Glossary

Terms

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

C

Closed Questions

Closed questions offer a set of appropriate answers from which the interviewee can choose. For example: "Which of these covers do you prefer, Cover #1 or Cover #2?"

Cognitive Interviewing

A cognitive interview is a special kind of interview that focuses on how people absorb information, think about what they see, and draw implications or conclusions.

Confidence Interval

A confidence interval refers to the statistical likelihood that a score falls within a given range around an estimate. This is important because nearly all health care quality scores are developed using a statistical sampling method, which means that there is some uncertainty about whether the sample reflects the population. The confidence interval tells you how confident you can be that the score for the sample represents the score for the entire membership or population. For instance, a 99-percent confidence interval means that, if you drew numerous samples, 99 percent of the estimates would fall within the given range. A narrower range (e.g., a 90-percent confidence interval) would give you less certainty about the estimate.

Cutpoint

A cutpoint is a statistical device for establishing tiers of performance for a given measure or category. It is a point at which you can say that those above that level are statistically different from those below that level.

D

Distribution Brokers

Distribution brokers are organizations or people who can serve as middlemen between you and your audience. Because of their relationships and familiarity with your intended audience, distribution brokers can be effective channels for delivering information to consumers.

Distribution of Scores

A distribution of scores is essentially a picture of the performance of competing health plans or providers. To create a distribution, you would plot each health care organization’s score for a given measure (or category) on one axis of a chart and the organization’s identity on the other axis.

F

Focus Groups

A focus group is a special kind of group discussion that is designed to elicit information about the wants, needs, viewpoints, beliefs, and experiences of your intended audience. Focus groups can help you better understand the expressions and terminology commonly used by people in your audience, as well as their attitudes and beliefs about health care. They are especially good at helping to uncover the reason behind people’s responses.

Framing

Framing refers to the emotional tone of the message you are communicating to consumers. For example, a positive frame would accentuate the benefits of looking at and using information on quality, while a negative frame would emphasize the risks of not doing so.

G

Gold Standard

A "gold standard" is a goal for health plan or provider quality that reflects a high but achievable level of performance. The purpose of setting a standard at this level is to encourage all players in the market to reach beyond their current level of performance.

H

Health Maintenance Organization (HMO)

A Health Maintenance Organization (HMO) is a managed care organization that provides health care in return for pre-set monthly payments. Most HMOs provide care through a network of doctors, hospitals, and other medical professionals that their members must use in order to be covered for that care.

I

Information Intermediaries

Information intermediaries are people who can answer health care consumers’ questions, address their concerns, and help them apply information on health care quality to their personal situations – whether face-to-face or over the telephone. In addition to providing a more personal interpretation of data on quality, an information intermediary can reinforce and supplement the information your audience has.

L

Layering

Layering refers to a way of presenting data so that the reader may look at information in both summary form and in detail. This allows readers to focus on whatever level of information suits their needs best.

M

Minimum Standard

A minimum standard is a level of quality that all health plans (or providers) would be required to meet in order to offer services to consumers.

O

Open-Ended Questions

An open-ended question allows a respondent to answer in whatever way he or she chooses, using his or her own words. Unlike closed questions, open-ended questions do not contain prompts for specific responses from interviewees.

Open Enrollment

Open enrollment is a period of time during which employees or beneficiaries can compare their health plan options (if any) and choose which plan to enroll in for the coming year. This period often takes place in the fall for an enrollment year that begins in January, but it could occur at any time.

P

POS Plans

Point-of-service (POS) plans function like health maintenance organizations (HMOs) but allow patients to seek care outside the plan’s network of doctors for an additional cost.

PPO Plans

A preferred provider organization (PPO) is a health care delivery system that controls costs by steering patients into more affordable medical settings. PPOs do this by negotiating provider discounts, encouraging preventive measures, implementing utilization management programs, and developing networks of doctors and hospitals. In return for offering medical services at negotiated reimbursement levels, these doctors and hospitals get access to more patients and/or more timely payments. Enrollees may use any provider in the PPO or outside of the PPO, but have a financial incentive—for example, lower coinsurance payments—to use providers within the PPO.

Provider Groups

A provider group refers to any combination of provider organizations (such as hospitals, medical groups, nursing homes, and tertiary facilities) that contract with each other to jointly seek out contracts with insurance companies and purchasers and to coordinate the delivery of care for their patients.

R

RFP or Request for Proposal

A request for proposal (RFP) is a written document requesting specific information from any parties wishing to compete for a contract. Large purchasers may issue RFPs to learn more about the quality and performance of health plans.

S

Sampling Error

Sampling error refers to the level of uncertainty surrounding a data point that is drawn from a sample of the relevant population.

Secondary Audience

A secondary audience is any group of people that may influence the decisions of the primary audience by providing assistance or advice. For example, secondary audiences for information on Medicare plans would include the adult children of seniors and the insurance counseling services available around the country.

Standardizing Scales

Quality measures are not necessarily based on the same scales (e.g., they may be based on a scale of 0 to 5, or 1 to 100). The standardizing of scales refers to the statistical process of converting or transforming scales to make them equivalent, which then allows you to make statistically valid comparisons or combinations of measures.

Statistical Significance

Statistical significance tells you whether two scores are really different from each other. One way to determine statistical significance is to check whether the confidence intervals around the scores overlap.

Summary Score/Composite Score

Summary scores, also referred to as composite scores in the context of CAHPS®, are a device for reporting health care quality information as concisely as possible by condensing a number of quality measures into a single piece of information. For example, rather than report scores for five preventive care measures, a sponsor could report one summary score for "Preventive Care" that reflects performance on all five measures.

U

Usability Testing

Usability testing refers to the process involved in learning whether and how consumers actually use your materials, what may be preventing them from doing so, and what could help them.

W

Weighting

Weighting refers to emphasizing some measures more than others when you combine individual results to create summary scores. For example, if you were to combine four measures into a single category, you could weight them equally (25 percent each). However, you may not believe that those measures are equally important (two of the measures reflect the experiences of all enrollees while the other two are pertinent to only a small segment of enrollees). In that case, you may want to give more weight to the first two measures (e.g., 35 percent and 40 percent) and less weight to the remaining two (10 percent and 15 percent).

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

A

Agency for Healthcare Research and Quality (AHRQ), formerly the Agency for Health Care Policy and Research (AHCPR)
URL: http://www.ahrq.gov
Phone: (301) 594-6662

The Agency for Healthcare Research and Quality is a subordinate agency of the U.S. Department of Health and Human Services. The primary function of AHRQ is to support research regarding the improvement of health care in multiple areas. AHRQ-sponsored research focuses on improving the outcomes and quality of health care, reducing its costs, addressing patient safety and medical errors, and broadening access to effective services. AHRQ also develops and distributes information designed to help people make better health care decisions.

American Society on Aging (ASA)
URL: http://www.asaging.org/ASA_Home_New5.cfm
Phone: (415) 974-9600

The American Society on Aging is an association of researchers, doctors, educators, business people, and policymakers interested in learning about the physical, emotional, economic, and social facets of aging. ASA carries out its mission through Web-enhanced teleconferences, computer-based training, and searchable databases that provide a consolidated source of education and training resources. ASA provides members with the opportunity to join Constituent Groups that provide specialized newsletters, membership directories, and annual programming in a particular area of interest.

B

Buyers Health Care Action Group (BHCAG)
URL: http://www.bhcag.com
Phone: (952) 896-5186

Established in 1988, the Buyers Health Care Action Group (BHCAG) is a strong coalition of 52 health care purchasers based in Minnesota and South Dakota. Most members and associate members are large, private employers; the State of Minnesota Department of Employee Relations (DoER), which represents 150,000 State employees and their dependents, is an associate member. Since 1997, BHCAG has sponsored an innovative purchasing initiative that combines financial incentives with information on quality and costs to help employees of participating members choose among competing provider-based "care systems," rather than insurer-based health plans. Through written materials, touch-screen kiosks, and the Internet, these employees and their dependents have access to descriptive information about each care system as well as scores based on patients’ reports of their experiences with the care systems.

C

California Cooperative Healthcare Reporting Initiative (CCHRI)
Phone: (415) 281-8660

Conceived in 1994, the California Cooperative Healthcare Reporting Initiative (CCHRI) is a collaboration of purchasers, health plans, and providers dedicated to giving California’s consumers important information about health plans. CCHRI is governed by an executive committee consisting of 15 elected representatives (five each from participating health plans, purchasers, and providers) that meets monthly. The Pacific Business Group on Health (PBGH), a coalition of large purchasers, is responsible for administering the program.

California HealthCare Foundation (CHCF)
URL: http://www.chcf.org
Phone: (510) 238-1040

The California HealthCare Foundation is a private, grant-making organization with the primary goals of increasing access to health care for underserved people and bettering the general health status of Californians. The CHCF accomplishes its goals in three ways: foundation-initiated projects, request-for-proposal projects, and projects initiated by unsolicited proposals.

California Public Employees’ Retirement System (CalPERS)
URL: http://www.calpers.ca.gov
Phone: (916) 326-3000

The California Public Employees’ Retirement System is an agency within the California State government responsible for providing retirement and health benefits to 1.2 million California public employees, retirees, and their families. The CalPERS health benefits program offers members and contracting employers access to 10 health maintenance organizations (HMOs), two preferred provider organizations (PPOs), and four special PPOs for members who belong to specific employee associations. In addition to its own initiatives to improve quality of care, CalPERS also participates in the quality measurement and improvement activities of the Pacific Business Group on Health.

Center for the Study of Services (Consumers’ Checkbook)
URL: http://www.checkbook.org
Phone: (202) 347-7283

The Center for the Study of Services (CSS) is an independent, nonprofit consumer organization founded in 1974 with support from the U.S. Office of Consumer Affairs. The main purpose of CSS is to provide consumers with information they can use to find high-quality services and products at the best possible prices. It is now supported entirely by subscription payments, donations from individual consumers, and fees for information services and books. Consumers’ Checkbook provides National information as well as local information for Chicago, San Francisco, and Washington, DC.

Centers for Medicare & Medicaid Services (CMS), formerly Health Care Financing Administration (HCFA)
URL: http://www.cms.hhs.gov
Phone: (410) 786-3000

The Centers for Medicare & Medicaid Services is a subordinate agency of the U.S. Department of Health and Human Services. CMS is responsible for Federal health insurance programs, including administration of the Medicare and Medicaid programs, which cover more than 70 million Americans. CMS spends over $360 billion a year buying health care services for beneficiaries of Medicare, Medicaid, and the State Children’s Health Insurance Program.

Colorado Business Group on Health
URL: http://www.coloradohealthonline.com/main.htm
Phone: (303) 922-0939

The Colorado Business Group on Health is a private, non-profit coalition of private and public sector companies that provide health care benefits to over 250,000 employees, retirees, and their families. The CBGH advocates employer-led activity to promote value in health care purchasing in Colorado.

Commonwealth Fund
URL: http://www.cmwf.org
Phone: (212) 606-3800

The Commonwealth Fund is a private foundation established in 1918 with the general objective of improving human welfare. The Fund supports independent research on health and social concerns and provides grants for projects that aim to improve health care practice and policy. In particular, the Fund is dedicated to improving care for vulnerable populations (such as children, the elderly, low-income families, and minority Americans) and helping the general populace become more informed about their health care.

Community Service Society of New York (CSSNY)
URL: http://www.cssny.org
Phone: (212) 254-8900

The Community Service Society of New York is a private, nonprofit social service organization that aims to help poor residents of New York City by doing work in the areas of income maintenance, health care, affordable housing, and education. CSSNY’s efforts in the health care arena are primarily in the form of research, education, policy analysis, and advocacy.

Consumer Assessment of Health Plans (CAHPS®)
URL: http://www.CAHPS-sun.org
Phone: 800-492-9261

The Consumer Assessment of Health Plans (CAHPS®) is a research project funded by the Agency for Healthcare Research and Quality (AHRQ) and in part by the Centers for Medicare & Medicaid Services (CMS), formerly the Health Care Financing Administration (HCFA). Commercial and public purchasers, health plans, and purchasing coalitions can use the CAHPS® survey and reporting kit to gather and disseminate comparable information on health care quality from the patient’s perspective. The CAHPS® toolkit includes standardized surveys for different kinds of enrollees, an analysis program, and templates for reporting findings to consumers. CAHPS® was developed by a consortium composed of Harvard University Medical School, RAND, the Research Triangle Institute (RTI), and Westat. Westat is responsible for providing technical assistance to users and also provides support to the CAHPS® Consortium.

Consumer Reports
URL: http://www.consumerreports.org/main/home.jsp
Phone: (914) 378-2000

Consumer Reports is a publication of the Consumers Union, an independent, nonprofit testing and information organization. The broad objective of the Consumers Union is to test products, inform the public, and ultimately protect consumers. The Consumers Union does not accept advertisements in Consumer Reports; income is derived solely from the sale of Consumer Reports (in print and online) and from neutral, noncommercial contributions, grants, and fees. Consumer Reports is widely available at public and many private libraries.

Coordinated Autos/UAW Reporting System (CARS)

The CARS project is a coordinated quality measurement and reporting initiative sponsored by the three U.S. auto manufacturers (General Motors, Ford, and Daimler-Chrysler), the United Auto Workers Union (UAW), and the Greater Detroit Area Health Council (GDAHC), a broad-based coalition of business, labor, hospitals, health plans, and others in Southeast Michigan. The purpose of CARS was to develop a common measurement methodology and presentation format for reporting information to consumers on the performance of health plans. While each sponsor still produces its own report card and open enrollment materials, the categories for measures included in the report and the presentation of information (e.g., language, graphics, rating system) are now standardized.

E

Employers Healthcare Alliance Cooperative (The Alliance)
URL: http://www.alliancehealthcoop.com
Phone: (608) 276-6620

Based in Madison, Wisconsin, the Employers Healthcare Alliance Cooperative represents more than 30 employers and 100,000 people in south central Wisconsin. The Alliance contracts directly on behalf of its members with both care systems (clinics) and hospitals. It evaluates each of these provider organizations by collecting performance data and distributing summary-level and detailed reports.

F

FACCT|ONE
URL:http://www.facct.org/measures/Develop/FACCTONE.htm
Phone: (503) 223-2228

Developed by the Foundation for Accountability, FACCT|ONE is a survey tool designed to measure how well health care organizations meet the needs of patients with chronic illnesses. So far, FACCT|ONE concentrates on common services related to the care and management of asthma, diabetes, and coronary artery disease. By focusing on aspects of care that are generally overlooked in accountability measures, FACCT|ONE allows purchasers, consumers, and oversight agencies to assess the performance of health care systems with regards to people with serious and frequent health care needs.

Federal Employees Health Benefits (FEHB)
URL: http://www.opm.gov/insure/health/index.htm

The Federal Employees Health Benefits Program is a Federally sponsored health benefits program covering over nine million Federal employees, retirees, former employees, family members, and former spouses. Carriers in the FEHB program provide coverage to most employees and retirees of the Federal Government and the Postal Service.

Foundation for Accountability (FACCT)
URL: http://www.facct.org
Phone: (503) 223-2228

The Foundation for Accountability is a nonprofit organization with the objective of helping Americans make the best possible health care decisions. The FACCT board of trustees is comprised of representatives from consumer organizations and purchasers of health care services and insurance, representing nearly 80 million Americans. FACCT accomplishes its goals by creating tools that help people understand and use quality information. This includes developing consumer-focused quality measures, supporting public education about health care quality, supporting efforts to gather and provide quality information, and promoting health policies that empower and inform consumers.

H

Health Plan Employer Data and Information Set (HEDIS®)
URL: http://www.ncqa.org/Pages/Programs/HEDIS/index.htm
Phone: NCQA (202) 955-3500

The Health Plan Employer Data and Information Set is a list of about 60 standardized performance measures developed and maintained by the National Committee for Quality Assurance (NCQA) in Washington, DC. The purpose of HEDIS® is to ensure that purchasers and consumers have the information they need to accurately compare the performance of managed health care plans. HEDIS® combines quality measures of process, structure, and outcomes with measures that reflect members’ reports and assessments of their experiences with health plans. Currently, most health plans report their HEDIS® results directly to NCQA as well as to their larger customers.

J

Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
URL: http://www.jcaho.org
Phone: (630) 792-5000

An independent, nonprofit organization, the Joint Commission on Accreditation of Healthcare Organizations is the leading accrediting and standards-setting body in health care. It evaluates and accredits nearly 20,000 health care organizations and programs in the United States. The main objective of the JCAHO is to promote improvements in the safety and quality of care provided to the public.

K

Kaiser Family Foundation
URL: http://www.kff.org
Phone: (650) 854-9400

The Kaiser Family Foundation is an independent philanthropic organization that focuses on major health care issues facing the United States. The Foundation serves as a source of facts and analysis for policymakers, the media, the health care community, and the general public. It accomplishes this by developing and running its own research and communications programs, often contracting with a variety of outside individuals and organizations. The Foundation also makes a small number of grants for unsolicited proposals every year.

M

Managed Health Care Association (MHCA)
URL: http://www.emhca.org
Phone: (202) 218-4121

The Employers' Managed Health Care Association is a league of National, private-sector employers that come together to share their experiences as purchasers and promote learning about the value of managed health care as a strategy for cost containment. The aim of the MHCA is to advance a high-quality, cost-effective, consumer-focused health care delivery system.

Medicaid
URL: http://www.cms.hhs.gov/medicaid/

Jointly funded by the Federal and State governments, Medicaid assists States in providing adequate medical care for individuals and families with low resources. Medicaid is the largest program providing medical and health services to needy persons. Within broad Federally established guidelines, every State sets its own eligibility standards; determines the type, amount, and duration of services; establishes the payment levels for services; and administers its own program.

Medicare
URL: http://www.medicare.gov
Phone: 800-MEDICARE (633-4227) or
TTY/TDD: 1-(877) 486-2048 (hearing and speech impaired)

Medicare is the primary Federal health insurance program for people 65 years of age and older, qualifying disabled persons who are less than 65 years of age, and persons with permanent kidney failure requiring dialysis or a transplant. The two components of Medicare are Hospital Insurance (Part A) and Medical Insurance (Part B), which covers visits to the doctor and other services.

Medicare Rights Center (MRC)
URL: http://www.medicarerights.org/Index.html
Phone: (212) 869-3850

The Medicare Rights Center provides free counseling to people with questions or concerns related to Medicare. Since it was founded in 1989, the MRC has helped more than one million people with Medicare-related issues. The MRC has conducted seminars and presentations with several private and governmental organizations, including the Department of Health and Human Services, AARP, and the American Public Health Association.

N

National Adult Literacy Survey
URL: http://nces.ed.gov/naal/
Phone: (202) 502-7374
(Andrew Kolstad, Senior Technical Advisor, Assessment Division)

The National Adult Literacy Survey was implemented in 1992 by the National Center for Education Statistics (NCES) and the Office of Vocational and Adult Education (OVAE). The survey represented a comprehensive effort to measure the literacy levels of persons age 16 and over living in the United States in 1992. The data were collected through household interviews in which respondents completed written exercises that assessed their literacy skills. NCES will be conducting this survey again in 2002.

National Association of Health Data Organizations (NAHDO)
URL: http://www.nahdo.org
Phone: (801) 587-9104

The National Association of Health Data Organizations is an alliance of State, Federal, and private-sector policy leaders and consultants. The main objective of NAHDO is to enhance the development of health information systems and develop responsible health information policies. To do this, NAHDO provides assistance with collection, analysis, dissemination, public availability, and use of health data.

National CAHPS® Benchmarking Database (NCBD)
URL: http://ncbd.CAHPS.org
Phone: (651) 430-0759

The National CAHPS® Benchmarking Database is sponsored by the Agency for Healthcare Research and Quality (AHRQ) and administered through a partnership between Westat, the Quality Measurement Advisory Service (QMAS), and The Picker Institute. The primary purpose of the NCBD is to facilitate comparisons of CAHPS® results among various types of CAHPS® survey sponsors. The NCBD also offers an important source of primary data for conducting specialized research that will enable improvements in future CAHPS® survey design and a better understanding of health plan and enrollee characteristics that influence health care quality.

National Center for Education Statistics (NCES)
URL: http://nces.ed.gov
Phone: (202) 502-7300

The National Center for Education Statistics is a subordinate agency of the U.S. Department of Education. The primary function of the NCES is to collect and analyze data related to education in the United States. Studies and other information are available at the Web site.

National Committee for Quality Assurance (NCQA)
URL: http://www.ncqa.org
Phone: (202) 955-3500

The National Committee for Quality Assurance is an independent, nonprofit organization that evaluates and reports on the quality of managed care organizations in the United States. In addition to developing HEDIS® and maintaining a database of results that is updated each year (known as Quality Compass), the NCQA conducts an extensive process to accredit health plans across the country. To date, more than half of the Nation’s HMOs participate in the NCQA’s voluntary accreditation program.

National Institute for Literacy (NIFL)
URL: http://novel.nifl.gov
Phone: (202) 233-2025

The National Institute for Literacy is a joint government institute administered by the Secretaries of Labor, Education, and Health and Human Services. The main objective of the NIFL is to make sure that any persons with literacy deficiencies can access services aimed at improving reading skills. The Institute acts as a focal point for public and private actions that support regional, State, and National literacy services.

National Opinion Research Center (NORC)
URL: http://www.norc.uchicago.edu
Phone: (773) 753-7500

The National Opinion Research Center is a nonprofit organization associated with the University of Chicago. NORC conducts surveys with the purpose of addressing critical issues facing government agencies, private foundations, educational institutions, and private companies. Many of the studies are used to form public policies, draft laws, and determine how resources are allocated.

O

Office of Personnel Management (OPM)
URL: http://www.opm.gov
Phone: (202) 606-0815

The Office of Personnel Management is the human resources agency of the Federal Government. OPM administers health benefits for Federal employees, manages the Federal retirement system, supports agencies with staffing tools, and provides guidance on labor-management relations, compensation policy development, and curricula to improve workforce performance.

P

Pacific Business Group on Health (PBGH)
URL: http://www.pbgh.org
Phone: (415) 281-8660

The Pacific Business Group on Health is a nonprofit coalition of 45 large employers that share a common goal of improving the quality of health care while moderating costs. Most of the member companies are in California and many have employees in multiple States. Purchaser members of PBGH represent nearly three million employees, retirees, and family members, accounting for three billion dollars in annual health care expenditures.

Q

Quality Measurement Advisory Service (QMAS)
URL: http://www.qmas.org
Phone: (206) 682-2811

The Quality Measurement Advisory Service is a program of the nonprofit Foundation for Health Care Quality based in Seattle, Washington. Initiated in 1996, QMAS assists local health care coalitions, purchasing groups, and health information organizations in measuring health care quality for purchasing and other purposes. QMAS holds educational meetings, produces guides on quality measurement, provides speaking and consulting services, manages collaborative projects, and provides a means for exchanging information among its affiliates.

R

RAND
URL: http://www.rand.org
Phone: (310) 393-0411

RAND is a California-based think tank with the mission of improving policy and decisionmaking through research and analysis. Researchers at RAND work on a variety of issues, assisting policymakers at all levels, leaders in many private-sector industries, and the public at large in efforts to improve the Nation's quality of life. RAND analyzes choices and developments in many areas, including defense, education, health care, criminal justice, labor, and community development.

S

State Health Insurance Assistance Programs (SHIP)
URL: http://www.medicare.gov/contacts/related/ships.asp
Phone: Ask about the SHIP in your State by calling 800-MEDICARE (633-4227) or TTY/TDD: (877) 486-2048 (hearing and speech impaired).

With financial support from the Federal Government (through the Centers for Medicare & Medicaid Services), the State Health Insurance Assistance Programs are State-run programs designed to provide free health insurance counseling and assistance for Medicare beneficiaries.