CCM (The Commission CCM & CDMS Exams) key terms

A collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates services and resources to meet a person's health needs and improve outcomes.

The deliberate organization of patient care activities and sharing of information among providers and settings to deliver safer, more effective, and efficient care.

A process that reviews whether health services are medically necessary, appropriate, and efficient before, during, or after care to control costs while protecting quality.

A delivery system that uses provider networks, care coordination, and financial incentives to control costs and improve quality for an enrolled population.

A payment method in which a provider receives a fixed amount per enrolled person for a set period, no matter how many services that person uses.

A reimbursement model that pays providers separately for each service delivered, so payment increases with the number and intensity of services.

A classification that groups inpatient hospital stays by diagnosis and procedure so payers can set a fixed payment per discharge.

A single payment shared by providers for all services in an episode of care, such as a joint replacement, to encourage coordination and reduce unnecessary spending.

A group of providers responsible for the cost and quality of care for a defined population, sharing in savings when spending and quality targets are met.

A team-based primary care model offering comprehensive, coordinated, accessible care and using health information technology to track and improve patient outcomes.

Coordinated services that ensure continuity and safety when a patient moves between settings, such as from hospital to home or a nursing facility.

A payment strategy that links reimbursement to quality, outcomes, and cost performance instead of volume, rewarding providers for meeting specified measures.

An approach that views health and illness as shaped by interacting biological, psychological, and social factors rather than by physical causes alone.

Conditions in the places where people live, learn, work, and play that affect health, such as income, housing, education, and access to food.

The degree to which a person can obtain, process, and understand basic health information and services needed to make appropriate health decisions.

A model describing readiness to change behavior in five stages: precontemplation, contemplation, preparation, action, and maintenance, used to tailor interventions to the person.

A collaborative counseling style using open questions, affirmation, reflection, and summary to strengthen a person's own motivation and commitment to behavior change.

A process of helping people gain confidence, knowledge, and control over decisions that affect their health and well-being so they can act as partners in care.

Short-term, immediate support aimed at stabilizing a person in acute distress, reducing risk, and connecting them with ongoing resources and treatment.

The ability to understand, respect, and adapt care to patients' cultural beliefs, values, language, and practices in order to reduce disparities and improve engagement.

A systematic, data-driven approach to studying processes and making changes that increase the likelihood of desired health outcomes and reduce errors.

A structured improvement method that tests a change through four steps-plan, do, study, and act-then refines or spreads what worked.

Comparing an organization's performance measures with established standards or best-performing peers to identify gaps, guide improvement efforts, and set realistic targets.

A quantifiable indicator used to assess the quality, efficiency, or outcomes of care against a defined target or standard and to track progress over time.

A standardized set of health plan performance measures covering preventive care, chronic disease management, and patient experience, used to compare quality across health plans.

A structured team method for investigating an adverse event to find underlying system failures and prevent recurrence instead of blaming individuals.

The process of grouping patients by their likelihood of poor outcomes or high resource use so interventions can target those who need them most.

Basic self-care tasks such as bathing, dressing, eating, toileting, and transferring that show how independently a person can function in daily life.

More complex tasks needed to live independently, such as managing money, shopping, cooking, using transportation, handling medications, and using a telephone.

A structured assessment of physical abilities such as lifting, standing, and endurance, used to determine work capacity and rehabilitation needs.

A multidisciplinary rehabilitation program that uses real or simulated work tasks and conditioning to help injured workers return to a specific job.

Services that help people with disabilities or injuries prepare for, obtain, and keep employment, including counseling, training, and job placement.

A change to a job, workplace, or work process that helps a qualified person with a disability perform essential functions, as required by disability law.

A federal law that protects the privacy and security of health information and sets rules for how covered entities may use and disclose it.

The process of giving a patient clear information about a treatment's risks, benefits, and alternatives so they can voluntarily decide whether to proceed.

A legal document stating a person's preferences for future medical care or naming someone to decide if the person becomes unable to speak for themselves.

The ethical and legal duty to protect a patient's private health information from unauthorized access, use, or disclosure and to share it only as permitted.

Acting on behalf of a patient to protect rights, obtain needed services, and ensure the person's preferences are respected within the care system.

The level of care and skill that a reasonably competent professional in the same field would provide under similar circumstances.

Failure to meet the standard of care owed to a patient, causing harm, proven through duty, breach, causation, and damages.