventable Emergency Room Visits (PPVs)
Part of the nationally recognized measures for
avoidable hospital use. The measures identify
emergency room visits that could have been avoided
with adequate ambulatory care.
Potentially Preventable Readmissions (PPRs)
Part of the nationally recognized measures for
avoidable hospital use. PPRs measure readmissions to a
hospital following a prior discharge from a hospital and
that is clinically-related to the prior hospital admission.
Qualified Health Plan (QHP)
A certified health insurance plan that provides
mandated benefits and meets cost-sharing and other
requirements.
Regional Health Information Organization (RHIO)
Collect health record data from healthcare providers in
their area and, with patient consent, allow this
information to be shared securely with other providers
in the region.
Safety Net Provider
A hospital or other health provider that meets the
criteria for eligibility to participate in a DSRIP project.
Statewide Health Information Network of New York
(SHIN-NY)
Connects RHIOs to create a private and secure network
spanning the entire State of New York.
Special Needs Plan (SNP)
A health plan designed for people with specific diseases
or characteristics.
Triple Aim
A framework for optimizing the health care system that
focuses on improving individual health and the health of
the population while reducing the cost of health care.