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Incentives In A Specialty Care Carve Out
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Book Synopsis Incentives in a Specialty Care Carve-out by : Moira Inkelas
Download or read book Incentives in a Specialty Care Carve-out written by Moira Inkelas and published by . This book was released on 2001 with total page 358 pages. Available in PDF, EPUB and Kindle. Book excerpt: Most state Medicaid agencies are turning to capitated prepayment to contain costs, to improve access to care, and to increase efficiency in the provision of services. However, many states have concerns about how the financial incentives that accompany prepaid care could affect services to chronically ill beneficiaries. Medicaid agencies are implementing a variety of prepayment strategies specifically for children with chronic conditions, often intended to reduce financial disincentives for providing adequate care. They range from excluding certain services, to allowing voluntary enrollment in prepaid health plans for some children while requiring others to enroll. Some have questioned how these different policies will affect provider behavior, and how this in turn will affect the care that a child receives. California implemented a set of dramatic changes to the delivery of health care to Medicaid beneficiaries during the 1990's. Much of the policy debate over access to services focused on how to preserve specialty care access for children with complex medical diagnoses while also improving access to primary care to the general population. As California's ambitious plan to expand managed care unfolded in its largest counties, a legislative effort preserved the traditional role of the Social Security Act, Title V Children with Special Health Care Needs program in authorizing services under the traditional fee-for-service system. Child Medicaid beneficiaries who are eligible for Title V are those with complex medical diagnoses.
Book Synopsis Improving the Quality of Health Care for Mental and Substance-Use Conditions by : Institute of Medicine
Download or read book Improving the Quality of Health Care for Mental and Substance-Use Conditions written by Institute of Medicine and published by National Academies Press. This book was released on 2006-03-29 with total page 528 pages. Available in PDF, EPUB and Kindle. Book excerpt: Each year, more than 33 million Americans receive health care for mental or substance-use conditions, or both. Together, mental and substance-use illnesses are the leading cause of death and disability for women, the highest for men ages 15-44, and the second highest for all men. Effective treatments exist, but services are frequently fragmented and, as with general health care, there are barriers that prevent many from receiving these treatments as designed or at all. The consequences of this are seriousâ€"for these individuals and their families; their employers and the workforce; for the nation's economy; as well as the education, welfare, and justice systems. Improving the Quality of Health Care for Mental and Substance-Use Conditions examines the distinctive characteristics of health care for mental and substance-use conditions, including payment, benefit coverage, and regulatory issues, as well as health care organization and delivery issues. This new volume in the Quality Chasm series puts forth an agenda for improving the quality of this care based on this analysis. Patients and their families, primary health care providers, specialty mental health and substance-use treatment providers, health care organizations, health plans, purchasers of group health care, and all involved in health care for mental and substanceâ€"use conditions will benefit from this guide to achieving better care.
Book Synopsis Managing Managed Care by : Institute of Medicine
Download or read book Managing Managed Care written by Institute of Medicine and published by National Academies Press. This book was released on 1997-04-21 with total page 394 pages. Available in PDF, EPUB and Kindle. Book excerpt: Managed care has produced dramatic changes in the treatment of mental health and substance abuse problems, known as behavioral health. Managing Managed Care offers an urgently needed assessment of managed care for behavioral health and a framework for purchasing, delivering, and ensuring the quality of behavioral health care. It presents the first objective analysis of the powerful multimillion-dollar accreditation industry and the key accrediting organizations. Managing Managed Care draws evidence-based conclusions about the effectiveness of behavioral health treatments and makes recommendations that address consumer protections, quality improvements, structure and financing, roles of public and private participants, inclusion of special populations, and ethical issues. The volume discusses trends in managed behavioral health care, highlighting the emerging role of the purchaser. The committee explores problems of overlap and fragmentation in the delivery of behavioral health care and discusses the issue of access, a special concern when private systems are restricted and public systems overburdened. Highly applicable to the larger health care system, this volume will be of particular interest to all stakeholders in behavioral healthâ€"federal and state policymakers, public and private purchasers, health care providers and administrators, consumers and consumer advocates, accrediting organizations, and health services researchers.
Download or read book PBMs written by Sheila Shulman and published by CRC Press. This book was released on 1998-06-18 with total page 216 pages. Available in PDF, EPUB and Kindle. Book excerpt: PBMs: Reshaping the Pharmaceutical Distribution Network provides HMOs and other third-party payers with information on the new and increasingly important role of pharmaceutical benefit companies (PBMs) in the health care industry. From this text, you will learn how PBMs can maintain and deliver a quality, cost-effective drug benefit plan to your company while achieving the anticipated market share for the product. PBMs: Reshaping the Pharmaceutical Distribution Network offers you suggestions on how to choose which PBM service is correct for your business, such as what qualifications to look for in a PBM, as well as what questions you should ask a respective company. This text also offers ways on how your company can benefit from becoming a client and may make your business more competitive in the pharmaceutical industry. PBMs: Reshaping the Pharmaceutical Distribution Network also informs you about the controversies that have arisen concerning the new position of PBMs in the industry. Through research and evaluation, this text addresses these issues from many different perspectives and gives you insight into other topics concerning PBMs, including: operating methods that PBMs currently rely on for designing and overseeing a drug benefit plan how the Food and Drug Administration currently views the role of PBMs and why they are contemplating regulatory intervention alerting PBMs, pharmacies, pharmaceutical companies, and managed care organizations to new legal issues involving fraud and abuse affecting pharmacy benefit management and pharmaceutical manufacturers reasons why retail drug chains and pharmacist organizations oppose recent industry developments regarding PBMs whether or not PBMs reflect a move toward greater centralized decisionmaking in the health care systemIn addition, PBMs: Reshaping the Pharmaceutical Distribution Network offers pharmaceutical companies, health care providers, and managed care organizations several suggestions for further research, which may make your business or your business relationships more efficient and productive in the future. If you or your company are considering the services of a pharmacy benefit management, PBMs: Reshaping the Pharmaceutical Distribution Network will guide you in choosing a company that helps you deliver the most cost-effective and efficient pharmaceutical benefits to customers.
Download or read book Mental Health written by and published by . This book was released on 1999 with total page 28 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Research Activities written by and published by . This book was released on 2001 with total page 350 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis Changing Health Care Systems and Rheumatic Disease by : Institute of Medicine
Download or read book Changing Health Care Systems and Rheumatic Disease written by Institute of Medicine and published by National Academies Press. This book was released on 1997-02-09 with total page 253 pages. Available in PDF, EPUB and Kindle. Book excerpt: Market forces are driving a radical restructuring of health care delivery in the United States. At the same time, more and more people are living comparatively long lives with a variety of severe chronic health conditions. Many such people are concerned about the trend toward the creation of managed care systems because their need for frequent, often complex, medical services conflicts with managed care's desires to contain costs. The fear is that people with serious chronic disorders will be excluded from or underserved by the integrated health care delivery networks now emerging. Responding to a request from the National Institute of Arthritis and Musculoskeletal and Skin Diseases, this book reflects the results of a workshop that focused on the following questions: Does the model of managed care or an integrated delivery system influence the types of interventions provided to patients with chronic conditions and the clinical and health status outcomes resulting from those interventions? If so, are these effects quantitatively and clinically significant, as compared to the effects that other variables (e.g., income, education, ethnicity) have on patient outcomes? If the type of health care delivery system appears to be related to patient care and outcomes, can specific organizational, financial, or other variables be identified that account for the relationships? If not, what type of research should be pursued to provide the information needed about the relationship between types of health care systems and the processes and outcomes of care provided to people with serious chronic conditions?
Book Synopsis Changing Welfare by : Rachel A. Gordon
Download or read book Changing Welfare written by Rachel A. Gordon and published by Springer Science & Business Media. This book was released on 2003-05-31 with total page 276 pages. Available in PDF, EPUB and Kindle. Book excerpt: Changing Welfare is concerned with the sweeping changes that took place in public assistance programs at the end of the 20th century and the way in which the original and reformed versions of these programs relate to the well-being of children and their families. The authors critically review the original conceptualizations and the new directions of programs offering cash assistance, food assistance, health insurance, and child protection services to low-income and disabled children and their families - thus, changes in the welfare programs themselves. And throughout, their concern is with whether and how these programs alter the opportunities for the development of the children targeted by these programs - thus, changes in the welfare of children and their families. The objective of each chapter of the book is to rigorously highlight key theoretical and research issues, including the identification of major empirical findings and unanswered questions. Wherever relevant, the chapters connect theory and research to policy and practice, pointing to recommendations and challenges for the future including alternative approaches for research, policy and practice. Changing Welfare is a valuable reference for practitioners and policy makers who are concerned with children and child-related issues, psychologists, sociologists, social workers, social program administrators, and students in psychology, social work, sociology, political science, and education.
Book Synopsis Primary Care by : Institute of Medicine
Download or read book Primary Care written by Institute of Medicine and published by National Academies Press. This book was released on 1996-09-05 with total page 411 pages. Available in PDF, EPUB and Kindle. Book excerpt: Ask for a definition of primary care, and you are likely to hear as many answers as there are health care professionals in your survey. Primary Care fills this gap with a detailed definition already adopted by professional organizations and praised at recent conferences. This volume makes recommendations for improving primary care, building its organization, financing, infrastructure, and knowledge baseâ€"as well as developing a way of thinking and acting for primary care clinicians. Are there enough primary care doctors? Are they merely gatekeepers? Is the traditional relationship between patient and doctor outmoded? The committee draws conclusions about these and other controversies in a comprehensive and up-to-date discussion that covers: The scope of primary care. Its philosophical underpinnings. Its value to the patient and the community. Its impact on cost, access, and quality. This volume discusses the needs of special populations, the role of the capitation method of payment, and more. Recommendations are offered for achieving a more multidisciplinary education for primary care clinicians. Research priorities are identified. Primary Care provides a forward-thinking view of primary care as it should be practiced in the new integrated health care delivery systemsâ€"important to health care clinicians and those who train and employ them, policymakers at all levels, health care managers, payers, and interested individuals.
Author :National Academies of Sciences, Engineering, and Medicine Publisher :National Academies Press ISBN 13 :0309682681 Total Pages :123 pages Book Rating :4.3/5 (96 download)
Book Synopsis Caring for People with Mental Health and Substance Use Disorders in Primary Care Settings by : National Academies of Sciences, Engineering, and Medicine
Download or read book Caring for People with Mental Health and Substance Use Disorders in Primary Care Settings written by National Academies of Sciences, Engineering, and Medicine and published by National Academies Press. This book was released on 2021-01-30 with total page 123 pages. Available in PDF, EPUB and Kindle. Book excerpt: Behavioral health conditions, which include mental health and substance use disorders, affect approximately 20 percent of Americans. Of those with a substance use disorder, approximately 60 percent also have a mental health disorder. As many as 80 percent of patients with behavioral health conditions seek treatment in emergency rooms and primary care clinics, and between 60 and 70 percent of them are discharged without receiving behavioral health care services. More than two-thirds of primary care providers report that they are unable to connect patients with behavioral health providers because of a shortage of mental health providers and health insurance barriers. Part of the explanation for the lack of access to care lies in a historical legacy of discrimination and stigma that makes people reluctant to seek help and also led to segregated and inhumane services for those facing mental health and substance use disorders. In an effort to understanding the challenges and opportunities of providing essential components of care for people with mental health and substance use disorders in primary care settings, the National Academies of Sciences, Engineering, and Medicine's Forum on Mental Health and Substance Use Disorders convened three webinars held on June 3, July 29, and August 26, 2020. The webinars addressed efforts to define essential components of care for people with mental health and substance use disorders in the primary care setting for depression, alcohol use disorders, and opioid use disorders; opportunities to build the health care workforce and delivery models that incorporate those essential components of care; and financial incentives and payment structures to support the implementation of those care models, including value-based payment strategies and practice-level incentives. This publication summarizes the presentations and discussion of the webinars.
Book Synopsis Crossing the Quality Chasm by : Institute of Medicine
Download or read book Crossing the Quality Chasm written by Institute of Medicine and published by National Academies Press. This book was released on 2001-07-19 with total page 359 pages. Available in PDF, EPUB and Kindle. Book excerpt: Second in a series of publications from the Institute of Medicine's Quality of Health Care in America project Today's health care providers have more research findings and more technology available to them than ever before. Yet recent reports have raised serious doubts about the quality of health care in America. Crossing the Quality Chasm makes an urgent call for fundamental change to close the quality gap. This book recommends a sweeping redesign of the American health care system and provides overarching principles for specific direction for policymakers, health care leaders, clinicians, regulators, purchasers, and others. In this comprehensive volume the committee offers: A set of performance expectations for the 21st century health care system. A set of 10 new rules to guide patient-clinician relationships. A suggested organizing framework to better align the incentives inherent in payment and accountability with improvements in quality. Key steps to promote evidence-based practice and strengthen clinical information systems. Analyzing health care organizations as complex systems, Crossing the Quality Chasm also documents the causes of the quality gap, identifies current practices that impede quality care, and explores how systems approaches can be used to implement change.
Book Synopsis Essentials of Managed Health Care by : Peter Reid Kongstvedt
Download or read book Essentials of Managed Health Care written by Peter Reid Kongstvedt and published by Jones & Bartlett Learning. This book was released on 2007 with total page 874 pages. Available in PDF, EPUB and Kindle. Book excerpt: Managed Care
Book Synopsis The Integrated Behavioral Health Continuum by : Laurel J. Kiser
Download or read book The Integrated Behavioral Health Continuum written by Laurel J. Kiser and published by American Psychiatric Pub. This book was released on 2008-11-01 with total page 335 pages. Available in PDF, EPUB and Kindle. Book excerpt: Until recently, behavioral health was defined within the strict dichotomy of inpatient and outpatient care -- a dichotomy that failed to mirror the range and complexity of human experience and clinical needs. Today's integrated system renders this dichotomy obsolete. Instead, service delivery integration processes offer an organized system of care rooted in a common vision and defined by processes intended to promote continuity and quality of care, coordination of efforts, efficiencies of operation, and seamless patient movement through an otherwise bewildering array of health care services. Unique in the literature, this volume brings together distinguished clinicians and policymakers who focus on the operational aspects of developing state-of-the-art integrated delivery systems. History and concept -- Why we need integrated health care delivery systems, including a model of service delivery integration that incorporates current barriers (e.g., ambiguous roles and responsibilities and lack of strategic alignment; how to design integrated delivery systems improving clinical outcomes, achieving fiscal and operating efficiencies, and aligning clinical and fiscal incentives) Structural foundations -- Access to the system of care for patients, payors, and employers; how to design level-of-care criteria; eight strategies that help clients move along the continuum; how to define level of care in today's managed care world; and the process of following therapeutic processes (i.e., philosophies, procedures, and practices used to create or support recovery and wellness) across the continuum Administrative and management processes -- How to reorient staff toward minimizing barriers and making the patient central to the system; documentation/information management and reimbursement (rates and rate structures, risk assumption); current research and its enormous potential to improve every aspect of care; quality assessments based on examining the driving forces behind the needs for monitoring and evaluating quality and outcomes; and the relation of behavioral health care systems, which seek to fully integrate clients and families into the fabric of their community and culture, to other systems A case vignette that highlights -- from the consumer's viewpoint -- the vital role of self-help during an episode of hospitalization and a discussion of future directions in integrated behavioral health care round out this remarkable volume. With its wealth of strategic and "nuts and bolts" information -- useful for alliances and single entities alike -- on how to harness operational forces in establishing an effective integrated behavioral health continuum, this volume will be welcomed by those who deliver direct services (psychiatric professionals) and those who administer and manage the integrated financing and delivery of quality care from public (U.S. government agencies) and private (managed care and insurance providers) sectors alike.
Book Synopsis Closing the Quality Gap by : Kaveh G. Shojania
Download or read book Closing the Quality Gap written by Kaveh G. Shojania and published by . This book was released on 2004 with total page 7 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis A Case Manager's Study Guide by : Denise Fattorusso
Download or read book A Case Manager's Study Guide written by Denise Fattorusso and published by Jones & Bartlett Learning. This book was released on 2004 with total page 420 pages. Available in PDF, EPUB and Kindle. Book excerpt: This is the most comprehensive print and electronic combination study guide case management certification! It contains the most up-to-date information, assures a uniform base knowledge for the successful case manager, and provides: study questions and practice exams to help you assess your skills and needs.
Download or read book Medicare written by Robert D. Reischauer and published by Brookings Institution Press. This book was released on 1997-12-01 with total page 348 pages. Available in PDF, EPUB and Kindle. Book excerpt: In this cross-cutting analysis, some of the nation's most prominent social insurance experts go beyond recent budget debates to examine the fundamental and technical choices Medicare poses for the American people in the next century. The book begins with a consideration of the underlying social contract between Medicare's beneficiaries and workers. Pointing out that Medicare historically has had particular significance for civil rights and women's economic security in addition to providing health security, the authors debate the appropriate social contract for the future. The book also lays out the challenges in financing Medicare as health care costs rise and the population ages. Several authors explore how the growth in managed care is likely to affect Medicare beneficiaries with particular emphasis on beneficiaries with chronic illness, and they address some of the policy changes needed to make managed care better. In addition, they also look at how managed-care tools could be applied to the fee-for-service sector. The book concludes with an examination of how public opinion, politics, and leadership affect the prospects for significant Medicare restructuring in the near and long term. Copublished with the National Academy of Social Insurance
Book Synopsis Integrating Behavioral Health and Primary Care by : Robert E. Feinstein
Download or read book Integrating Behavioral Health and Primary Care written by Robert E. Feinstein and published by Oxford University Press. This book was released on 2017 with total page 593 pages. Available in PDF, EPUB and Kindle. Book excerpt: Integrated care incorporates behavioral and physical health services into primary care and specialty medical environments. These models of care are patient-centered. population focused, and delivered by a multidisciplinary team of medical professionals. This book is practical, office-based, comfortably accessible, and intended for mental health professionals, primary care and medical specialists, and professional health students, residents, and other professionals working in integrated care environments.
