Glossary

A person-centered care team taking responsibility for improving quality of care, care coordination and health outcomes for a defined group of individuals, to reduce care fragmentation and avoid unnecessary costs for individuals and the health system.

Groups of doctors, hospitals, and other health care professionals that work together to give patients high-quality, coordinated service and health care, improve health outcomes, and manage costs. ACOs may be in a specific geographic area and/or focused on patients who have a specific condition, like chronic kidney disease.

Alternative Payment Models, such as those tested by the CMS Innovation Center, reward health care providers for delivering high-quality and coordinated care. APMs can apply to a specific:

• Health condition, like end-stage renal disease.
• Care episode, like joint replacement.
• Provider type, like primary care providers.
• Community, like rural areas.
• Innovation within Medicare Advantage, Medicare Part D, or Medicaid.

A way of paying health care providers or organizations in which they receive a predictable, upfront, set amount of money to cover the predicted cost of all or some of the health care services for a specific patient over a certain period of time.

The organization of a patient’s care across multiple health care providers. Care coordination is a foundational element of accountable care.

The attainment of the highest level of health for all people, where everyone has a fair and just opportunity to attain their optimal health regardless of race, ethnicity, disability, sexual orientation, gender identity, socioeconomic status, geography, preferred language, or other factors that affect access to care and health outcomes.

Integrated health care services delivered in a setting and manner that is responsive to individuals and their goals, values and preferences, in a system that supports good provider–patient communication and empowers individuals receiving care and providers to make effective care plans together. Accountable Care should be person centered care.

Health services that cover a range of prevention, wellness, and treatment for common illnesses. Primary care providers include doctors, nurses, nurse practitioners, and physician assistants. They often maintain long-term relationships with patients and advise and treat a range of health-related issues. They may also coordinate a patient’s care with specialists.

A way to calculate what to pay a health provider based on a patient’s overall health, burden of illness, their likely use of health care services and the costs of those services.

An agreement in which an ACO healthcare provider participant is held financially responsible for the quality and cost of care delivered to patients in exchange for flexibilities regarding the way they deliver care.

The process of holding participating states accountable for quality and population health outcomes, while constraining costs of health care services delivered in a state or specified sub-state region. As applied by the CMS Innovation Center, this process takes places across all health care payers, including Medicare, Medicaid, and private health insurers and plans.

Designing patient-centered care that focuses on quality, provider performance and the patient experience.