All healthcare is local, meaning certain terms look different depending on which market or organization you find yourself in, but the following terms have especially mutable definitions.
1. Population health. It's one of the most prevalent terms in healthcare today but one with no agreed-upon meaning. I'm in awe that this dynamic can persist in healthcare, an industry where people likely die if clinicians don't have a decent grip on basic definitions.
Population health has all the makings of a decent buzzword. It sounds forward-thinking and is just vague enough to easily pepper conversations without much scrutiny. But we're getting to a point where population health is starting to become so misused, we almost need a new term entirely.
For instance, a qualitative interview study led by a researcher from New York City-based Weill Cornell Medical College found many people who work in accountable care organizations and public health agencies view the terms population health, public health and community health as the same or similar.
People working for ACOs most commonly said "population health" referred to a defined group of patients. Sometimes these were directly described as the ACOs' "attributed" patients or those for whom the organization was at risk for financially, and sometimes as the ACO host organization's patients more generally. The second most common perception of the phrase "population health" was that it referred to all the people living in a geographical area.
To close on a more definitive note, one of the first Google search results for "population health" leads to a 2003 article by David Kindig, MD, PhD, and Greg Stoddart, PhD, in the U.S. National Library of Medicine. The article is called "What is Population Health?" Here is the first line from the article's abstract:
Population health is a relatively new term that has not yet been precisely defined.
A lot has changed since 2003. That sentence isn't one of them.
2. Accountable care. This term has many cousins, such as value-based care and pay-for-performance. Accountable care is often used in relation to population health, but the two are hardly synonymous. Accountable care's polar opposite, of course, is fee-for-service or pay-for-volume.
So while we understand where "accountable care" fits on the lexicon map in relation to other terms, we're still in the dark about what it actually refers to: a healthcare philosophy or a payment model? Does it refer to a contract with a payer or Dr. Don Berwick's triple aim? The definition of accountable care is still weak enough that people can use it as specifically or generally as they find convenient in their conversation at the time.
3. Top/best. Hospital rankings and ratings have proliferated in recent years, and each agency has its own method for data collection, analysis, weighting and so forth. What might be a top hospital from one index might not make the cut for another. It's the nature of the game, but it also causes neuroses among hospital executives (if their organization was recognized for X, why not Y?) and confusion among consumers who are desperate for guidance in their clinical decisions.
Recognition as "top" or "best" also makes hospitals more competitive, and in quite an explicit way. Remember when Massachusetts General Hospital in Boston threw a duck boat parade when it was named the No. 1 hospital in the country by U.S. News & World Report in 2012? The next year, it cinched the No. 2 spot, losing out to Johns Hopkins Hospital in Baltimore, which was previously the No. 1 hospital for 21 consecutive years. Mass General refrained from a parade in 2013.
Top/best doesn't technically fit on this list, as the terms do have definitions depending on the accolade. (Beauty lies in the eyes of the beholder, after all.) The risk here is that these words are often used in vernacular without acknowledgement of rankings' complex calculations and methodologies.
4. Prices. Charges, prices and costs, oh my. We learn about prices as children, and the concept grows more sophisticated as we age. It takes research and financial savvy to identify the "price" of a college degree, house or car, but most all adults are able to figure these things out. The fundamentals of price and cost hold true. So this might be why pricing in the wild, wild West of healthcare has so many adults at a loss: Our rudimentary understanding of price is almost useless.
The language piece is only part of this mess. There are 50 shades of "price" in healthcare, and it's not unusual for a conversation about price to quickly devolve until you find yourself with a completely different terminology than what you started with. Many advocates for price transparency accuse hospitals of having sky-high prices, but hospitals are quick to get technical and distinguish prices from hospital charges. That's one distinction. Another? The charge, or "sticker price," hardly reflects the amount hospitals are paid by insurers, patients or the government. The amount hospitals are reimbursed for hospitalization costs is most often less than the sticker price. And I won't digress into the other wild cards, such as items patients see on hospital bills for intangible, unnoticeable items, like "facility fees."
It must drive healthcare leaders crazy when people say they know the price of a cheeseburger, but not the price of a blood test (admittedly, I've written that exact thing). Patient-friendly pricing is a rarity in healthcare, maybe because even those in the industry do not have a stable framework to discuss prices. The language is spotty, each market is different and hospital chargemasters contain tens of thousands of items. Will we ever get to a point where we can compare apples to apples? Will it ever become normal for patients to know — or easily learn — the true price tag of an item or service? Until we get the language ironed out, I don't see how this can be the case.
5. Strategic affiliation. The two organizations aren't quite merged (they often remain legally separate and independent), but they are likely sharing resources, be it health IT, clinical data, best practices or administrative services. (Like the couple that's been together for eight years, isn't married, but shares a house, dog and car.) Many executives will make it a point to say their strategic affiliation is not a "stepping stone" to a merger or acquisition, even though many experts will think otherwise. Some organizations that have struck strategic affiliations make for an unorthodox pairing, such as Catholic and secular health systems.
The fine print for these deals varies, but that's not necessarily where this term has a muddled definition. We don't expect every strategic affiliation to be cut from the same cloth. Rather, the basic model itself raises some big questions. Who calls the shots? How can organizations benefit from one another if they both have different administrative teams, cultures and financials? Do both parties equally benefit (and if so, how)? And at the end of the day, why not just merge?
To affiliate your strategy with that of another organization — as the term suggests — is a huge move. Some strategic affiliations are closer-knit than others, and it's those close-knit ones that really resemble merged organizations — but would rather downplay the affiliation. This term will likely remain murky until a majority of strategic affiliations have commonalities. That way, even when two organizations strike a strategic affiliation, we won't have to wait to read the fine print to know what to expect.