Glossary of Terms
ACA (Affordable Care Act)
The comprehensive health care reform law enacted in March 2010 and upheld by the U.S Supreme Court in June 2012. The law was enacted in two parts: The Patient Protection and Affordable Care Act was signed into law on March 23, 2010 and was amended by the Health Care and Education Reconciliation Act on March 30, 2010. The name “Affordable Care Act” is used to refer to the final, amended version of the law.
ACE (AHCCCS Customer Eligibility)
A computer system that determines eligibility for the Arizona Long Term Care System (ALTCS), Supplemental Security Income (SSI), Medical Assistance Only (MAO), KidsCare, and other AHCCCS programs.
A joint clinically integrated network backed by two of Arizona's largest hospital and health care organizations, Dignity Health and Vanguard Health Systems, which owns Abrazo Health.
ACO (Accountable Care Organization)
A group of health care providers who give coordinated care, chronic disease management, and thereby improve the quality of care patients get. The organization’s payment is tied to achieving health care quality goals and outcomes that result in cost savings.
Arizona’s Medicaid agency that offers health care programs to serve Arizona residents. Individuals must meet certain income and other requirements to obtain services.
APIPA (Arizona Physician’s IPA)
Offered by United Healthcare, it is one of Arizona’s largest health plans. It offers a product known as APIPA to cover beneficiaries of two groups: Arizona Health Care Cost Containment System (AHCCCS) and Arizona Children’s Health Insurance Program (CHIP/KidsCare).
Banner Health Network
An Arizona patient care and business partnership between Arizona Integrated Physicians, the Banner Medical Group, the Banner Physician Hospital Organization (BPHO), and Banner Health designed to provide a coordinated patient care experience to Medicare beneficiaries and other members in private sector insurance plans.
CI (Clinical Integration) or MCI (Meaningful Clinical Integration)
An FTC-recognized model of physician group contracting based upon development of a robust quality improvement program with real accountability among otherwise independent physicians. It integrates and rewards physician members around a common commitment to quality measures based on scientific evidence.
An organized physician group whose payer contracts are negotiated upon the principles of standardized quality measurements, lower health care costs, and improved outcomes.
A branch of the U.S. Department of Health and Human Services that administers Medicare, Medicaid, and the Children’s Health Insurance Program.
CRS (Children’s Rehabilitative Services)
An arm AHCCCS that provides specialized services to children with complex health care needs.
EMR/EHR (Electronic Medical Record/Electronic Health Record)
A computerized system where security-protected patient records are created, used, exchanged, stored, and retrieved by health care professionals and insurers.
A health care payment model that reimburses providers for each treatment and/or procedure administered to a patient. This model rewards providers based upon the quantity of services provided, not the quality of those services.
GPO (Group Purchasing Organization)
An entity that helps health care providers achieve savings and efficiencies by combining purchasing volume and using it as leverage to negotiate discounts with manufacturers, distributors and other vendors. GPOs can help you purchase vaccines at a discount, purchase insurance for your staff at group rates or even access discount to office supplies.
IPA (Integrated Physician Association)
A multi-specialty, physician-led, integrated health care delivery organization or association (see CIO).
MSO (Management Services Organization)
An organization owned by a group of physicians, a physician-hospital joint venture, or investors in conjunction with physicians that provides practice management and administrative support services to individual physicians or group practices. It relieves physicians of non-medical business functions so they may focus on the clinical aspects of their practice.
PCMH (Patient-centered Medical Home)
A model of medical management designed to promote comprehensive, coordinated, patient-centered care delivered by a team of physicians and nurses. In a patient-centered medical home, primary care providers and members of their team coordinate all of a patient’s health needs. The model supports fundamental changes in primary care service delivery and payment reforms whose ultimate goal is improving health care quality.
PCIO (Pediatric Clinically Integrated Organization)
An organized physician group specifically focused on the care of pediatric patients whose payer contracts are negotiated upon the principles of standardized quality measurements, lower health care costs, and improved outcomes.
PCCN (Phoenix Children’s Care Network)
The name given to the physician-led clinically integrated organization currently being assembled by community-based physicians in partnership with Phoenix Children’s Hospital.
PCMG (Phoenix Children’s Medical Group)
A collection of more than 200 physicians employed by Phoenix Children’s Hospital.
Methodologies and strategies that are implemented to more closely align community physicians with a hospital ranging from offers of employment to other forms of integration. Effective alignment results in physicians who are highly engaged in hospital strategies for improving quality, creating operating efficiencies, and ensuring financial viability.
PHO (Physician Hospital Organization)
A legal or informal organization that bonds hospitals and their attending medical staff that is typically structured by creating a new entity that is jointly owned by physicians and a hospital. PHOs are frequently developed for the purpose of contracting with managed care plans.
SHP (Scottsdale Health Partners)
An Arizona limited liability company created as a partnership between Scottsdale Healthcare Hospitals and Scottsdale Physician Organization. SHP is a physician-led organization focused on improving care quality, efficiency, cost and coordination.
An alternative contracting strategy that places emphases on increasing quality, reducing medical costs, improving patient outcomes, and sharing risk and responsibility for controlling medical cost trends for patient populations.