Funding of correctional health care and its implications

2015 ◽  
Author(s):  
Robert L. Trestman
Keyword(s):  
Health Care ◽  
Resource Constraints ◽  
Health Care Cost ◽  
Care Delivery ◽  
Models Of Care ◽  
Fee For Service ◽  
Community Healthcare ◽  
Correctional Settings ◽  
Incarcerated Population ◽  
Correctional Healthcare

Correctional healthcare is funded through a range of mechanisms, reflecting many of the community fee-for-service and managed care parallels. Like community healthcare, utilization of healthcare in correctional settings is increasing. It is however, often under more significant budgetary constraints and tighter management. The funding of correctional healthcare is a complex enterprise, driven by constitutionally mandated care obligations on the one hand, and resource constraints on the other. Along with the dramatic increase in the incarcerated population during the past two decades, correctional healthcare has evolved as well. The costs of care are quite substantial, and the diversity of models of care delivery offer an administrative challenge, a financial challenge to the relevant jurisdiction, and a significant opportunity for cost effectiveness. Unfortunately, as of yet, no comparative study of funding models has been done. As integrated electronic health and financial records are gradually introduced into correctional settings, opportunities for such studies, and the policy guidance provided by those results, may yield important information applicable to health care cost and outcome management in society more broadly. This chapter includes a discussion of global capitation, per inmate costs, at-risk contracting, liability concerns, performance indicators, and a variety of contractual relationships.

Direct Primary Care: A Successful Financial Model for the Clinical Practice of Lifestyle Medicine

2021 ◽  
pp. 155982762110066
Author(s):  
Amy R. Mechley
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Care Delivery ◽  
Health Care Systems ◽  
Well Being ◽  
The United States ◽  
Fee For Service ◽  
Financial Model ◽  
Lifestyle Medicine ◽  
Direct Primary

Primary care has been shown to significantly decrease the overall cost of a population’s health care while improving the quality of each person’s well-being. Lifestyle medicine (LM) is ideally positioned to be delivered via primary care and has been shown to improve short- and long-term health outcomes of patients and populations. Direct primary care (DPC) represents a viable alternative to the fee-for-service reimbursement model. It has been shown to be economically and financially sustainable. Furthermore, it has the potential to fulfill the Quadruple Aim of health care in the United States. LM practiced in a DPC model has the potential to transform health care delivery. This article will discuss the need for health care systems change, provide an overview of the DPC model, demonstrate a basic understanding of the benefits, and review the steps needed to de-risk the investment of time, money, and resources for our future DPC providers.

scholarly journals Group Medical Visits and Clinician Wellbeing

2020 ◽  
Vol 9 ◽  
pp. 216495612097397
Author(s):  
Ariana Thompson-Lastad ◽  
Paula Gardiner
Keyword(s):  
Health Care ◽  
Care Delivery ◽  
Cost Savings ◽  
Models Of Care ◽  
Group Medical Visits ◽  
Integrative Health ◽  
Medical Visits ◽  
Integrative Health Care ◽  
Wide Range ◽  
Clinical Benefits

There is strong evidence for clinical benefits of group medical visits (GMVs) (also known as shared medical appointments) for prenatal care, diabetes, chronic pain, and a wide range of other conditions. GMVs can increase access to integrative care while providing additional benefits including increased clinician-patient contact time, cost savings, and support with prevention and self-management of chronic conditions. During the COVID-19 pandemic, many clinical sites are experimenting with new models of care delivery including virtual GMVs using telehealth. Little research has focused on which clinicians offer this type of care, how the GMV approach affects the ways they practice, and their job satisfaction. Workplace-based interventions have been shown to decrease burnout in individual physicians. We argue that more research is needed to understand if GMVs should be considered among these workplace-based interventions, given their potential benefits to clinician wellbeing. GMVs can benefit clinician wellbeing in multiple ways, including: (1) Extended time with patients; (2) Increased ability to provide team-based care; (3) Understanding patients’ social context and addressing social determinants of health. GMVs can be implemented in a variety of settings in many different ways depending on institutional context, patient needs and clinician preferences. We suggest that GMV programs with adequate institutional support may be beneficial for preventing burnout and improving retention among clinicians and health care teams more broadly, including in integrative health care. Just as group support benefits patients struggling with loneliness and social isolation, GMVs can help address these and other concerns in overwhelmed clinicians.

Adult Care in Cystic Fibrosis

2019 ◽  
Vol 40 (06) ◽  
pp. 857-868 ◽  
Author(s):  
J. Stuart Elborn
Keyword(s):  
Health Care ◽  
Cystic Fibrosis ◽  
Care Delivery ◽  
Health Care Systems ◽  
Well Being ◽  
Models Of Care ◽  
Adult Care ◽  
Care Systems ◽  
Expanding Population ◽  
Almost All

AbstractCystic fibrosis (CF) is now more common in adults than children in countries with well-developed health care systems. The number of adults continues to increase and will further increase if the new cystic fibrosis transmembrane conductance regulator (CFTR) modulators are disease modifying. Most of the complex morbidity and almost all the mortality of CF occur in adults and will increasingly follow this pattern even with new effective modulator therapies. Maintaining good quality of life including social functioning and maximizing survival for adults are the key priorities. This requires a highly knowledgeable and adaptable multidisciplinary team, which, though focused on maintaining lung health, requires an increasing range of other disciplines and specialties to maximize well-being. Changes in health care systems will require current models of care to adapt to provide care for the large number of adult patients. With increasing survival and age, many are likely to have both CF morbidities and additional diseases of aging. New models are needed for health care delivery for this expanding population with complex medical conditions.

Minority Access and Health Reform: A Civil Right to Health Care

1994 ◽  
Vol 22 (2) ◽  
pp. 127-137 ◽  
Author(s):  
Sidney Dean Watson
Keyword(s):  
Health Care ◽  
Civil Rights ◽  
Health Care Reform ◽  
Health Care Professionals ◽  
Minority Health ◽  
Care Delivery ◽  
Universal Coverage ◽  
Fee For Service ◽  
Major Barrier ◽  
Right To Health Care

Health care reform that includes universal coverage could lower a major barrier to care for people of color and ethnic minorities—the inability to pay for care. But universal coverage alone, even with comparable fee-for-service payment or appropriately risk-adjusted capitated reimbursement, will not eradicate the racial and ethnic inequities in health care delivery. Restrictive admissions practices, geographic inaccessibility, culture, racial stereotypes, and the failure to employ minority health care professionals will still create barriers to minority health care. In addition to universal financing, health care reform should include new civil rights legislation to address and reduce these noneconomic barriers to minority health care.

scholarly journals Alternative payment approaches for advancing comprehensive medication management in primary care

2020 ◽  
Vol 18 (4) ◽  
pp. 2238
Author(s):  
Katherine Pham
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Care Delivery ◽  
Medication Management ◽  
Fee For Service ◽  
Care Providers ◽  
Care Community ◽  
Improved Outcomes ◽  
And Performance ◽  
Value Based Care

The increasing prevalence of complex, chronic conditions has profound implications on the growing demand and cost of health care. The Center for Medicare and Medicaid Innovation is testing data-driven approaches to care delivery and payment that are drawn from innovative practices of health care providers and other partners in the health care community. The shift from fee-for-service to value-based care and performance-based payment places increased priority on improved outcomes at lower costs. To advance comprehensive medication management, pharmacists need to understand the opportunities in the evolving value-based payment models and align medication optimization with the specific goals and incentives of these models.

scholarly journals Clinicians’ Experience of Providing Care: A Rapid Review

2020 ◽  
Author(s):  
Maha Pervaz Iqbal ◽  
Elizabeth Manias ◽  
Laurel Mimmo ◽  
Stephen Mears ◽  
Briony Jack ◽  
...  
Keyword(s):  
Health Care ◽  
Health System ◽  
Care Delivery ◽  
Grey Literature ◽  
Clinical Work ◽  
Models Of Care ◽  
Rapid Review ◽  
Measurement Tools ◽  
Clinician Experience ◽  
System Sustainability

Abstract BackgroundHealth care services internationally are refocussing care delivery towards patient centred, integrated care that utilises effective, efficient and innovative models of care to optimise patient outcomes and system sustainability. Whilst significant efforts have been made to examine and enhance patient experience, to date little has progressed in relation to provider experience. This review aims to explore this knowledge gap by capturing evidence of clinician experience, and how this experience is defined and measured in the context of health system change and innovation.Methods:A rapid review of published and grey literature review was conducted utilising a rapid evidence assessment methodology. 79 studies retrieved from the literature were included in the review. 14 articles were identified from the grey literature search and one article obtained via hand searching. In total, 94 articles were included in the review. This study was commissioned by and co-designed with the New South Wales, Ministry of Health.Results:Clinician experience of delivering health care is inconsistently defined in the literature, with identified articles lacking clarity regarding distinctions between experience, engagement and work-related outcomes such as job satisfaction. Clinician experience was commonly explored using qualitative research that focused on experiences of discrete health care activities or events in which a change was occurring. Such research enabled exploration of complex experiences. In these contexts, clinician experience was captured in terms of self-reported information that clinicians provided about the health care activity or event, their perceptions of its value, the lived impacts they experienced, and the specific behaviours they displayed in relation to the activity or event. Moreover, clinician’s experience has been identified to have a paucity of measurement tools. Conclusion:Literature to date has not examined clinician experience in a holistic sense. In order to achieve the goals identified in relation to value-based care, further work is needed to conceptualise clinician experience and understand the nature of measurement tools required to assess this. In health system application, a broader ‘clinician pulse’ style assessment may be valuable to understand the experience of clinical work on a continuum rather than in the context of episodes of change/care.

Models of Care

2017 ◽  
Author(s):  
Tyson Sawchuk ◽  
Joan K. Austin ◽  
Debbie Terry
Keyword(s):  
Health Care ◽  
Health Care Services ◽  
Care Delivery ◽  
Hospital Setting ◽  
Models Of Care ◽  
Stepped Care ◽  
Patient Centered ◽  
Care Approach ◽  
Centered Care ◽  
Care Models

This chapter addresses common barriers to care delivery in psychogenic nonepileptic seizures (PNES) and limitations of current approaches. Theoretical and practical considerations in delivering PNES care are discussed. These include a stepped-care approach, which offers a strategy for efficiently managing health care resources and has promise in treatment of PNES. Patient-centered care, a general approach to providing health care services in a manner that takes into consideration the patients’ expressed needs, desires, and preferences, is also considered. Examples of care models are presented, including a pediatric model for PNES recently developed and being tested in a Canadian hospital setting. Future directions for the development of care models in PNES are discussed and a list of recommendations is provided.

Remote Monitoring of Patient- and Family-Generated Health Data in Pediatrics

PEDIATRICS ◽  
2022 ◽  
Author(s):  
Carolyn Foster ◽  
Dana Schinasi ◽  
Kristin Kan ◽  
Michelle Macy ◽  
Derek Wheeler ◽  
...  
Keyword(s):  
Health Care ◽  
Digital Literacy ◽  
Care Delivery ◽  
Digital Health ◽  
Health Care Team ◽  
Models Of Care ◽  
Health Data ◽  
Care Needs ◽  
Case Examples ◽  
Health Technologies

Remote patient monitoring (RPM) is a form of telemedicine that involves the collection and transmission of health data from a patient to their health care team by using digital health technologies. RPM can be leveraged to aggregate and visualize longitudinal patient-generated health data for proactive clinical management and engagement of the patient and family in a child’s health care. Collection of remote data has been considered standard of care for years in some chronic pediatric conditions. However, software limitations, gaps in access to the Internet and technology devices, digital literacy, insufficient reimbursement, and other challenges have prevented expansion of RPM in pediatric medicine on a wide scale. Recent technological advances in remote devices and software, coupled with a shift toward virtual models of care, have created a need to better understand how RPM can be leveraged in pediatrics to improve the health of more children, especially for children with special health care needs who are reliant on high-quality chronic disease management. In this article, we define RPM for the general pediatric health care provider audience, provide case examples of existing RPM models, discuss advantages of and limitations to RPM (including how data are collected, evaluated, and managed), and provide a list of current RPM resources for clinical practitioners. Finally, we propose considerations for expansion of this health care delivery approach for children, including clinical infrastructure, equitable access to digital health care, and necessary reimbursement. The overarching goal is to advance health for children by adapting RPM technologies as appropriate and beneficial for patients, families, and providers alike.

scholarly journals Managed Care and Health Care Expenditures: Evidence from Medicare, 1990-1994

1998 ◽  
Vol 1 (1) ◽  
Author(s):  
Laurence C. Baker ◽  
Sharmila Shankarkumar
Keyword(s):  
Health Care ◽  
Managed Care ◽  
Market Share ◽  
Health Care Policy ◽  
Care Delivery ◽  
Health Care Expenditures ◽  
Spillover Effects ◽  
Fee For Service ◽  
Health Care Market ◽  
Care Activity

Increases in the activity of managed care organizations may have "spillover effects," influencing the entire health care delivery system's performance, so that care for both managed-care and non–managed-care patients is affected. Some proposals for Medicare reform have incorporated spillover effects as a way that increasing Medicare HMO enrollment could contribute to savings for Medicare.This paper investigates the relationship between HMO market share and expenditures for the care of beneficiaries enrolled in traditional fee-for-service Medicare. We find that increases in systemwide HMO market share (which includes both Medicare and non-Medicare enrollment) are associated with declines in both Part A and Part B fee-for-service expenditures. The fact that managed care can influence expenditures for this population, which should be well insulated from the direct effects of managed care, suggests that managed-care activity can have broad effects on the entire health care market. Increases in Medicare HMO market share alone are associated with increases in Part A expenditures and with small decreases in Part B expenditures. This suggests that any spillovers directly associated with Medicare HMO enrollment are small.For general health care policy discussions, these results suggest that assessment of new policies that would influence managed care should account not only for its effects on enrollees but also for its systemwide effects. For Medicare policy discussions, these findings imply that previous results that seemed to show large spillover effects associated with increases in Medicare HMO market share, but inadequately accounted for systemwide managed-care activity and relied on older data, overstated the magnitude of actual Medicare spillovers.

scholarly journals Frailty and Dementia: Differences in Health Care Utilization and Costs

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 821-821
Author(s):  
Stephanie Denise Sison ◽  
Gahee Oh ◽  
Sandra Shi ◽  
Brianne Olivieri-Mui ◽  
Ellen McCarthy ◽  
...  
Keyword(s):  
United States ◽  
Health Care ◽  
Health Care Utilization ◽  
Retrospective Cohort ◽  
Care Delivery ◽  
The United States ◽  
Care Utilization ◽  
Fee For Service ◽  
Total Cost ◽  
Nuanced Understanding

Abstract Frailty and dementia are associated with poor health outcomes and increased health care utilization. A more nuanced understanding of this dynamic may be useful in improving care and developing policies. This retrospective cohort study was conducted using 5% random sample of Medicare fee-for-service beneficiaries (n=1,132,367; mean age 76.2 years; 57.9% female) in 2014-2016. We compared average 1-year home time (number of days alive outside of the hospital and SNF), mean total cost per beneficiary, and number of incident ICU stays per 100 person-years (PY) across four groups: frailty and dementia, dementia alone, frailty alone or neither. Frailty and dementia were identified using validated claims-based algorithms. We also determined differences in costs per group across different regions within the United States. Beneficiaries with both frailty and dementia had a high 1-year mortality rate of 21.9% (vs. dementia alone [9.7%], frailty alone [9.4%] or neither [2.1%]), while having less home time (306 days; difference of 36 days, 31 days, and 53 days, respectively), and more incident ICU stays per 100 PY (29.9 vs 9.5, 25.8, and 5.6, respectively). Mean total costs for beneficiaries with both was $26,030 compared to other groups ($12,096, $24,693, and $9,029, respectively). Across the United States, range of costs varied the most for beneficiaries with both frailty and dementia ($13,244-31,987 vs $4,621-15,364, $20,090-30,965, and $7,672-10,450, respectively). Increase in health care utilization and wide geographic variation in costs associated with patients with frailty and dementia suggests room for improvement in health care delivery to improve outcomes of this group.

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