Health Policy Frameworks
Expert-defined terms from the Professional Certificate in Policy Analysis and Health Policy course at London School of Business and Administration. Free to read, free to share, paired with a professional course.
Access to Care refers to the ability of individuals to obtain necessary healthca… #
The concept of access to care is complex and multifaceted, involving not only the physical availability of healthcare services but also the financial and social barriers that may prevent individuals from accessing care. For example, individuals living in rural areas may have limited access to specialty care due to the lack of specialists in their area, while individuals with low incomes may struggle to afford the costs of healthcare.
Accountable Care Organization (ACO) is a healthcare organization that is account… #
ACOs aim to improve the quality and efficiency of care by coordinating services and sharing resources, for example, an ACO may use data analytics to identify high-risk patients and provide them with targeted interventions to prevent hospitalizations.
Administrative Simplification refers to the process of streamlining administrati… #
Administrative simplification can help reduce the administrative burden on healthcare providers and improve the efficiency of healthcare services, for example, the use of electronic health records can reduce the need for manual data entry and improve the accuracy of patient information.
Adverse Selection refers to the phenomenon where individuals with higher healthc… #
Adverse selection can lead to higher healthcare costs and reduced access to care for individuals with lower healthcare needs, for example, if individuals with higher healthcare needs are more likely to purchase health insurance, the cost of premiums may increase, making it more difficult for individuals with lower healthcare needs to afford coverage.
Affordability of Care refers to the ability of individuals to pay for necessary… #
The affordability of care is a complex issue, involving not only the cost of healthcare services but also the financial resources available to individuals, for example, individuals with low incomes may struggle to afford the costs of healthcare, even with health insurance, due to high deductibles and copayments.
Alternative Payment Models (APMs) refer to payment models that aim to improve th… #
APMs can help reduce healthcare costs and improve the quality of care by aligning payment incentives with quality and efficiency goals, for example, a pay-for-performance incentive may reward healthcare providers for achieving certain quality metrics, such as reducing hospital readmissions.
Benefit Design refers to the process of designing health insurance benefits to m… #
Benefit design can help improve access to care and reduce healthcare costs by ensuring that individuals have access to necessary healthcare services, for example, a health insurance plan may cover preventive care services, such as annual physicals and screenings, to encourage individuals to seek early treatment and prevent more costly care.
Bundled Payment refers to a payment model where a single payment is made for a b… #
Bundled payment can help reduce healthcare costs and improve the quality of care by incentivizing healthcare providers to deliver efficient and effective care, for example, a bundled payment for a joint replacement surgery may include all the services necessary for the procedure, from preoperative care to postoperative rehabilitation.
Care Coordination refers to the process of organizing and managing patient care… #
Care coordination can help improve the quality and efficiency of care by ensuring that patients receive timely and effective care, for example, a care coordinator may help a patient navigate the healthcare system and ensure that they receive all the necessary services, from primary care to specialty care.
Chronic Care Management refers to the process of managing and coordinating care… #
Chronic care management can help improve the quality and efficiency of care by ensuring that individuals with chronic conditions receive timely and effective care, for example, a chronic care management program may provide individuals with diabetes with education and support to manage their condition and prevent complications.
Clinical Decision Support (CDS) refers to the use of technology to support healt… #
CDS can help improve the quality and safety of care by providing healthcare providers with accurate and timely information, for example, a CDS system may alert a healthcare provider to potential drug interactions or provide guidance on the best course of treatment for a patient with a specific condition.
Community Health Worker (CHW) refers to a healthcare worker who provides support… #
CHWs can help improve access to care and reduce healthcare disparities by providing individuals with culturally sensitive and linguistically appropriate care, for example, a CHW may provide education and support to individuals with diabetes on how to manage their condition and prevent complications.
Comorbidity refers to the presence of one or more additional conditions co #
occurring with a primary condition, it is an important concept in Health Policy Frameworks, related terms include multimorbidity, complex care, and care coordination. Comorbidity can help improve the quality and efficiency of care by ensuring that individuals with multiple conditions receive timely and effective care, for example, a care coordinator may help an individual with diabetes and heart disease manage their conditions and prevent complications.
Consumer #
Directed Healthcare (CDH) refers to a healthcare approach that empowers individuals to take a more active role in their healthcare decisions, CDH is a key concept in Health Policy Frameworks, related terms include patient-centered care, health literacy, and financial incentives. CDH can help improve the quality and efficiency of care by providing individuals with the information and resources they need to make informed decisions about their care, for example, a CDH approach may provide individuals with access to their medical records and allow them to make decisions about their treatment.
Cost Containment refers to the process of reducing healthcare costs while mainta… #
Cost containment can help reduce healthcare costs and improve the affordability of care by identifying and eliminating unnecessary costs, for example, a cost containment strategy may reduce the use of unnecessary tests and procedures.
Cost Sharing refers to the process of dividing healthcare costs between individu… #
Cost sharing can help reduce healthcare costs and improve the affordability of care by providing individuals with incentives to use healthcare services more efficiently, for example, a cost-sharing arrangement may require individuals to pay a deductible before receiving coverage for healthcare services.
Cultural Competence refers to the ability of healthcare providers to provide car… #
Cultural competence can help improve access to care and reduce healthcare disparities by providing individuals with care that is tailored to their unique needs, for example, a healthcare provider may provide care in a patient's preferred language to improve communication and understanding.
Data Analytics refers to the use of data and statistical methods to analyze and… #
Data analytics can help improve the quality and efficiency of care by providing healthcare providers with accurate and timely information, for example, a data analytics system may identify high-risk patients and provide healthcare providers with targeted interventions to prevent hospitalizations.
Disease Management refers to the process of managing and coordinating care for i… #
Disease management can help improve the quality and efficiency of care by ensuring that individuals with specific diseases or conditions receive timely and effective care, for example, a disease management program may provide individuals with diabetes with education and support to manage their condition and prevent complications.
Electronic Health Record (EHR) refers to a digital version of a patient's medica… #
EHRs can help improve the quality and efficiency of care by providing healthcare providers with accurate and timely information, for example, an EHR system may allow healthcare providers to access a patient's medical history and provide more effective care.
Evidence #
Based Medicine (EBM) refers to the use of scientific evidence to inform medical decisions, EBM is a crucial concept in Health Policy Frameworks, related terms include clinical guidelines, research evidence, and quality metrics. EBM can help improve the quality and safety of care by providing healthcare providers with accurate and timely information, for example, an EBM approach may provide healthcare providers with guidance on the best course of treatment for a patient with a specific condition.
Health Disparities refer to the differences in health outcomes and healthcare ac… #
Health disparities can help identify and address the unique needs of diverse patient populations, for example, a health disparities report may identify disparities in healthcare access and outcomes for individuals with low incomes and provide recommendations for addressing these disparities.
Health Information Technology (HIT) refers to the use of technology to support h… #
HIT can help improve the quality and efficiency of care by providing healthcare providers with accurate and timely information, for example, a HIT system may allow healthcare providers to access a patient's medical history and provide more effective care.
Health Literacy refers to the ability of individuals to obtain, process, and und… #
Health literacy can help improve access to care and reduce healthcare disparities by providing individuals with the information and resources they need to make informed decisions about their care, for example, a health literacy program may provide individuals with education and support to manage their health and prevent disease.
Healthcare Access refers to the ability of individuals to obtain necessary healt… #
Healthcare access can help improve the quality and efficiency of care by ensuring that individuals have access to necessary healthcare services, for example, a healthcare access program may provide individuals with low incomes with access to healthcare services and reduce healthcare disparities.
Healthcare Quality refers to the degree to which healthcare services meet establ… #
Healthcare quality can help improve the safety and effectiveness of care by providing healthcare providers with accurate and timely information, for example, a quality metric may measure the rate of hospital readmissions and provide healthcare providers with targeted interventions to reduce readmissions.
Healthcare Reform refers to the process of changing the healthcare system to imp… #
Healthcare reform can help improve the quality and efficiency of care by addressing the unique needs of diverse patient populations, for example, a healthcare reform effort may expand access to healthcare services for individuals with low incomes and reduce healthcare disparities.
Interoperability refers to the ability of different healthcare systems to commun… #
Interoperability can help improve the quality and efficiency of care by providing healthcare providers with accurate and timely information, for example, an interoperable system may allow healthcare providers to access a patient's medical history and provide more effective care.
Managed Care refers to a healthcare approach that aims to improve the quality an… #
Managed care can help reduce healthcare costs and improve the quality of care by providing healthcare providers with incentives to deliver high-value care, for example, a managed care organization may provide healthcare providers with pay-for-performance incentives to improve quality metrics.
Medical Home refers to a healthcare approach that provides comprehensive and coo… #
Medical home can help improve the quality and efficiency of care by providing individuals with a single point of contact for all their healthcare needs, for example, a medical home may provide individuals with access to primary care, specialty care, and preventive care services.
Mental Health refers to the emotional, psychological, and social well #
being of individuals, mental health is a crucial concept in Health Policy Frameworks, related terms include behavioral health, substance abuse, and mental health parity. Mental health can help improve the quality and efficiency of care by providing individuals with access to necessary mental health services, for example, a mental health program may provide individuals with access to counseling, therapy, and medication management.
Network Design refers to the process of designing healthcare networks to meet th… #
Network design can help improve access to care and reduce healthcare costs by providing individuals with access to necessary healthcare services, for example, a network design may provide individuals with access to primary care, specialty care, and preventive care services.
Patient Engagement refers to the process of involving patients in their healthca… #
Patient engagement can help improve the quality and efficiency of care by providing individuals with the information and resources they need to make informed decisions about their care, for example, a patient engagement program may provide individuals with access to their medical records and allow them to make decisions about their treatment.
Patient Safety refers to the degree to which healthcare services minimize the ri… #
Patient safety can help improve the quality and efficiency of care by providing healthcare providers with accurate and timely information, for example, a patient safety metric may measure the rate of hospital-acquired infections and provide healthcare providers with targeted interventions to reduce infections.
Pay #
for-Performance (P4P) refers to a payment model that rewards healthcare providers for delivering high-quality care, P4P is a crucial concept in Health Policy Frameworks, related terms include value-based care, quality metrics, and cost containment. P4P can help improve the quality and efficiency of care by providing healthcare providers with incentives to deliver high-value care, for example, a P4P program may reward healthcare providers for achieving certain quality metrics, such as reducing hospital readmissions.
Population Health refers to the health outcomes of a specific population, popula… #
Population health can help improve the quality and efficiency of care by providing healthcare providers with accurate and timely information, for example, a population health metric may measure the rate of diabetes in a specific population and provide healthcare providers with targeted interventions to reduce the incidence of diabetes.
Preventive Care refers to the healthcare services that aim to prevent illness an… #
Preventive care can help improve the quality and efficiency of care by reducing the incidence of illness and disease, for example, a preventive care program may provide individuals with access to screenings, vaccinations, and health education.
Primary Care refers to the first level of contact between individuals and the he… #
Primary care can help improve the quality and efficiency of care by providing individuals with access to necessary healthcare services, for example, a primary care physician may provide individuals with access to preventive care, diagnostic testing, and treatment.
Quality Metrics refer to the measures used to assess the quality of healthcare s… #
Quality metrics can help improve the quality and efficiency of care by providing healthcare providers with accurate and timely information, for example, a quality metric may measure the rate of hospital readmissions and provide healthcare providers with targeted interventions to reduce readmissions.
Reimbursement refers to the process of paying healthcare providers for their ser… #
Reimbursement can help improve the quality and efficiency of care by providing healthcare providers with incentives to deliver high-value care, for example, a reimbursement model may reward healthcare providers for achieving certain quality metrics, such as reducing hospital readmissions.
Risk Adjustment refers to the process of adjusting healthcare costs and quality… #
Risk adjustment can help improve the quality and efficiency of care by providing healthcare providers with accurate and timely information, for example, a risk adjustment model may identify high-risk patients and provide healthcare providers with targeted interventions to prevent hospitalizations.
Social Determinants of Health (SDH) refer to the social and environmental factor… #
SDH can help improve the quality and efficiency of care by providing healthcare providers with accurate and timely information, for example, an SDH metric may measure the rate of poverty in a specific population and provide healthcare providers with targeted interventions to address the social determinants of health.
Telehealth refers to the use of technology to deliver healthcare services remote… #
Telehealth can help improve access to care and reduce healthcare costs by providing individuals with access to necessary healthcare services, for example, a telehealth program may provide individuals with access to specialty care, primary care, and preventive care services.
Value #
Based Care (VBC) refers to a healthcare approach that aims to improve the quality and efficiency of care by incentivizing healthcare providers to deliver high-value care, VBC is a crucial concept in Health Policy Frameworks, related terms include pay-for-performance, quality metrics, and cost containment. VBC can help improve the quality and efficiency of care by providing healthcare providers with incentives to deliver high-value care, for example, a VBC program may reward healthcare providers for achieving certain quality metrics, such as reducing hospital readmissions.
Value #
Based Payment (VBP) refers to a payment model that rewards healthcare providers for delivering high-quality care, VBP is a key concept in Health Policy Frameworks, related terms include pay-for-performance, quality metrics, and cost containment. VBP can help improve the quality and efficiency of care by providing healthcare providers with incentives to deliver high-value care, for example, a VBP program may reward healthcare providers for achieving certain quality metrics, such as reducing hospital readmissions.
Workflow Optimization refers to the process of streamlining healthcare workflows… #
Workflow optimization can help improve the quality and efficiency of care by reducing unnecessary steps and improving communication among healthcare providers, for example, a workflow optimization program may reduce the time it takes to discharge patients from the hospital and improve patient satisfaction.