Glossary

a | b | c | d | e | f | g | h | i | j | l | m | n | o | p | q | r | s | t | u | v | w

Click one of the letters above to be taken to a page of all terms beginning with that letter.

P4P: See pay for performance
Parameter: One or more quantities that define a theoretical model but that do not relate to the actual measurements or attributes of a variable. This can also refer to specific choices made in designing a program (e.g., the income level at which individuals become eligible, the size of a tax credit).
Patient experience: Refers to how patients evaluate their encounters with the health care system, generally framed by their expectations of how they should be treated.
Patient safety: Freedom from accidental injury in a health care setting. The establishment of operational systems and processes that minimize the likelihood of medical errors and maximize the likelihood of intercepting such errors when they occur and before they cause harm.
Patient safety event: See adverse event
Patient satisfaction: The degree to which the individual regards a health care service or product, or the manner in which it is delivered by the provider, as useful, effective, or beneficial.
Patient-centered: Providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide clinical decisions.
Patient-level data: Information that can be analyzed for individual patients, in contrast to population-level data, which are aggregated and cannot be used to evaluate trends in individuals. Special procedures are needed to ensure confidentiality of patient-level data, in accordance with HIPAA.
Pay for performance: Refers to the general strategy of promoting quality improvement by rewarding providers (physicians, clinics or hospitals) who meet certain performance expectations with respect to health care quality or efficiency. Initiatives reflect the efforts of purchasers of health care (from the federal government to private insurers) to use their purchasing power to change the behavior of health care providers.
Pay or play: A mandate under which employers are required to either provide a minimum level of health insurance coverage to their employees or pay into a state insurance fund. (See also employer mandate).
Payer: An entity (usually other than the patient) that finances or reimburses the cost of medical services (for example, governments and insurance companies).
Payment update: The Centers for Medicare & Medicaid Services (CMS) process of reviewing the rates and methods related to Medicare reimbursement to make changes as needed to reflect current costs; the Medicare Payment Advisory Commission (MedPAC) advises CMS on payment policy updates.
Performance measure: Ways to objectively measure the degree of success a program has had in achieving its stated objectives, goals, and planned program activities.
Performance threshold: A specified target that is set for evaluating a task or action. These thresholds may be relative (e.g., by quintile) or absolute (e.g., a fixed numerical target).
Personal Health Care Services: Tasks performed in a place of residence on a per-visit or per-hour basis to meet the identified needs of patients who have (or are at risk of) an injury, illness, or disabling condition and who require assistance in personal care (e.g., getting out of bed, bathing, dressing, grooming, getting to doctors' appointments). May be provided by home health aides, personal care aides, or home attendants.
Personalized medicine: See genetic-based care
Pharmacy Benefit Managers/Pharmacy Benefit Management: Independent organizations and subsidiaries of drug companies or insurance companies that specialize in reducing the cost of pharmaceuticals, typically in support of self-insured employers, government entities, private insurers, third party administrators, HMOs, hospital systems, etc. Typically PBMs set up pharmacy benefits (formularies), negotiate rates with drug companies, administer rebates, set up pharmacy networks and/or mail order systems, and process claims.
Physician Group Practice Demonstration: A three-year, national Centers for Medicare & Medicaid Services (CMS) initiative to test the effect of pay for performance in ten physician groups participating in the Medicare program.
Physician Quality Reporting Initiative: An ongoing Centers for Medicare & Medicaid Services (CMS) pay for performance initiative that gives individual physicians participating in Medicare a bonus for reporting information on quality measures that are relevant to their area of practice.
Picture Archiving and Communication System: A computerized system for storing medical images (such as x-ray and MRI), that facilitates access to image-based diagnostic medical information by health care providers. It replaces having to rely on hard-copy versions of the images that are kept with a patient's paper medical record.
Point of Service: A health plan that allows the employee or beneficiary to receive their medical care outside of the health plan network, although out-of-network care is discouraged through the use of financial incentives (i.e., higher out-of-pocket costs) and requirements for full documentation for out-of-network use.
Pool: See risk pool
Portability: Federal law provides a guarantee of health insurance coverage with a new employer by limiting the ability of a new employer plan to exclude coverage for preexisting conditions; by providing additional opportunities to enroll in a group health plan if you lose other coverage; by prohibiting discrimination against new employees based on health factors; and by guaranteeing that certain individuals will have access to individual health insurance policies. (See also HIPAA).
Practitioner: Any individual who is qualified to work in a health care profession (e.g., physician, nurse); such an individual is often required to be licensed as defined by state law.
Preferred Drug List: See formulary
Preferred Provider Organization: A health plan that involves a contract between organizations (such as self-insured employers, insurance companies, and third party administrators) and health care providers (both professional and institutional) under which the health care providers agree to provide health services to a specific population for predetermined fees. Unlike in HMOs and other similar organizations, PPO physicians are paid on a fee-for-service basis (rather than by salary or per capita rates) and do not accept insurance risk.
Premier Hospital Quality Incentive Demonstration: Centers for Medicare & Medicaid Services (CMS) initiative, in partnership with Premier, a national organization of not-for-profit hospitals, to test the effects of pay for performance on quality in the hospital setting. The initiative included performance measures related to heart attack, heart failure, pneumonia, coronary artery bypass graft, and hip and knee replacements.
Premium: A payment for an insurance policy for a given period of time. Premiums are determined by insurance company actuaries based on insurance company costs for administering the program and paying for services rendered by health care practitioners, plus a profit margin. Actuaries determine the exposure to risk according to the specific provisions of the policy and then set a premium rate.
Prescription Drug Hierarchical Condition Category: A case mix-adjusted method used by the Centers for Medicare & Medicaid Services (CMS) to determine payments to private health plans under the Medicare Part D prescription drug benefit.
Prescription Drug Hierarchical Condition Category: See RxHCC
Presumptive eligibility: A program that enables potentially-eligible pregnant women (in the case of Medicaid) and children (in the case of the State Children's Health Insurance Program) to receive benefits for a limited period of time while their eligibility for full benefits is determined.
Prevalence: The number of cases of a disease existing in a given population at a specific period of time (period prevalence) or at a particular moment in time (point prevalence).
Price discrimination: A policy of setting different prices for different buyers even though the cost of the item is the same.
Price sensitive: See elasticity
Primary care: Basic health care provided by a medical professional (e.g., a general practitioner or pediatrician) with whom a patient has initial contact and by whom the patient may be referred to a specialist for further treatment; a branch of medicine that emphasizes the care of the simpler and more common illnesses and injuries.
Primary Care Case Management: A managed fee-for-service arrangement in which primary care providers are paid a monthly fee (in addition to fee-for-service reimbursement for medical services), to coordinate care and provide gate-keeping services for Medicaid beneficiaries.
Primary Care Physician: A physician who specializes in family practice, general internal medicine, general pediatrics, or obstetrics and gynecology. This physician provides the initial care for a patient, and refers the patient, when appropriate, for specialist care. (See also primary care.)
Prior authorization: Under a system of utilization review, a requirement imposed by a health plan or third party administrator that a provider justify the need for delivering a particular service in order to receive reimbursement. Prior authorization may apply to all services or only to those that are potentially expensive and/or overused.
Privately insured: See commercially insured
Process measure: An indicator of the quality of medical care that documents the content or means of care used (for example, the percentage of cases of strep throat that are cultured before treatment). Measuring the results of process changes will indicate if care is improving.
Process reengineering: A strategy directed toward major rethinking, redesign and restructuring of an organization's processes.
Protein Pump Inhibitor: Any of a group of drugs that inhibit the activity of protein pumps (proteins that are capable of pumping out compounds that could pose a threat to the cell) and are used to inhibit gastric acid secretion in the treatment of ulcers and gastroesophageal reflux disease.
Public finance: Direct and indirect spending on health care in the U.S. occurs at all levels of government: federal, state, and local. In addition to direct government expenditures (such as provision of public insurance and funding for health facilities), government is engaged in "tax expenditures" on health care through the tax deductibility of employer-provided health insurance and through tax exemption for non-profit health care organizations.
Public reporting: The gathering and sharing of information on health care practice on a national, regional, or state level in order to inform patients (and prospective patients) about the cost, quality, and/or outcomes of services provided by health plans, health care organizations, and/or individual providers.
Punitive damages: Damages awarded to punish a defendant and to deter a defendant and others from committing similar acts in the future.
Purchasing coalition: Generally, groups of private employers that join together to increase their purchasing power and bargaining leverage in the health insurance marketplace, for the purpose of increasing value and quality of care. Examples of purchasing coalitions include the Pacific Business Group on Health and the National Business Group on Health.
Purchasing pool: Assembling individuals or many small groups into a single entity for the purpose of purchasing health insurance. The primary goals of purchasing pools are to: increase coverage; reduce premiums; offer greater health plan choice to workers in small firms; make comparison shopping easier; and reduce administrative costs through economies of scale.
Purchasing power: The number of goods and services that current income can purchase.

Top