Health Care Delivery System Exam Guide Questions; Latest

Health Care Delivery System Exam Guide Questions; Latest Health Care Delivery System Ambulatory Care Outpatient services requiring no overnight stay Acute Care Treatment of medical conditions of recent onset ch ...

Health Care Delivery System Exam Guide Questions; Latest Health Care Delivery System Ambulatory Care Outpatient services requiring no overnight stay Acute Care Treatment of medical conditions of recent onset chronic Care Treatment of a chronic condition: any illness or impairment expected to last a year or longer that limists what one can do, or requires ongoing medical care. Long-term Care A range of supportive, rehabilitative, nursing, and palliative services provided to people whose capacit to perform daily activities is restricted due to chronic disease or disability. End of Life Care Care given to patients in their final stages of life, including symptom, pain, and medication management. Palliative Care A comprehensive type of care, addressing physcial and mental health issues, spirituality, and family care. Reasons for PCP shortages Cost of medical school, workload. Sources of Fragmentation Page 189 Physician Silos, Underdeveloped Health Information Technology, Lack of Care Coordination, lack of incentives to coordinate care, focus on Acute care. Models of better coordinated and integrated care Page 194 These models place the responsibility for change on practitioners, health plans, and health information systems. The Chronic Care Model Page 194 Keeping providers focused on maintaining health rather than restoring it, requires a combination of case management, aggressive follow-up, and ensuring that information I relayed to patients in ways that are compatible with their culture and background. A crucial aspect is patient's own self-management. Patient-Centered Medical Homes Page 195 Physician directed medical practice with a team of providers in which each patient has an ongoing relationship with a personal physician. Accountable Care Organizations An integrated healthcare delivery system that includes physicians, hospitals, and other providers and that takes responsibility for the overall health of a covered population Four Model of Health Care Delivery-Model 1 Integrated Delivery System (IDS) or Multispecialty Group Practice (MSGP) with a health plan. Including a health ins. function in an IDS provides flexibility, aligned incentives and expertise in organizing leading to high value care. Ex. Kaiser Permanente. physicians are paid capitation. Four Model of Health Care Delivery-Model 2 IDS OR MSGP without a health plan. integrated clinical practice, education, and research. Physicians are paid on a salary. Four Model of Health Care Delivery-Model 3 Private Networks of independent providers. organize independent providers to deliver health care services under contract to one or more insurers. Four Model of Health Care Delivery-Model 4 Government-Facilitated networks of independent providers. Govt. takes an active role in organizing independent providers, usually to create a delivery system for Medicaid beneficiaries. Attributes of an Ideal Health Care Delivery System 1-Easy access to appropriate care, culturally competent-responsive to patients needs. 2-Information continuity-EHR integration to all providers at point of care. 3-Care coordination and transitions: patient care is coordinated among multiple providers, and transitions across care settings are actively managed Attributes of an Ideal Health Care Delivery System 4-Peer review and team work for high value care 5-Continuos innovation: Continuously innovating and learning in order to improve the quality, value, and patients' experiences of health care delivery.6-System Accountability: There is clear accountability for the total care of patients. High Quality Health Care The degree to which health services for individuals and populations increase the likelihood of desire outcomes. Core competencies for health administrators - Page 253 Policy/Procedure, Quality improvement from the administrative level, focus on quality/safety- Align goals, Strategic imperatives, Implementation and continually enhance work environment. Rationing of Health Care Page 259 Limiting the services to situations that add the greatest value. Rationing or setting treatment priorities. Centers of Excellence (COE's) Participation is based on quality indicators. Usually very specific like transplant services. Cost Shifting Page 268 The provider shifts costs not covered by Medicare and Medicaid to other payers, by requiring higher reimbursement rates from them. Third Party Payer Entity paying on behalf of a patient or a provider. Payers identifies a set of services for which they will cover a set population for a certain premium. Supply Chain Group Purchasing, negotiate better prices-volume equity. Aligning supply logistics, reduce storage. CER System Page 278