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The Performance Improvement Imperative
The Performance Improvement Imperative

... enhancing patient experiences with care, and lowering the growth in health care costs. To that end, the federal government, in partnership with other public and private participants in the health care sector, should seek by 2016 to double the current annual rate of improvement in quality-of-care met ...
Payment-by-Outcome in Long-Term Condition Management
Payment-by-Outcome in Long-Term Condition Management

... contact patients when they are more likely to be receptive to medical advice, such as when they receive a new diagnosis, experience changes in medication or are discharged from hospital.14 The timing of advice and treatments is thought to have a significant impact on patients’ willingness to co-prod ...
Health as Human Capital: Theory and Implications
Health as Human Capital: Theory and Implications

... Prices and costs are also relevant. If the worker must forfeit income if not at work, the lost income will be compared with the value of leisure time when deciding whether to return to work. Obviously, the more generous the income replacement available in sick leave and disability income programs co ...
Palliative Care Definitions
Palliative Care Definitions

... CAPC-Center to Advance Palliative Care (https://www.capc.org/about/palliative-care/) Palliative care, and the medical sub-specialty of palliative medicine, is specialized medical care for people living with serious illness. It focuses on providing relief from the symptoms and stress of a serious ill ...
Provincial End-of-Life Care Action Plan for British Columbia
Provincial End-of-Life Care Action Plan for British Columbia

... Australia led the way for many jurisdictions in incorporating a population needs-based approach into end-of-life care using a model they called the palliative approach. This model is based on the principle that palliative care services must be effective, efficient and ethically delivered at the medi ...
Confronting the Barriers to - National Academy of Social Insurance
Confronting the Barriers to - National Academy of Social Insurance

... characteristics that makes health care markets different from typical, competitive markets. Among these characteristics, is the existence of uncertainty in the incidence of disease and in the efficacy of treatment and the asymmetry of information between the buyer—the patient—and the seller—the phys ...
Ambulatory Services: Urgent Care Policy Options
Ambulatory Services: Urgent Care Policy Options

... while providing convenient hours and minimal wait times. Urgent care providers are not intended to provide emergency intervention for critical, major trauma, lifethreatening or potentially disabling conditions. The scope of operations, hours of operation, scope of services, and the nature of the phy ...
Stretcher Transportation Services
Stretcher Transportation Services

... Task: The care team, including the most responsible physician or designated health care provider, should : a) Assess‎the‎person’s‎nature‎and‎magnitude‎of‎risk‎for‎clinical‎decline‎during‎transport;‎and b) For persons at high risk, consider whether the person should be deemed to be medically unstable ...
Presentation: Payment Reform Quality Measurement Work Group
Presentation: Payment Reform Quality Measurement Work Group

...  Be based on a standard of care or evidence-based science. Pay-forperformance incentives or penalties must rely on measures that are supported by an evidence-base.  Promote payment approaches that provide due consideration for positive incentives and align with state and federal policies.  Accura ...
Oncology Nursing Documentation Guidelines
Oncology Nursing Documentation Guidelines

... Collaboration with the health care team about co-morbid conditions that have been identified and assessments on how they may impact the cancer disease process and the individual/ family response to illness Past cancer, treatment and response History and knowledge of current illness Any self reported ...
Glossary of Terms
Glossary of Terms

... coverage and enroll in a Qualified Health Plan (QHP) through the Marketplace. They can make specific recommendations about which plan you should enroll in. They’re also licensed and regulated by states and typically get payments, or commissions, from health insurers for enrolling a consumer into an ...
the File - NAHU Education Foundation
the File - NAHU Education Foundation

... Health plan pays a fixed dollar payment to providers for the care that members receive in a given time period, such as a month ...
Assessment of the safety and quality of hospital care for
Assessment of the safety and quality of hospital care for

... The assessment tool and methods were based on the experience gained in the use of the paediatric assessment tool, which was developed in 2001 by WHO and then widely used globally, including in the European Region, and on the experience gathered by WHO Regional Office for Europe in the implementation ...
Primary Care Vision, Roles and Opportunities (Jan 2011)
Primary Care Vision, Roles and Opportunities (Jan 2011)

... people have with the health system to seek services for diagnosis, treatment and follow up for a specific health problem, or to access routine screening such as an annual checkup (CARNA, 2008). Strengthening primary care has become a focus of health care reform in Alberta and beyond, since most chro ...
to Risk Adjustment - Coderclass.com LLC
to Risk Adjustment - Coderclass.com LLC

... particularly if the patient is experiencing other acute conditions. It is likely that these diagnoses would be part of a general overview of the patient’s health when treating coexisting conditions for all but the most minor of medical encounters. Co-Existing conditions also include ongoing conditio ...
Case Studies in Billing and Coding in the Carolinas
Case Studies in Billing and Coding in the Carolinas

... position to know the patient’s home care needs. While technically the PCP could sign the form as they will see the patient in the allotted time frame (90 days before or 30 days after start of services), they would not have a clear understanding of the needs of the patient at that time. This is a sep ...
Baskets of Care - Minnesota Department of Health
Baskets of Care - Minnesota Department of Health

... Comprehensive asthma care for children ages 5 to 18 years, diagnosed with asthma. This care is provided in one year and includes assessment and monitoring, education, control of environmental factors, medications and devices, and the use of an urgent care center. Emergency department and hospital in ...
Three Legged Stool
Three Legged Stool

... Integrated delivery systems provide for the seamless coordination of health care services across the continuum of care. This means that physician services, hospital care, prescription drugs, and other health care services are integrated and delivered through an organized system whose overriding purp ...
What is Cultural Competence?
What is Cultural Competence?

... Physicians and hospitals who wish to participate in federally funded medical programs, specific requirements are articulated in the language of the contract relating to cultural issues, such as linguistic access: • Balanced Budget Act of 1997 • Medicare • Medicaid ...
3. Cultural Diversity and the Bottom Line
3. Cultural Diversity and the Bottom Line

... Physicians and hospitals who wish to participate in federally funded medical programs, specific requirements are articulated in the language of the contract relating to cultural issues, such as linguistic access: • Balanced Budget Act of 1997 • Medicare • Medicaid ...
PPT
PPT

... the options and services to meet the individual’s needs using communication and available resources to promote quality cost effective outcomes.”  “A system with many elements: health assessment, planning, procurement, delivery and coordination of services, and monitoring to assure that the multiple ...
ACT IMP WORKING TOGETHER TO MEET CHILDREN’S
ACT IMP WORKING TOGETHER TO MEET CHILDREN’S

... behalf of specific patients. Providers’ roles may change or fluctuate over time based on the patient’s development, patient/family preferences, and/or the patient’s response to treatment.17,18 Despite the ...
Medicaid Delivery System and Payment Reform
Medicaid Delivery System and Payment Reform

... Primary Care Case Management (PCCM): PCCM is a model of Medicaid managed care that is outlined in the Medicaid statute. In PCCM programs, state Medicaid agencies contract with primary care providers to provide, locate, coordinate, and monitor primary care services for Medicaid beneficiaries who sele ...
eTable 3. Study characteristics for trials of primary preventive care a
eTable 3. Study characteristics for trials of primary preventive care a

... •Subspecialty clinic •Primary care ...
CULTURALLY CONGRUENT NURSING CARE
CULTURALLY CONGRUENT NURSING CARE

... Pediatrics states that Mexican-American children are 12 times more likely to have a regular primary care provider if their parent(s) speaks English (Flores, 2000). Additionally, a Journal of Pediatrics’ case study evidenced that the single most important factor in making MexicanAmericans comfortable ...
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Managed care

The term managed care or managed health care is used in the United States to describe a variety of techniques intended to reduce the cost of providing health benefits and improve the quality of care (""managed care techniques""), for organizations that use those techniques or provide them as services to other organizations (""managed care organization"" or ""MCO""), or to describe systems of financing and delivering health care to enrollees organized around managed care techniques and concepts (""managed care delivery systems"")....intended to reduce unnecessary health care costs through a variety of mechanisms, including: economic incentives for physicians and patients to select less costly forms of care; programs for reviewing the medical necessity of specific services; increased beneficiary cost sharing; controls on inpatient admissions and lengths of stay; the establishment of cost-sharing incentives for outpatient surgery; selective contracting with health care providers; and the intensive management of high-cost health care cases. The programs may be provided in a variety of settings, such as Health Maintenance Organizations and Preferred Provider Organizations.The growth of managed care in the U.S. was spurred by the enactment of the Health Maintenance Organization Act of 1973. While managed care techniques were pioneered by health maintenance organizations, they are now used by a variety of private health benefit programs. Managed care is now nearly ubiquitous in the U.S, but has attracted controversy because it has had mixed results in its overall goal of controlling medical costs. Proponents and critics are also sharply divided on managed care's overall impact on the quality of U.S. health care delivery.
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