Regulation of “Downstream” and Direct Risk Contracting by Health Care Providers: The Quest for Consumer Protection and a Level Playing Field

1997 ◽  
Vol 23 (4) ◽  
pp. 449-486
Author(s):  
Douglas J. Witten
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Care Delivery ◽  
Quality Care ◽  
Effective Means ◽  
Economic Incentives ◽  
Care Providers ◽  
Levels Of Care ◽  
Playing Field ◽  
The Individual

As the delivery of health care continues to be driven by the search for an effective means of reducing costs and delivering quality care to the greatest number of people, the industry’s most beloved buzzword, perhaps ironically, has a root suggestive of a focus on the individual: capitation. Capitation is widely regarded as a method of realigning economic incentives to produce fair prices, real value, reasonable profits and predictable growth in costs. Beyond being a mere payment mechanism, though, capitation represents a philosophical shift to an accountability approach for health care delivery, whereby focus is increasingly directed on prepayment of capitated amounts to risk-bearing delivery systems. Theoretically, the premise makes a great deal of sense: to achieve optimal levels of care delivered and costs expended, incentivize persons or entities with the capacity to affect such levels so that economic reward follows effective management of resources.Placing, for the moment, faith in the innovative capacities of the marketplace to seek out new and improved ways of delivering health care, the evolution of the capitated arrangement indicates that what makes sense in theory may also make sense in practice.

Managing Care in the New Era of “Systems-Think”: The Implications for Managed Care Organizational Liability and Patient Safety

2001 ◽  
Vol 29 (3-4) ◽  
pp. 290-304 ◽  
Author(s):  
Alice A. Noble ◽  
Troyen A. Brennan
Keyword(s):  
Health Care ◽  
Managed Care ◽  
Health Care Providers ◽  
Medical Error ◽  
Financial Incentives ◽  
Care Delivery ◽  
Care Providers ◽  
Dominant Form ◽  
New Era ◽  
The Individual

Three major trends in American health policy are intersecting in a fascinating way. First, managed care has grown to become the most dominant form of health-care delivery, leading to reductions in health-care costs as insurers are able to influence health-care providers with financial incentives. Second, the present growth of managed care has slowed, almost to a standstill, largely on account of consumers questioning what effects these financial incentives are having on the care of patients — questioning that has been expressed in particular through lawsuits against managed care companies.Third, we are experiencing a renewed interest in the existence of medical error and how it may be reduced as a result of the Institute of Medicine’s (IOM) report, To Err Is Human: Building a Safer Health System. The most important aspect of this renaissance in error reduction has been its emphasis on health care as a system that can be made better through system-oriented change. The most frustrating aspect is that the IOM did not endorse change in malpractice liability, which consistently puts the impetus for reducing medical error on the individual provider rather than the system as a whole.

mHealth: Mobile Technologies to Virtually Bring the Patient Into an Oncology Practice

2017 ◽  
pp. 144-154 ◽  
Author(s):  
Nathan A. Pennell ◽  
Adam P. Dicker ◽  
Christine Tran ◽  
Heather S. L. Jim ◽  
David L. Schwartz ◽  
...  
Keyword(s):  
Health Care ◽  
Clinical Practice ◽  
Health Care Providers ◽  
Care Delivery ◽  
Clinical Care ◽  
Quality Care ◽  
Cost Effective ◽  
Mobile Technologies ◽  
Care Providers ◽  
Oncology Practice

Accompanied by the change in the traditional medical landscape, advances in wireless technology have led to the development of telehealth or mobile health (mHealth), which offers an unparalleled opportunity for health care providers to continually deliver high-quality care. This revolutionary shift makes the patient the consumer of health care and empowers patients to be the driving force of management of their own health through mobile devices and wearable technology. This article presents an overview of technology as it pertains to clinical practice considerations. Telemedicine is changing the way clinical care is delivered without regard for proximity to the patient, whereas nonclinical telehealth applications affect distance education for consumers or clinicians, meetings, research, continuing medical education, and health care management. Technology has the potential to reduce administrative burdens and improve both efficiency and quality of care delivery in the clinic. Finally, the potential for telehealth approaches as cost-effective ways to improve adherence to treatment is explored. As telehealth advances, health care providers must understand the fundamental framework for applying telehealth strategies to incorporate into successful clinical practice.

scholarly journals Quality Improvement Goals for Acute Kidney Injury

2019 ◽  
Vol 14 (6) ◽  
pp. 941-953 ◽  
Author(s):  
Kianoush Kashani ◽  
Mitchell Howard Rosner ◽  
Michael Haase ◽  
Andrew J.P. Lewington ◽  
Donal J. O'Donoghue ◽  
...  
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Health Care Providers ◽  
Care Delivery ◽  
Quality Care ◽  
Hospital Setting ◽  
Kidney Injury ◽  
Cost Of Care ◽  
Care Providers ◽  
Improvement Programs

AKI is a global concern with a high incidence among patients across acute care settings. AKI is associated with significant clinical consequences and increased health care costs. Preventive measures, as well as rapid identification of AKI, have been shown to improve outcomes in small studies. Providing high-quality care for patients with AKI or those at risk of AKI occurs across a continuum that starts at the community level and continues in the emergency department, hospital setting, and after discharge from inpatient care. Improving the quality of care provided to these patients, plausibly mitigating the cost of care and improving short- and long-term outcomes, are goals that have not been universally achieved. Therefore, understanding how the management of AKI may be amenable to quality improvement programs is needed. Recognizing this gap in knowledge, the 22nd Acute Disease Quality Initiative meeting was convened to discuss the evidence, provide recommendations, and highlight future directions for AKI-related quality measures and care processes. Using a modified Delphi process, an international group of experts including physicians, a nurse practitioner, and pharmacists provided a framework for current and future quality improvement projects in the area of AKI. Where possible, best practices in the prevention, identification, and care of the patient with AKI were identified and highlighted. This article provides a summary of the key messages and recommendations of the group, with an aim to equip and encourage health care providers to establish quality care delivery for patients with AKI and to measure key quality indicators.

scholarly journals A systematic review of providers’ experiences of facilitating group antenatal care

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Jalana Lazar ◽  
Laura Boned-Rico ◽  
Ellinor K. Olander ◽  
Christine McCourt
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Antenatal Care ◽  
Health Care Providers ◽  
Health Care Professionals ◽  
Structural Changes ◽  
Care Delivery ◽  
Quality Care ◽  
Care Providers ◽  
Screening Guidelines

Abstract Background Group antenatal care is a rapidly expanding alternative antenatal care delivery model. Research has shown it to be a safe and effective care model for women, but less is known about the perspectives of the providers leading this care. This systematic review examined published literature that considered health care professionals’ experiences of facilitating group antenatal care. Methods Systematic searches were conducted in seven databases (Cinahl, Medline, Psychinfo, Embase, Ovid Emcare, Global Health and MIDRS) in April 2020. Qualitative or mixed methods studies with a significant qualitative component were eligible for inclusion if they included a focus on the experiences of health care providers who had facilitated group antenatal care. Prisma screening guidelines were followed and study quality was critically appraised by three independent reviewers. The findings were synthesised thematically. Results Nineteen papers from nine countries were included. Three main themes emerged within provider experiences of group antenatal care. The first theme, ‘Giving women the care providers feel they want and need’, addresses richer use of time, more personal care, more support, and continuity of care. The second theme, ‘Building skills and relationships’, highlights autonomy, role development and hierarchy dissolution. The final theme, ‘Value proposition of group antenatal care’, discusses provider investment and workload. Conclusions Health care providers’ experience of delivering group antenatal care was positive overall. Opportunities to deliver high-quality care that benefits women and allows providers to develop their professional role were appreciated. Questions about the providers’ perspectives on workload, task shifting, and the structural changes needed to support the sustainability of group antenatal care warrant further exploration.

scholarly journals Integrating Family Caregivers of People With Alzheimer’s Disease and Dementias into Clinical Appointments: Identifying Potential Best Practices

2019 ◽  
Vol 39 (11) ◽  
pp. 1184-1194 ◽  
Author(s):  
Joan M. Griffin ◽  
Catherine Riffin ◽  
Rachel D. Havyer ◽  
Virginia S. Biggar ◽  
Meryl Comer ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Health Care ◽  
Best Practices ◽  
Family Caregivers ◽  
Health Care Providers ◽  
Care Delivery ◽  
Quality Care ◽  
Spousal Caregivers ◽  
Care Providers

Family caregiver engagement in clinical encounters can promote relationship-centered care and optimize outcomes for people with Alzheimer’s disease and related dementias (ADRD). Little is known, however, about effective ways for health care providers to engage family caregivers in clinical appointments to provide the highest quality care. We describe what caregivers of people with ADRD and people with mild cognitive impairment (MCI) consider potential best practices for engaging caregivers as partners in clinical appointments. Seven online focus groups were convened. Three groups included spousal caregivers ( n = 42), three included non-spousal caregivers ( n = 36), and one included people with MCI ( n = 15). Seven potential best practices were identified, including the following: “acknowledge caregivers’ role and assess unmet needs and capacity to care” and “communicate directly with person with ADRD yet provide opportunities for caregivers to have separate interactions with providers.” Participants outlined concrete steps for providers and health care systems to improve care delivery quality for people with ADRD.

Current Practices and Challenges of Medical Services on Health Care System of Mandalay General Hospital

2019 ◽  
Vol 31 (2) ◽  
pp. 131
Keyword(s):  
Health Care ◽  
General Hospital ◽  
Health Care Providers ◽  
Quality Care ◽  
Healthcare Providers ◽  
Medical Services ◽  
Tertiary Level ◽  
Care Providers ◽  
Level Hospital ◽  
Care System

In Myanmar, the main challenge to provide quality healthcare by Universal Health Care approach is documented as low health services coverage with substantial wealth-based inequality. To achieve the effective health care system, strong medical care system is essential. Understanding on challenges and needs in provision of medical services among patients and health care providers is critical to provide quality care with desirable outcomes. The aim of the study was to explore the patients’ and health care providers’ perceptions on the challenges in provision of medical services at the Mandalay General Hospital. This was a qualitative study conducted at the tertiary level hospital (Mandalay General Hospital). The data was collected by using focus group discussions and in-depth interviews with hospitalized patients or attendants, healthcare providers such as medical doctors, nurses, laboratory scientists and hospital administrators in March 2017. The qualitative data was analyzed using themes by themes matrix analysis. Most patients were satisfied with the care provided by the doctors because they believed that they received quality care. However, some patients complained about long waiting time for elective operation, congested conditions in the ward, burden for investigations outside the hospital for urgent needs and impolite manners of general workers. Healthcare providers reported that they had heavy workload due to limited human and financial resources in the hospital, poor compliances with hospital rules and regulation among patients and attendants, and inefficient referral practices from other health facilities. Other challenges experienced by healthcare providers were lack of ongoing training to improve knowledge and skills, limited health infrastructure and inadequate medicinal supplies. The findings highlighted the areas needed to be improved to provide quality health care at the tertiary level hospital. The challenges and problems encountered in this hospital can be improved by allocating adequate financial and human resources. The systematic referral system and hospital management guidelines are needed to reduce workload of health staff.

Genetic Predispositions, Prophylactic Treatments and Private Health Insurance: Nothing is Better Than a Good Pair of Genes

1997 ◽  
Vol 23 (1) ◽  
pp. 45-68 ◽  
Author(s):  
Alexandra K. Glazier
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Genetic Predisposition ◽  
Genetic Linkage ◽  
Dna Analysis ◽  
Care Delivery ◽  
Medical Community ◽  
Care Providers ◽  
Linkage Studies ◽  
Prophylactic Measures

Discovering the genetic basis of a particular disease is not only of great interest to the medical community; private health insurers are also anxiously awaiting the results of genetic linkage studies. Apart from the scientific value of DNA studies, the results of genetic linkage research are relevant to health care delivery in two principal ways. First, identifying the genetic origin of a disease may allow doctors to detect the disease earlier. If doctors know that an individual is genetically predisposed to a particular disease, then health care providers can increase screening efforts and watch for early symptoms. Second, if an individual has a genetic predisposition to a particular disease, health care providers may employ preventive or “prophylactic" measures to reduce or eliminate the risk of developing the disease or condition to which the individual is genetically predisposed. Genetic linkage studies will soon allow more individuals to learn of their own genetic predispositions to certain diseases. Currently genetic predisposition tests (both pedigrees of family history and DNA analysis) can indicate that an individual is at high risk for developing a disease.

Nurse Practitioner Challenges to the Orthodox Structure of Health Care Delivery: Regulation and Restraints on Trade

1985 ◽  
Vol 11 (2) ◽  
pp. 195-225
Author(s):  
Karla Kelly
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Health Care Delivery ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Allied Health ◽  
Care Delivery ◽  
The United States ◽  
Care Providers ◽  
Allied Health Care

AbstractUntil recently, physicians have been the primary health care providers in the United States. In response to the rising health care costs and public demand of the past decade, allied health care providers have challenged this orthodox structure of health care delivery. Among these allied health care providers are nurse practitioners, who have attempted to expand traditional roles of the registered nurse.This article focuses on the legal issues raised by several major obstacles to the expansion of nurse practitioner services: licensing restrictions, third party reimbursement policies, and denial of access to medical facilities and physician back-up services. The successful judicial challenges to discriminatory practices against other allied health care providers will be explored as a solution to the nurse practitioners’ dilemma.

Challenges of Providing Health Care in Complex Emergencies: A Systematic Review

2021 ◽  
pp. 1-5
Author(s):  
Hesam Seyedin ◽  
Morteza Rostamian ◽  
Fahimeh Barghi Shirazi ◽  
Haleh Adibi Larijani
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Health Services ◽  
Health Care Providers ◽  
Health Care Delivery ◽  
Qualitative Content Analysis ◽  
Care Delivery ◽  
Information Access ◽  
Care Providers ◽  
Complex Emergencies

Abstract Providing health care in times of complex emergencies (CEs) is one of the most vital needs of people. CEs are situations in which a large part of the population is affected by social unrest, wars, and food shortages. This systematic review study was conducted to identify the challenges of health-care delivery in CEs. We searched terms related to health-care delivery and CEs in PubMed, Web of Sciences, Science Direct, and Google scholar databases, as well as Persian databases SID and Magiran. The searching keywords included: “Health Care, Complex Crises, War, Humanitarian, Refugees, Displaced Persons, Health Services, and Challenges.” Of 409 records, we selected 6 articles based on the Preferred Reporting Items for Systematic Reviews (PRISMA) checklist. Studies were analyzed through qualitative content analysis. The results show that CEs affect health-care delivery in 4 primary areas: the workforce, infrastructure, information access, and organization of health services. These areas can pose potential threats for health-care providers and planners at times of emergencies. Thus, they should be informed about these challenges to strengthen the health-care system.

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