·  Accountable Care Organization (ACO) – A group of healthcare providers who work together to improve patient care and reduce costs. They earn rewards for keeping patients healthy and lowering expenses.

·  Affordable Care Act (ACA) – A U.S. law that makes health insurance more affordable and available to more people, including protections for those with pre-existing conditions.

·  Behavioral Health Integration – The coordination of mental health and substance use treatment with primary care to improve overall patient well-being.

·  Care Coordination – The process of organizing a patient’s healthcare services to ensure smooth communication between doctors, nurses, and specialists.

·  Centers for Disease Control and Prevention (CDC) – A U.S. government agency that works to prevent diseases, protect public health, and promote healthy living.

·  Center for Medicare and Medicaid Services (CMS) – A federal agency that manages Medicare, Medicaid, and health insurance regulations in the U.S.

·  Chronic Care Management – Ongoing healthcare services provided to patients with long-term conditions, such as diabetes or heart disease, to help them stay healthy.

·  Clinical Integrated Network (CIN) – A group of doctors and hospitals that work together to improve patient care while lowering costs.

·  DME (Durable Medical Equipment) – Medical devices like wheelchairs, oxygen tanks, or walkers that help patients with long-term health needs.

·  Emergency Room (ER) Diversion – Programs that help patients get the right care outside of the ER, such as urgent care or telehealth, to reduce unnecessary hospital visits.

·  End-Stage Renal Disease (ESRD) – The final stage of kidney failure where dialysis or a transplant is needed to survive.

·  Federally Qualified Health Center (FQHC) – A community health clinic that provides affordable healthcare services, especially for underserved populations.

·  Formulary – A list of prescription drugs covered by a health insurance plan.

·  HCC Coding (Hierarchical Condition Category) – A medical coding system used to predict healthcare costs based on patient diagnoses.

·  Health Equity – The goal of making sure everyone has fair access to healthcare, regardless of income, race, or background.

·  Health Resources and Services Administration (HRSA) – A U.S. agency that helps provide healthcare to underserved communities.

·  Healthcare Marketplace – A government-run website where people can compare and buy health insurance plans under the Affordable Care Act.

·  Medical College Admission Test (MCAT) – A standardized exam required for students applying to medical school.

·  Medical Loss Ratio (MLR) – The percentage of health insurance premiums that must be spent on patient care rather than administrative costs or profits.

·  Medical Risk Adjustment (MRA) – A method used by insurance companies to estimate healthcare costs based on patient conditions.

·  Medicaid – A government program that provides free or low-cost healthcare to low-income individuals and families.

·  Medicare – A federal health insurance program for people aged 65 and older or those with certain disabilities.

·  Medicare Advantage – A private insurance alternative to Medicare that offers extra benefits like dental and vision coverage.

·  Medication Reconciliation – The process of reviewing and updating a patient’s medication list to prevent errors and ensure safe treatment.

·  Network Management – The process of organizing healthcare providers in an insurance plan to ensure quality care at the best cost.

·  Patient-Centered Medical Home (PCMH) – A healthcare model that focuses on personalized, coordinated, and accessible care for patients.

·  Pay for Performance – A payment model where healthcare providers earn bonuses for meeting quality and efficiency goals.

·  Payor – A company or government program that pays for healthcare services, such as insurance companies, Medicare, or Medicaid.

·  Percent of Premium – The percentage of an insurance premium that goes toward covering medical care rather than administrative costs.

·  Population Health – The study of health trends in groups of people to improve care and prevent disease.

·  Preferred Provider List – A list of doctors, hospitals, and specialists covered by a health insurance plan.

·  Primary Care – The first point of contact for patients, usually provided by family doctors, pediatricians, or general practitioners.

·  Provider Incentive – A bonus or reward given to doctors and hospitals for meeting quality or cost-saving goals.

·  Provider Scorecard – A report that measures a doctor or hospital’s performance based on quality, patient satisfaction, and efficiency.

·  Quality Improvement – Programs designed to make healthcare safer, more effective, and more patient-friendly.

·  Risk Management – The process of identifying and reducing potential risks in healthcare to protect patients and providers.

·  Social Determinants of Health – Non-medical factors like income, education, and housing that affect a person’s health.

·  Specialty Care – Healthcare services provided by specialists, such as cardiologists, oncologists, or orthopedic surgeons.

·  Total Cost of Care (TCOC) – The total amount spent on a patient’s healthcare over a period of time, including doctor visits, hospital stays, and medications.

·  Transitional Care Management – Support services that help patients move from hospital care back to their home or another care setting safely.

·  Value-Based Care – A healthcare model that rewards doctors and hospitals for quality and patient outcomes rather than the number of services provided.

·  Value-Based Contracting – Agreements between healthcare providers and insurance companies that focus on paying for results, not just services.