ACO (Accountable Care Organization)
A group of doctors, hospitals, and other healthcare providers who voluntarily collaborate to deliver coordinated, high-quality care to Medicare patients.
ACO Agreement Period
The duration of time an ACO is contracted with CMS to participate in a program like MSSP.
ACO Governing Body
The leadership structure responsible for oversight and strategic direction of the ACO.
ACO REACH
A CMS model (Realizing Equity, Access, and Community Health) that builds on Direct Contracting to promote health equity and advanced risk-sharing.
Advanced APM (Alternative Payment Model)
A payment model that includes both upside and downside financial risk and qualifies for additional CMS incentives.
Alternative Payment Model (APM)
A payment approach that incentivizes high-quality, cost-efficient care, often tied to specific conditions or populations.
Attribution
The process of assigning patients to a provider or ACO for accountability and performance measurement.
Benchmark
A spending target or quality threshold used to evaluate ACO performance.
Beneficiary
A person enrolled in Medicare or Medicaid who receives healthcare services.
CAHPS (Consumer Assessment of Healthcare Providers and Systems)
A standardized survey tool that measures patient experience and satisfaction.
Capitation
A payment model where providers receive a fixed amount per patient, regardless of how many services are provided.
Care Coordination
The organization of patient care activities to ensure appropriate and efficient delivery of healthcare services.
Care Gap
A missed or overdue preventive or chronic care service that may impact patient outcomes.
Chronic Care Management (CCM)
Services provided to patients with multiple chronic conditions to improve health outcomes and reduce hospitalizations.
Clinical Integration
The alignment of healthcare providers across settings to improve care coordination and outcomes.
Downside Risk
A financial arrangement where providers are responsible for losses if care costs exceed benchmarks.
EHR (Electronic Health Record)
A digital version of a patient’s medical history used to support care coordination and data sharing.
EHR API Integration
The process of connecting external applications to EHR systems to enable data exchange and automation.
HEDIS (Healthcare Effectiveness Data and Information Set)
A widely used set of performance measures in managed care.
Interoperability
The ability of different health IT systems to exchange and use patient data effectively.
MSSP (Medicare Shared Savings Program)
A CMS program that incentivizes ACOs to reduce healthcare costs while meeting quality benchmarks for Medicare beneficiaries.
Patient-Centered Medical Home (PCMH)
A care model that emphasizes comprehensive, coordinated, and accessible care centered around the patient.
Population Health
A strategy focused on improving health outcomes for a defined group by addressing clinical and social determinants of health.
Preventive Care
Health services that prevent illness or detect issues early, such as screenings and immunizations.
Quality Measures
Metrics used to assess the effectiveness, safety, and patient-centeredness of care.
Risk Adjustment
A method to account for the health status of patients when comparing provider performance or setting payment benchmarks.
Shared Savings
A financial incentive where providers share in cost savings achieved through efficient, high-quality care.
Sidekick
PBACO’s proprietary platform designed to support real-time data access, patient engagement, and workflow automation.
Two-Sided Risk Model
A model where providers share in both savings and losses.
Upside Risk
A financial model where providers can share in savings but are not liable for losses.
Value-Based Care
A healthcare delivery model that rewards providers for quality and outcomes rather than volume of services.
