Flexible Spending Account (FSA) An arrangement you set up through your employer to pay for many of your out-of-pocket medical expenses with tax-free dollars. These expenses include insurance copayments and deductibles, and qualified prescription drugs, insulin and medical devices.
Further reading –
https://www.healthcare.gov/glossary/flexible-spending-account-FSA/
Average Wholesale Price – A benchmark used for pricing and reimbursement of prescription drugs for both government and private payers. AWP is not a true representation of actual market prices for either generic or brand drug products. AWP has often been compared to the “list price” or “sticker price”, meaning it is an elevated drug price that is rarely what is actually paid. It is provided by pricing services.
Further reading –
http://www.ncsl.org/research/health/medicaid-pharmaceutical-laws-and-policies.aspx
Joint Commission for Accreditation of Health Organizations – a private, nonprofit organization whose mission is to continuously improve the safety and quality of care provided to the public; it does this through the provision of health accreditation and related services that support performance improvement in health care organizations. JCAHO is governed by a 28-member Board of Commissioners that includes nurses, physicians, consumers, medical directors, administrators, providers, employers, labor representatives, health plan leaders, quality experts, ethicists, health insurance administrators, and educators. The corporate members of JCAHO are the American College of Physicians-American Society of Internal Medicine, the American College of Surgeons, the American Dental Association, the American Hospital Association, and the American Medical Association.
Further reading –
Data Use Agreement – The Privacy Act of 1974 requires the Centers for Medicare & Medicaid Services (CMS) to account for all disclosures of personally identifiable information (PII). CMS uses the DUA to account for all such disclosures.
Further reading –
The National Health Expenditure Accounts (NHEA) are the official estimates of total health care spending in the United States. Dating back to 1960, the NHEA measures annual U.S. expenditures for health care goods and services, public health activities, government administration, the net cost of health insurance, and investment related to health care. The data are presented by type of service, sources of funding, and type of sponsor.
U.S. health care spending grew 5.8 percent in 2015, reaching $3.2 trillion or $9,990 per person. As a share of the nation’s Gross Domestic Product, health spending accounted for 17.8 percent.
Further reading –
Osteoporosis Management in Women Who Had a Fracture – The percentage of women 67–85 years of age who suffered a fracture and who had either a bone mineral density (BMD) test or prescription for a drug to treat osteoporosis in the six months after the fracture.
Further reading –
https://www.qualitymeasures.ahrq.gov/summaries/summary/49727
Statin Therapy for Patients With Cardiovascular Disease –
The percentage of males 21–75 years of age and females 40–75 years of age who were identified as having clinical atherosclerotic cardiovascular disease (ASCVD) and met the following criteria.
Members who were dispensed at least one high or moderate-intensity statin medication during the measurement year.
Members who remained on a high or moderate-intensity statin medication for at least 80% of the treatment period.
Further reading –
Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents – The percentage of members 3–17 years of age who had an outpatient visit with a PCP or OB/GYN and who had evidence of the following during the measurement year.
• BMI percentile documentation*.
• Counseling for nutrition.
• Counseling for physical activity.
* Because BMI norms for youth vary with age and gender, this measure evaluates whether BMI percentile is assessed rather than an absolute BMI value.
Further reading –
https://providers.amerigroup.com/ProviderDocuments/KSKS_HEDIS_WellChildVisitsWeightAssessment.pdf
Well-Care Visits in the First 15 Months of Life – The percentage of members who turned 15 months old during the measurement year and who had the following number of well-child visits with a PCP during their first 15 months of life: no well child visits, 1 well-child visit, 2 well-child visits, 3 well-child visits, 4 well-child visits, 5 well-child visits, 6 or more well-child visits.
Further reading –
Upper Respiratory Infection – Appropriate Treatment for Children With Upper Respiratory Infection . The percentage of children 3 months–18 years of age who were given a diagnosis of upper respiratory infection (URI) and were not dispensed an antibiotic prescription. *The measure is reported as an inverted rate [1 – (numerator/eligible population)]. A higher rate indicates appropriate treatment of children with URI (i.e., the proportion for whom antibiotics were not prescribed).
Further reading –
https://providers.optimahealth.com/clinicalreference/Pages/Avoidance-of-Antibiotic-Use.aspx
