ACO REACH: Accouuntable Care Organization Realizing Equity, Access, and Community Health Model.

Attribution: Method of identifying a patient-provider health care relationship. it is based on providers accepting accountability for managing the full continuum of care for their patients.

CAHPS: Consumer Assessment of Healthcare Providers & Systems

CMS: Centers for Medicare & Medicaid Services
Direct Contracting (from Medicare Direct Contracting math/methodology). attribution: includes MSSP, but also includes voluntary by patients, also provider specialty status

E/M: Evaluation & Management

FFV: Fee for Value

FFS: Fee for Services

HEDIS: Healthcare Effectiveness Data and Information Set

HMO: Health Maintenance Organization

HOS: Health Outcomes Survey (HOS)

Medicare Advantage: Also known as Medical Advantage Plans are another way to get Medicare Part A and Part B covarage. They are sometimes called “Part C” or “MA Plans”. they can also include drug coverage (Part D). It includes HMO, PPO, PFFS, MSA and SPN plans (See definitions in this webpage.

MLR: It is a basic financial measurement used in the Affordable Care Act to encourage health plans to provide value to enrollees. If an insurer uses 80 cents out of every premium dollar to pay its customers' medical claims and activities that improve the quality of care, the company has a medical loss ratio of 80%. A medical loss ratio of 80% indicates that the insurer is using the remaining 20 cents of each premium dollar to pay overhead expenses, such as marketing, profits, salaries, administrative costs, and agent commissions. The Affordable Care Act sets minimum medical loss ratios for different markets, as do some state laws.

MSA: Medicare Medical Savings Account

MSO - Managed Services Organization - It refers to health care specific administrative and management services that provide the necessary support to succeed in health care practices and services.

When used as a business/organization model term in the FFFV world, it means the organization that fills in all the gaps for physician/provider organizations. The PrevMed Physician Prevention network is an MSO. We provide all the extra functions a doctor or NP needs to provide full FFV work. That means we do all the quality managements services like HEDIS, CAHPS, HOS, & Risk Management. We also provide CCM, TCM, RPM, & other services to provide “the glue” that holds patient engagement together for a preventive medicine experience. We even help with AWVs & virtual visits when needed.

MSSP: Medicare Shared Savings Programs
MSSP attribution: This refers to a program methodology to identify the beneficiaries associated with an MSSP. it is usually based in the plurality of E/M spend over a year.

PFFS: Private Fee-for-Service

PPO: Preferred Provider Organization

SNP: Special Needs Plans
“Straight” Medicare: It refers to the “traditional” medicare that includes Fee-For-Service health plans including Part A and Part B.
“Up-side only”: profit-sharing-only; risk arrangements in which the providers can share savings, but are not liable for risks. (These have far less financial opportunity than risk-sharing contracts. But they are also far safer financially for the provider organization. Assumption of medical risk is hard; don’t go there without the proper protection.)