Population and equity
Access to Care
Access to care describes whether patients can obtain appropriate services when and where they need them.
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Reference
Essential healthcare strategy terms and definitions for leaders, strategists, and researchers.
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Access to care describes whether patients can obtain appropriate services when and where they need them.
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An accountable care organization (ACO) is a group of doctors, hospitals, and other healthcare providers who voluntarily come together to deliver coordinated, high-quality care to a defined patient population.
Accreditation is external evaluation of a healthcare organization against defined standards for quality, safety, governance, and operations.
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AI governance is the set of policies, review processes, accountability structures, and monitoring practices used to manage artificial intelligence in healthcare.
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Ambulatory care refers to services delivered without an overnight hospital stay, including primary care, specialty clinics, urgent care, ambulatory surgery, imaging, infusion, and virtual visits.
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Bundled payments, also known as episode-based payments, are a healthcare reimbursement model in which a single payment covers all services related to a defined clinical episode of care.
Capitation is a payment model in which healthcare providers receive a fixed, per-member-per-month (PMPM) payment for each patient enrolled in their panel, regardless of the number or type of services delivered.
Care coordination is the deliberate organization of patient care activities between two or more participants involved in a patient's care to facilitate the appropriate delivery of healthcare services.
Care management is the organized support provided to patients with complex needs, chronic conditions, or high risk of avoidable utilization.
Certificate of need (CON) is a state regulatory process requiring approval before certain healthcare facilities, beds, equipment, or services can be added or expanded.
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Clinical integration is a collaborative arrangement among otherwise independent healthcare providers who agree to adopt common clinical protocols, share data, and coordinate care delivery to improve quality and efficiency.
Clinical pathways are standardized, evidence-informed care processes for defined conditions, procedures, or patient populations.
A community health needs assessment (CHNA) is a required process for tax-exempt hospitals to identify significant health needs in the communities they serve.
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Digital health is a broad category encompassing the use of technology, data, and computing platforms to improve healthcare delivery, patient engagement, and health outcomes.
Downside risk means a provider organization can owe money back to a payer if spending or performance falls outside contract terms.
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Fee-for-service is a reimbursement model in which healthcare providers are paid separately for each visit, test, procedure, or service they deliver.
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Health equity is the principle that every person should have a fair and just opportunity to attain their highest level of health, and that systemic barriers to health based on race, ethnicity, socioeconomic status, geography, gender identity, disability, or other factors should be identified and eliminated.
Health information exchange (HIE) refers to the electronic sharing of clinical data between healthcare organizations, enabling providers to access and use patient information regardless of where care was delivered.
Health system strategy is the enterprise plan that sets priorities across markets, service lines, partnerships, capital, workforce, digital capabilities, and operating performance.
A hierarchical condition category (HCC) is part of the CMS risk adjustment methodology used to estimate expected healthcare costs based on documented diagnoses and demographics.
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Interoperability is the ability of healthcare systems to exchange, interpret, and use data across organizations and technology platforms.
Medicare Advantage is the privately administered alternative to traditional Medicare, also known as Medicare Part C.
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The Medicare Shared Savings Program (MSSP) is the CMS accountable care organization program for Medicare fee-for-service beneficiaries.
Patient experience encompasses all interactions that patients have with the healthcare system, including their care from health plans, doctors, nurses, and staff in hospitals, physician practices, and other healthcare facilities.
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Payer mix is the distribution of revenue or volume by payer category, such as commercial insurance, Medicare, Medicaid, self-pay, and other government programs.
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Physician alignment refers to the strategies health systems use to build collaborative relationships with physicians around shared goals of clinical quality, operational efficiency, and financial performance.
A physician enterprise is the organized physician network, medical group, or provider platform affiliated with a health system.
Population health management (PHM) is a strategic approach to improving the health outcomes of a defined group of individuals by monitoring and identifying health concerns, implementing targeted interventions, and coordinating care across the continuum.
Price transparency refers to policies and practices that make healthcare prices, negotiated rates, and patient cost estimates easier to access and compare.
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Prior authorization is a payer review process requiring approval before a medication, procedure, admission, or service is covered.
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Quality measures are standardized metrics used to evaluate healthcare structure, process, outcomes, safety, patient experience, and equity.
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Readmissions are hospital admissions that occur after a recent discharge, often measured within 30 days.
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Remote patient monitoring uses connected devices and digital workflows to collect patient health data outside traditional care settings.
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Revenue cycle management (RCM) encompasses all administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue.
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Risk adjustment is a statistical methodology used in healthcare to account for differences in patient health status and expected healthcare costs when comparing outcomes, allocating resources, or setting reimbursement rates.
Service line strategy is the planning and management of a defined clinical business area such as cardiovascular, oncology, orthopedics, behavioral health, or womens health.
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Site-of-care shift is the movement of services from higher-cost settings to lower-cost or more convenient settings, such as from inpatient hospitals to outpatient departments, ambulatory surgery centers, home care, or virtual care.
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Social determinants of health (SDOH) are the non-medical factors that influence health outcomes, encompassing the conditions in which people are born, grow, work, live, and age.
Supply chain resilience is the ability of a healthcare organization to maintain critical supplies, equipment, pharmaceuticals, and vendor services during disruption.
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Telehealth is the delivery of healthcare services, education, monitoring, or care coordination through virtual communication technologies.
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Total cost of care is the full spending associated with a defined patient population or episode, including inpatient, outpatient, professional, pharmacy, post-acute, and ancillary services.
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Utilization management is the set of clinical and administrative processes used to ensure services are medically necessary, appropriately timed, and delivered in the right setting.
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Value-based care is a healthcare delivery model in which providers are reimbursed based on patient health outcomes rather than the volume of services delivered.
Workforce planning is the discipline of forecasting, recruiting, deploying, retaining, and developing the staff needed to deliver care and run healthcare operations.