Category Descriptions

Blog Categories Description
Accountable Care Organizations (ACOs) An Accountable Care Organization (ACO) is type of managed care organization in which physicians, hospitals and other providers takes responsibility for the health and wellness of a population of patients, including responsibility for high quality, appropriateness, and efficiency of the care provided.
Accountable Care Organization Provider Network Referral Analysis includes characterization of the providers contributing to the care of the ACOs population, the formal referral relationships and referral patterns, and the de-factor referral patterns implied when multiple providers care for the same patients.
Accountable Care Organization Provider Performance Analysis includes comparative measurement, over time, of providers’ quality, appropriateness, efficiency and outcomes of care and the patients’ satisfaction with that care, as needed to inform practice improvement efforts and support fair allocation of incentive resources.
Accountable Care Organization Reimbursement and Gain Sharing includes the agreed-upon approach to paying the ACO and its participating providers for health care services rendered and bearing risk as well as the approach to allocating revenues and bottom-line gains to participating stakeholders.
Accountable Care Organization Strategy includes the process of developing consensus about mission, vision, goals, objectives, strengths, weaknesses, competitors, future investments and development roadmap.
Accountable Care Organization Structure and Governance includes the formation of legal entities, leadership positions, committees, communication channels, and associated policies and procedures.
Clinical Process Improvement Clinical Process Improvement includes efforts to re-design, transform or incrementally improve decision-making and care-delivery processes within and across clinical settings so as to achieve measurable increases in quality, appropriateness and efficiency of care and patients’ satisfaction with that care.
Clinical Practice Guidelines and Protocols includes practice policies, algorithms, rules, criteria, pathways and other proactively-determined designs for clinical decision-making processes, developed based on explicit or subjective methods, based on evidence or expert consensus opinions.
A philosophy and methodology of management of production processes that emphasizes involving process experts, customers and front-line workings in identifying key quality characteristics (KQCs) , collecting and analyzing data regarding variation to understand the apparent cause-effect relationships between key process variables (KPVs) and KCCs, using small-scale, short-duration pilot tests of proposed process improvements, and then acting to hold the gains from successful improvements.
A philosophy and methodology of management of production processes that emphasizes engaging front-line production team members in the mapping of current state processes, identifying and eliminating wasteful steps that do not add value to the customer, and developing consensus about and implementing future state processes that are more efficient and that produce high quality products or services.
Provider Based Care Management includes care delivery processes involving physicians and ancillary professionals coordinating care and teaching and facilitation effective patient self-management and healthy behaviors, possibly in collaboration or coordination with care management services delivered through health plans, employers and care management companies.
Dr. Ward’s Methods Notes Dr. Ward’s opinions about how to conceptualize and do things, including analysis, system design, project management, development lifecycle, organizational structure, incentives, and more. A work always in progress, never completed.
Evaluation Methods Evaluation Methods include methods for measuring and comparing the relevant outputs of one or more care processes or care providers to identify best practices, support equitable allocation of incentive resources, or support future decisions about network affiliation or referrals. These methods are borrowed and adapted from other fields, including epidemiology, biostatistics, econometrics and other social and physical sciences.
Appropriateness Measurement is assess the degree to which health care services that are ordered or delivered conform to standards of care regarding medical necessity.
Care Relationship Derivation, sometimes called “attribution” involves analyzing claims or other available data to infer the existence of a relationship between a patient and a provider for a time period, used when complete data regarding formally declared care relationships is not available.
Efficiency Measurement compares the quantity of care process outputs to the resources required as inputs to the process. Sometimes “efficiency” is used as a synonym for “cost”, without regard to the quantity of outputs.
Episode Grouping involves analyzing claims or other data to infer the start and end dates of disease treatment periods and derive associations between specific services and those periods.
Evaluation Tricks to watch out for include regression to the mean, volunteer bias, migration bias, and the “risk factor switcharoo”.
Opportunity Analysis involves comparison of the actual performance of a care provider to the performance that a benchmark performer would have if they had the same population as the care provider. This type of analysis is used to inform prioritization of practice improvement efforts.
Outcomes Measurement assesses the physiologic results of a care process or the experiences of the patient regarding change in function.
Risk Adjustment is used when comparing the performance of two care processes (or providers) to address potential confounding variables by applying the observed performance to a standardized population to “level the playing field”.
Satisfaction Measurement assesses the degree to which a care process meets or exceeds the expectations of the patient.
Quality Measurement assesses the compliance of a care process to standards of care.
Health Information Technology Health Information Technology includes diverse systems used by health care providers, patients and health plans to capture, store, exchange, display and analyze health care data, and, more importantly, to facilitate, coordinate and improve health care processes.
Care Planning systems are information systems used by health care providers to create, edit, communicate and track the status of patient problems and the associated services ordered to address those problems. They may offer point-of-care decision support and care plan templates to improve the quality and consistency of clinical decision-making processes. They may be accessible by patients.
Care Relationship Management systems are used to derive apparent current care relationships from historical health care data and to management the capture and change control workflow associated with the process by which patients and care providers view, validate and edit declared care relationship data, as needed to support care processes, provider performance measurement and Accountable Care Organization processes.
Clinical Process Management and Workflow systems are information systems that are used by health care providers to proactively design clinical decision-making and care delivery processes and to concurrently orchestrate and track the execution of these processes. They may support simulation of design-stage care processes and analysis of process performance of production care processes.
Electronic Medical Records (EMRs), also including the terms Electronic Health Records (EHR) and Computerized Patient Record (CPR) refer to information systems that are used by health care providers to capture, store, and display health information. Such systems may be confined to one care setting, or extend across settings. Such systems may also includes use for population management and research and may provide access by patients.
Health Information Exchange (HIE) includes systems and processes to share data regarding patients, providers and health care services among authorized parties to support care processes, clinical process improvement, research, and accountability.
Personal Health Record (PHR) includes information systems that are used by patients and their families to enter health information and to view health information about them from health care providers and health plans. PHR systems may be accessible by care providers and may be integrated with other health information systems.
Registries includes systems that are used by health care providers, public health officials and researchers to manage analyzable health information for a population of patients, to support health care delivery, clinical practice improvement, disease surveillance and research. Registries may be accessible my patients, and may be integrated with other health information systems.
Modelling Methods Modelling Methods include diverse methods used to explore and understand the implications of assumptions related to a system, process or decision and to make quantitative estimates of future outcomes under alternative scenarios to support proactive decision-making.
Agent-based Modelling is a method for computational simulation used to explore and understand processes and their possible consequences. The method, widely used in the social sciences, physics, meteorology and engineering, involves programming computer objects to behave in a simulated environment, interacting with other agents over time, to create relatively simple models capable of representing and exploring complex dynamic systems.
Cost-Effectiveness Analysis (CEA) is a method for comparing alternative clinical interventions taking into account not only the health outcomes experienced by the patient but also the health care costs that are borne by the health plan, Accountable Care Organization, or society. This is generally accomplished by creating a single utility measure encompassing all incremental patient health outcomes (such as a Quality-Adjusted Life Year) and comparing that in a ratio to the incremental cost, and then comparing the ratio to some threshold that reflects the values of the policy-makers or the constituents they represent.
Decision Analysis is a philosophy and method used to formally compare alternatives, generally by creating a single utility metric encompassing all relevant and material outcomes, determining the value of that metric and the probability for each of the possibly scenarios for each alternative, and comparing the probability-weighted utility for each alternative to determine which offers the highest expected utility. The method has been used for decades to support evidence-based practice guidelines.
Model-Based Reporting is a methodology for establishing a routine reporting framework that shows not only counts and summary statistics of performance metrics, but also projects the future implications of actual performance through the lens of a model that includes planned performance and explicit assumptions.
Bibliography Bibliography includes references to scientific papers, book chapters, abstract presentations and other authoritative sources that we feel have long term value and relevance to our work. New thinking and findings, not just current events.

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