PHM Glossary: M

Management – Active, Passive, Maintenance

Management is a method of segmenting a population targeted for improved health outcomes according to the opportunities for improvement and risks for poor outcomes of each segment and their corresponding resource needs.

Those in active management are deemed to present the greatest opportunity for short-term improvement. They require tertiary chronic care management measures to reduce complications of disease and disability. Their care management plans are characterized by regularly scheduled, proactive interactions designed to facilitate and accelerate the adoption of positive health practices and the individual’s assumption of responsibility for his/her overall health management. They warrant ongoing assessments, care planning, goal setting, interventions, and monitoring.

Those in passive management have demonstrated by their behaviors a greater degree of proficiency in managing their health. Their stratification will reflect their lower risk. They warrant intermittent and less intensive interactions and interventions than those in active management. Resources, such as Internet Web sites, are often provided for participants to obtain health information as needed. Evaluation is performed periodically to assess for disease progression, ensure stability, and restratify.

Maintenance management is typically reserved for participants who have achieved their health goals and mastered optimal self-management behaviors. Also included in this category may be people whose course of disease is not considered to be modifiable. They warrant surveillance, often by claims analysis and predictive modeling, to ensure stability and to identify early the emergence of new risk factors and conditions that may jeopardize or further complicate their health status.

See also stratification.

BIBLIOGRAPHY:

Kongstvedt, P. (2003). Essentials of managed health care (4th ed.). Gaithersburg, MD: Aspen Publishers.

Master patient index

Identifies all patients who have been treated in a facility or enterprise and lists the medical record or identification number associated with the name. An index can be maintained manually or as a part of a computerized system.

BIBLIOGRAPHY

(AHIMA)

 

Master provider index

A database of health care professionals and their identifying characteristics designed to ensure uniform and consistent identification and cross reference all health care professionals in the development of health care technology.

MEANINGFUL USE

Created by the Health Information Technology for Economic and Clinical Health (HITECH) Act as part of the American Recovery and Reinvestment Act of 2009 (ARRA). The term being defined by regulation by the Centers for Medicare and Medicaid Services will govern the way in which providers qualify for Medicare and Medicaid incentive payments for the adoption of health information technology and use of electronic health records (EHRs). The central goal of these regulations is to foster the adoption of HIT by providers and to establish the foundation for improving quality, efficiency and safety in the delivery of health care through meaningful use of EHRs.

BIBLIOGRAPHY

HITECH Act

Measurement

The act of measuring uses metrics that quantify variables being assessed in an evaluation. By measurement, we meant the process of assigning symbols or numbers according to a specific set of rules to evaluate a physical state or activity. For more information, refer to the CCA Outcomes Guidelines Report.

See also measures.

BIBLIOGRAPHY

Care Continuum Alliance. (2010). Outcomes guidelines report, vol. 5. Washington, DC: Care Continuum Alliance.

Last, J. (2001). A dictionary of epidemiology (4th ed.). Oxford: Oxford University Press.

Measures

Nonmonetary measures refer to items such as utilization, quality of life, and satisfaction that are not directly quantifiable in monetary terms.

Measure of central tendency is a general term that describes the characteristics of the distribution of a set of values or measurements around a value or values at or near the middle of the set. Mean (average), median, and mode are the measures of central tendency.

For more information, refer to the CCA Outcomes Guidelines Report.

See also measurement.

BIBLIOGRAPHY

Care Continuum Alliance. (2010). Outcomes guidelines report, vol. 5. Washington, DC: Care Continuum Alliance.

Last, J. (2001). A dictionary of epidemiology (4th ed.). Oxford: Oxford University Press.

Medicaid

For Medicaid beneficiary, see beneficiary - Medicare or Medicaid.

Medicare

For Medicare beneficiary, see beneficiary - Medicare or Medicaid.

Medicare Advantage

Medicare Advantage Plans are health plan options in which the Medicare beneficiary receives all Medicare-covered health care, including prescription drug coverage, through the plan of choice. These plans include: Medicare health maintenance organizations (HMOs); preferred provider organizations (PPOs); private fee-for-service plans; and Medicare special needs plans. The Medicare Advantage option generally offers extra benefits and lower copayments than traditional Medicare. The Medicare Advantage beneficiary may be required to go to doctors or hospitals belonging to the plan. Under the Medicare Advantage Plan, an individual’s Medigap policy will not pay any deductibles, copayments, or other cost-sharing under the Medicare Health Plan.

BIBLIOGRAPHY

Department of Health & Human Services. Medicare Advantage Plans. http://www.medicare.gov/choices/advantage.asp

Medication Adherence

Medication adherence is defined as the extent to which a patient takes medications as prescribed by their health care providers. The two most commonly used methods of measuring medication adherence are Medication Possession Ratio (MPR) and Proportion of Days Covered (PDC). PDC provides more conservative estimate of medication adherence (compared to MPR) when multiple medications are intended to be used concomitantly

Medication Possession Ratio is calculated as follows:

  total Rx days of supply  
  last Rx date – first Rx date + last Rx days of supply  

Proportion of Days Covered is calculated as follows:

  total days all drug(s) available  
  days in follow-up period  

In addition to evaluating medication adherence, medication persistence is used to evaluate how well patients comply with the medication regimen/treatment for the prescribed length of time. It is calculated as the time from the initial prescription fill until the patient has a gap in therapy.

Please see Care Continuum Alliance Outcomes Guidelines Report Volume 5 for a more detailed description.

BIBLIOGRAPHY

Osterberg L, Blaschke T. (2005). Adherence to Medication. N Engl J Med. 353:487-497.

Cramer JA, Roy A, Burrell A, et al.(2008) Medication compliance and persistence: Terminology and definitions. Value Health 11:44–47.

Moral Hazard

Moral hazard refers to the effect that is sometimes observed that the existence of insurance (or third-party payment) incites adverse (or sometimes illegal) behavior, to the detriment of the payer.

DETAILED EXPLANATION

An example of illegal behavior resulting from the existence of an insurance contract would be a company that starts a fire on its premises to collect on its fire insurance policy. An example of adverse (but legal) behavior would be the choice by an insured individual of a brand-name drug (rather than a generic equivalent) because insurance covers both drugs with an equal co-pay. “Health insurance makes expensive services look cheap to patients and more profitable to providers. As a result, middle class people who are well insured consume more and more-expensive services.” (Pauly, 2003).

Moral hazard does not require the commission of an illegal or adverse act, such as those above. Individuals will often choose to go without insurance, even when affordable options exist, because the individual has access to noninsurance sources of coverage (such as Medicaid, or hospital emergency care).

A related issue is that of adverse selection. Adverse selection occurs when an individual has more information about his or her condition or state than the underwriting insurer or entity responsible for financing care and takes advantage of this knowledge. For example, an individual with a chronic condition who is offered a rate appropriate to the healthy individual pool at no additional charge would be selecting adversely against the insurance pool. Whether this action is legal or illegal will depend on the insurer’s (and regulatory) requirements for full disclosure of the individual’s condition.

BIBLIOGRAPHY

Nyman, J. “Is Moral Hazard Inefficient? The Policy Implications of A New Theory.” Health Affairs, 23 (5), (Sept. Oct. 2004) 194-199.

Pauly, M. “Should We Be Worried About High Real Medical Spending Growth in the U.S.” Health Affairs, Web Exclusive. (2003).

Morbidity / Morbidity Rate

Morbidity is the state of having a disease or medical condition. In common clinical usage, any disease state, including diagnosis and complications, is referred to as morbidity.

Morbidity rate refers to the number of people who are ill or who have a specific condition during a specified time period divided by the number of people in the total population. The denominator may be defined as the entire population or may be limited to a specific subpopulation based on gender, age group, geography, or other characteristics.

BIBLIOGRAPHY

Hennekens C, Buring J. Epidemiology in Medicine. Boston: Little, Brown & Company; 1987.

Mortality / Mortality Rate

Mortality relates to the frequency of death within a population and typically expressed as a mortality rate.

Mortality rate refers to the number of deaths that occurred during a specified time period divided by the number of people in the total population. Mortality rates can be calculated as total (crude) mortality or as disease-specific mortality and may be defined based on the entire population or may be limited to a specific subpopulation based on gender, age group, geography, or other characteristics.

BIBLIOGRAPHY

Hennekens C, Burin J. Epidemiology in Medicine. Boston: Little, Brown & Company; 1987.

Motivational Interviewing

Motivational interviewing is a directive, consumer-centered counseling style for eliciting behavior change by helping individuals to explore and resolve ambivalence. Compared with nondirective counseling, it is more focused and goal-directed. Motivational Interviewing is a skillful clinical style for eliciting from consumers their own good motivation for making behavior change in the interest of their health. The overall approach is described as collaborative, evocative and honoring the consumer autonomy.

Motivational Interviewing has four guiding principles:

  • to resist the righting reflex
  • to understand and explore the patient’s own motivations
  • to listen with empathy
  • to empower the patient, encouraging hope and optimism.

These four principles can be remembered by the acronym RULE: Resist, Understand, Listen and Empower.

BIBLIOGRAPHY

Rollnick S, Miller WR. What is Motivational Interviewing? Behavioral and Cognitive Psychotherapy. 1995; 23: 325-334.

Rollnick S, Miller W.R. Butler, Motivational Interviewing in Health Care. 2008; 1:6-8.