Understanding the Value Behind Health Care’s Terminologies

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Whether it be an important date or nuanced concept that requires further research, I always keep a notepad next to my laptop in case I need to record something.

As I joined the Cambia Grove team and the health care innovation community in August of last year, one of the first things that Executive Director Maura Little said to me was: 

“We have two rules at Cambia Grove: Have fun, and question everything.” 

After a few weeks at Cambia Grove, my enthusiasm for advancing health care innovation meant that rule #2 filled my notepad in no time . As a recent graduate from Seattle University in Interdisciplinary Liberal studies, I’m accustomed to in-depth research, long writing assignments and navigating complex ideas.

With fresh eyes for the health care landscape, I took this opportunity to identify the commonplace terms capable of more closely aligning community efforts to transform health care. During my research, I noticed our underperforming health care system is defined by complex concepts, abbreviations and definitions that can alienate many looking to help. At times, our sector takes for granted each term’s contextual meaning - not just the textbook definition, but its fundamental value in relation to transforming health care. For example, interoperability at face value, is the ability for systems to exchange and make use of information. However, in health care, interoperability is essential towards reducing misdiagnoses, duplication, and other factors relating to improving population health and patient outcomes. 

So, in the spirit of questioning everything, below is a short list that seeks to demystify some of the terms we use every day. Because oftentimes, words can be just that- words. But sometimes, words resonate deeply with us, guide our work and guide the principles we stand for. I look forward to building on this running list for all to reference. As we continue to transform health care, please, feel free to reach out to me at Nolan@cambiagrove.com to add words or phrases that could use further explanation.  

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Community Health 

A medical specialty that focuses on the physical and mental well-being of the people in a specific geographic region

Community health impacts everything as it focuses on a holistic approach to a community’s well-being. It works best when the members of the community work together to ensure everyone in their region has access to high quality health care. In addition, supporting services and initiatives that reduce the health gap caused by race, ethnicity, socioeconomic status and other factors that affect health. 

Consumer driven health care 

Consumer-driven health care (CDHC) refers to a type of health insurance plan that allows members to use health savings accounts, health reimbursement accounts, or similar medical payment accounts to pay routine health care expenses. 

In our past conferences, Lauren Vela, Senior Director of Member Value at Purchaser Business Group on Health, said that CDHC was the “best and worst thing to happen.” What she meant was that while CDHC has increased health care costs, it has more importantly enabled consumers to recognize and yield their power to demand a system that puts them first. 

Culture 

When the term “culture” is referring to health care, it includes the predominant beliefs and practices that define and drive behavior within the ecosystem. Culture must be open, inclusive and equitable to socialize challenges and ensure that created solutions match existing problems. 

Fee-For-Service  

A system of health care payment in which a provider is paid separately for each service rendered. 

Medicare, and select Medicare advantage plans, are examples of fee-for-service (FFS) coverage. Alternatives to fee-for-service programs include value-based or bundled payments, in which providers are paid based on outcomes and efficiency rather than each separate procedure. 

Healthcare vs. Health Care 

“Health care” refers to the improvement and maintenance of a person or persons through medical means or otherwise.

“Healthcare” is an industry, system or field that aims to facilitate the delivery of care to consumers.  

Health Care Innovator 

Individuals across the health care sector who introduce or advocate for new methodologies, ideologies, or solutions, to develop and improve our health care system. If you’re looking for a community of health care innovators that aim to develop and advance solutions, apply to join the Cambia Grove Membership

Health Equity 

Health equity will be achieved when everyone can attain their full health potential. 

Health equity is often discussed in terms of dismantling health inequities, or, how to ensure everyone has a chance to live their healthiest life. Historically, health inequities have been caused by social, political and economic factors outside a person’s control. To make this right, we must dismantle systems that have underserved and discriminated against whole communities. 

HL7® Fast Health Care Interoperability Resources (FHIR®)  

The HL7 FHIR standard defines how health care information can be exchanged between different software and computing systems.  

FHIR is a long-awaited interoperability rule that allows systems to exchange health information that results in coordinated, cost-effective and higher quality of care. This standard will allow patients to receive their own health information while aiming to reduce duplication and overall cost of the health care system.  

Incentives 

Incentives include positive reinforcements (e.g. financial/non-financial rewards, recognition, positive impact, etc.) and negative consequences (e.g. fines, penalties, etc.) that drive stakeholders’ behavior. 

The most effective incentives drive stakeholder behavior to design a more patient-centered health care system while aligning other stakeholder incentives to support sustainable change. 

Infrastructure 

These include formal and informal arrangements, and key resources needed to enable innovators and those that work to transform health care to implement their work and execute their strategy, as well as the right technical and physical systems to connect solutions with end users. 

The infrastructure must be encouraging of systemic changes to support innovation. 

Interoperability 

Interoperability within health care means the exchange of health information across organizational boundaries to advance effective care delivery. 

Data exchange allows each of the 5 Points of Health Care™ to access critical health information in a timely fashion, reducing duplication and misdiagnoses, mitigating physician burnout and improving the overall quality of care. 

Patient-Centered Health Care 

Providing care that is respectful of, and responsive to, individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions. 

When it comes to the overall health care system, patients need to be at the center of the discussion in their own care. Care should be collaborative, accessible and equitable to improve the individual health outcome of the patient. 

Social determinants of health (SDOH) 

Social determinants of health, also referred to as social drivers of health (SDOH) are conditions in the places where people live, learn, work and play that affect a wide range of health risks and outcomes.  

This refers to non-medical aspects that affect people’s health outcomes. Addressing and investing in the root causes that drive social determinants of health can help dismantle health inequities throughout the U.S. 

Healthy People 2030 uses this framework to outline the five areas of SDOH:

  • Health Care Access & Quality 
  • Education Access & Quality 
  • Social & Community Context 
  • Economic Stability 
  • Neighborhood & Built Environment 

The Triple Aim 

The Triple Aim is a framework developed to help health care systems optimize performance by measuring the results of a three-pronged approach: Improving population health, improving experience of care and reducing per capita costs. 

The Triple Aim aligns stakeholder strategies for a better health care system with mutually agreed upon measurements. This combined lens quickly identifies whether an innovation can support positive health care transformation. 

Cambia Grove’s Health Care Innovation Advancement Framework lays the foundation for the health care sector to advance impactful, sustainable innovation that realizes the Triple Aim.  

Value-based Care 

A form of reimbursement that ties payments for care delivery to the quality of care provided and rewards providers for both efficiency and effectiveness. 

An incentive model designed to drive holistic patient care instead of itemizing charges for individual patient services. The hope for value-based care payment models is to ensure the improvement of population health and patient health outcomes by addressing unmet patient needs.  

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About Nolan Jekich

Nolan joined the Cambia Grove team in August of 2020. His primary role consists of communicating and marketing Cambia Grove’s mission across various social networking services. 

Before Cambia Grove, he graduated from Seattle University where he played baseball and received a Bachelor’s of Arts in Interdisciplinary Liberal Studies. He has a combination of written and verbal communications experience in several business industries. Nolan was drawn to health care after he volunteered at Bailey Gatzert Elementary School at the start of 2020. He wants to have long-lasting, meaningful impact within the community by making health care more accessible and affordable to individuals and families of every economic background. He is ecstatic to join the organization that focuses on implementing change throughout the health care system. 

When he is not looking to communicate the journey of innovating health care, he enjoys exercise, golf, and writing. Nolan looks forward to helping Cambia Grove communicate the transformation of the health care system, improving his skills as a marketer, and serving his community. 

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