scholarly journals Hospital Mergers and Public Accountability: Tennessee and Virginia Employ a Certificate of Public Advantage

2018 ◽  
Author(s):  
Erin C. Fuse Brown
Keyword(s):  
Health Care ◽  
Population Health ◽  
Health Care Providers ◽  
Antitrust Enforcement ◽  
Care Providers ◽  
Public Accountability ◽  
Milbank Memorial Fund ◽  
Hospital Mergers ◽  
Potential Benefits ◽  
State Oversight

Rapid health care consolidation has led to rising health care prices, diminished access to care, and reduced incentives for quality improvement. States have a variety of tools to address these adverse consequences of the loss of health care competition, ranging from state antitrust enforcement to global budgets or provider rate-regulation. One of the tools is a “certificate of public advantage” (COPA) or cooperative agreement under which the state approves a health care merger and shields it from antitrust enforcement in exchange for state oversight and supervision of the merged entities’ conduct. COPAs are controversial. The Federal Trade Commission and economists vehemently oppose COPAs, citing evidence that health care consolidation leads to higher prices and does not yield efficiencies, savings, or improved quality. The risks of COPAs are that they create, in essence, a state-sanctioned monopoly that could significantly raise prices, reduce consumer choice and access, and disinvest in essential services that may be less profitable but are critical for population health. Nevertheless, particularly in rural areas, health care providers seek to consolidate to weather mounting financial challenges. In response, states are exploring COPAs as a tool to exercise oversight over the merging parties’ health care prices, secure commitments for investments in population health, promote beneficial health care integration, and maintain access to rural health care providers. This report, published by the Milbank Memorial Fund, describes the twin COPAs approved by Tennessee and Virginia in 2017 to allow health systems, Wellmont Health System and Mountain States Health Alliance, to merge to form Ballad Health System, a combined entity that holds a near-monopoly in southwest Virginia and northeast Tennessee. This case study highlights the unique features of the Ballad Health COPA, involving two states’ COPA laws, and describes the legal authority, factors and commitments secured for approval, and the states’ resources and coordination for ongoing supervision. It remains to be seen whether the states can implement the COPAs with sufficient rigor and oversight to ensure the benefits of COPAs outweigh their risks. COPAs are a risky policy solution because they permit health care mergers that would not pass antitrust scrutiny and may result in untenable price increases and other adverse effects. On the other hand, COPAs may offer potential benefits in terms of population health and access particularly for struggling rural communities. Stringent, well-resourced, and long-term state oversight is key to avoiding the risks of monopoly and enforcing the commitments to population health and cost control. Whether states can prevent the adverse outcomes and reap the potential benefits under a COPA remains an open question, but Tennessee and Virginia are poised to try.Suggested citation: ERIN C. FUSE BROWN, MILBANK MEMORIAL FUND, HOSPITAL MERGERS AND PUBLIC ACCOUNTABILITY: TENNESSEE AND VIRGINIA EMPLOY A CERTIFICATE OF PUBLIC ADVANTAGE (2018), https://www.milbank.org/publications/hospital-mergers-and-public-accountability-tennessee-and-virginia-employ-a-certificate-of-public-advantage/.

Risky Business: Proposed Reform of the Antitrust Laws As Applied to Health Care Provider Networks

1998 ◽  
Vol 24 (1) ◽  
pp. 59-87
Author(s):  
Natalie Marjancik
Keyword(s):  
Health Care ◽  
Health Care Provider ◽  
Health Care Providers ◽  
Care Provider ◽  
Health Care Services ◽  
Care Delivery ◽  
Antitrust Enforcement ◽  
Care Providers ◽  
Antitrust Laws ◽  
Provider Networks

Because the health care industry comprises over thirteen percent of the American economy, law enforcers increasingly apply antitrust law to all aspects of health care delivery and financing. Through antitrust enforcement, consumers receive the benefits of lower health care costs and improved health care services. To achieve further cost savings, health care providers are forming, as well as joining, many different types of provider network joint ventures. Providers form networks, expect ing “them to generate efficiencies, reduce excess capacity, improve utilization, permit greater specialization and enhance quality.” However, because they organize competing physicians and enable them to collaborate on prices and set fee schedules, provider networks raise serious antitrust concerns. Consequently, the federal government and courts are increasingly focusing their antitrust enforcement efforts on the formation and anticompetitive activities of provider networks.In Part I, this Note addresses the degree to which network providers must be economically and financially integrated to legally collaborate and set prices. Part II briefly explains the procedures one may use to enforce the federal antitrust laws. Following this explanation of antitrust enforcement procedures, Part III discusses the relevant statutory and case law applicable to health care provider networks.

scholarly journals Perceptions about preconception care among health care providers in Ibadan, southwest Nigeria - A qualitative study

2019 ◽  
Author(s):  
Oludoyinmola Omobolade Ojifinni ◽  
Latifat Ibisomi
Keyword(s):  
Health Care ◽  
Maternal Health ◽  
Health Care Providers ◽  
Pregnancy Outcomes ◽  
Preconception Care ◽  
Reproductive Age ◽  
Care Seeking ◽  
Care Providers ◽  
Medical Problems ◽  
Potential Benefits

Abstract Background: Preconception care (PCC) is a recognised strategy for optimising maternal health and improving maternal and neonatal outcomes. Research has shown that PCC services are minimally available and yet to be fully integrated into maternal health services in Nigeria. This study explored the perceptions about PCC services among health care providers in Ibadan, Nigeria. Methods: This was a case study research among 26 health care providers – 16 specialist physicians and nine nurses covering 10 specialties: Obstetrics/Gynaecology, Cardiology, Endocrinology among others at the primary, secondary and tertiary health care levels. In-depth interviews were digitally recorded, transcribed verbatim and analysed on MAXQDA using thematic analysis. Results: Six main themes were identified from the data – scope of PCC, people who require PCC, where PCC services can be provided, acceptability of PCC services, relevance of PCC to different specialties including gynaecologists, cardiologists, nephrologists, psychiatrists and possible benefits of PCC. PCC was viewed as care for women, men and couples before pregnancy to optimise health status and ensure positive pregnancy outcomes. Almost all participants stated that PCC services should be offered at all three levels of health care with referral when needed from the lower to higher levels. The prevailing opinion on the circumstances when PCC is required was that although all people of reproductive age would benefit, those who had medical problems such as hypertension, sickle cell disease, diabetes and infertility would benefit more. Participants opined that delayed health care seeking observed in the community may influence acceptability of PCC especially for people without known pre-existing conditions. All specialist physicians identified the relevance of PCC to their practice and identified potential benefits of PCC. The potential benefits outlined included opportunity to plan and prepare for pregnancy to ensure positive pregnancy outcomes. Conclusion: Preconception care is perceived as being more important for promoting positive pregnancy outcomes in people with known medical problems and is relevant to different specialities of medical practice. Provision of the service will however require establishment of guidelines and its uptake will depend on acceptability to people with known medical problems who will benefit from the service.

The Evolution of a Public Health Policy: Health Care Providers and the Transmission of HIV

1994 ◽  
Vol 24 (3) ◽  
pp. 535-548 ◽  
Author(s):  
Sally Guttmacher
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health Care Providers ◽  
Public Health Policy ◽  
Health Care Facilities ◽  
Care Providers ◽  
The Public ◽  
Care Facilities ◽  
Potential Benefits ◽  
Spread Of Infection

The single known instance of transmission of HIV from a health care provider to a patient raised issues concerning the responsibility of clinicians to their patients, and sparked debate over policies to prevent the spread of HIV in health care facilities. The intensity and politicization of the debate were reflected in revision of the Centers for Disease Control guidelines to control the spread of infection at health care facilities, and in legislation proposed in Congress. The guidelines and proposed legislation provoked responses by public health and medical organizations, several of which considered the measures to be unnecessarily restrictive and too costly in terms of potential benefits. This article describes the events and responses that took place during 1991–1992 after the public was made aware of the case involving transmission from provider to patient. The author examines the situation in the context of public health efforts to control the spread of HIV.

scholarly journals Perspectives on marijuana use and effectiveness

2017 ◽  
Vol 7 (4) ◽  
pp. 333-343 ◽  
Author(s):  
Stacey S. Cofield ◽  
Amber Salter ◽  
Tuula Tyry ◽  
Christina Crowe ◽  
Gary R. Cutter ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Health Care ◽  
Health Care Providers ◽  
Care Providers ◽  
Research Committee ◽  
The North ◽  
Current Usage ◽  
Before And After ◽  
History Of ◽  
Potential Benefits

AbstractBackground:Interest in and use of marijuana by persons with multiple sclerosis (MS) has increased. While potential benefits have been reported, so have concerns about potential risks. Few large studies have been conducted about the perceptions and current usage of marijuana and medical cannabinoids in persons with MS.Methods:Participants in the North American Research Committee on Multiple Sclerosis (NARCOMS) registry were surveyed in 2014 regarding legality and history of marijuana usage, both before and after diagnosis with MS.Results:A total of 5,481 participants responded, with 78.2% female, 90% relapsing disease at onset, and a current mean age of 55.5 (10.2) years. Sixty-four percent had tried marijuana prior to their MS diagnosis, 47% have considered using for their MS, 26% have used for their MS, 20% have spoken with their physician about use, and 16% are currently using marijuana. Ninety-one percent think marijuana should be legal in some form. Men, those with higher disability, current and past nicotine smokers, and younger age were associated with a higher likelihood of current use.Conclusions:The majority of responders favor legalization and report high interest in the use of marijuana for treatment of MS symptoms, but may be reluctant to discuss this with health care providers. Health care providers should systematically inquire about use of marijuana.

scholarly journals Identification, assessment, and management of pain in patients with advanced dementia

2016 ◽  
Vol 6 (2) ◽  
pp. 89-94 ◽  
Author(s):  
Kasey L. Malotte ◽  
Mary Lynn McPherson
Keyword(s):  
Health Care ◽  
End Of Life ◽  
Health Care Providers ◽  
Symptom Burden ◽  
Self Report ◽  
Care Providers ◽  
Advanced Dementia ◽  
Patient Behavior ◽  
Potential Benefits ◽  
Prevalent Symptom

Abstract Patients with advanced dementia have a high symptom burden at end of life. Many of those with dementia have reports of symptoms similar to those without dementia, yet are treated less frequently. Pain is a prevalent symptom that can be underrecognized because of the ability of the patient to self-report. Several tools are available to help with the identification of pain, but they should only be one aspect in the overall assessment. Health care providers must anticipate this and screen for and treat potential pain. This includes obtaining a self-report, searching for potential causes for pain, observing patient behavior, gaining proxy reporting of pain, and attempting an appropriate analgesic trial. It is beneficial for all those involved with a patient's care to screen for pain because of the potential benefits in decreasing behaviors and subsequent antipsychotic use.

scholarly journals Perceptions about preconception care among health care providers in Ibadan, southwest Nigeria - A qualitative study

2019 ◽  
Author(s):  
Oludoyinmola Omobolade Ojifinni ◽  
Latifat Ibisomi
Keyword(s):  
Health Care ◽  
Maternal Health ◽  
Health Care Providers ◽  
Pregnancy Outcomes ◽  
Preconception Care ◽  
Reproductive Age ◽  
Care Providers ◽  
Medical Problems ◽  
Care Services ◽  
Potential Benefits

Abstract Background Preconception care (PCC) is a recognised strategy for optimising maternal health and improving maternal and neonatal outcomes. Research has however shown that preconception care services are not routinely provided as part of maternal health services in Nigeria. This study explored the perceptions about preconception care services among health care workers in Ibadan, Nigeria.Methods This was a qualitative descriptive study involving 25 in-depth interviews among 16 specialist physicians and nine nurses covering 10 specialties: Obstetrics/Gynaecology, Cardiology, Endocrinology among others at the primary, secondary and tertiary health care levels. Interviews were digitally recorded, transcribed verbatim and analysed on MAXQDA using thematic analysis.Results Six main themes were identified from the data – what PCC is, people who require PCC, where PCC services can be provided, acceptability of PCC services, the relevance of PCC to different specialties including gynaecologists, cardiologists, nephrologists, psychiatrists and the possible benefits of PCC. PCC was viewed as care for women, men and couples before pregnancy to optimise health status and ensure positive pregnancy outcomes. Almost all the participants stated that PCC services should be offered at all three levels of health care with referral when needed from the lower to higher levels. The prevailing opinion on the circumstances when PCC is required was that although all people of reproductive age would benefit, those who had medical problems such as hypertension, sickle cell disease, diabetes and infertility would benefit more. Acceptance and use of PCC services could however be hindered by the attitude of potential clients especially for those without any known pre-existing condition who may not use the service even if they were aware of its existence. All specialist physicians identified the relevance of PCC to their practice and identified potential benefits of PCC. The potential benefits outlined included opportunity to plan and prepare for pregnancy to ensure positive pregnancy outcomes.Conclusion Preconception care is important for positive pregnancy outcomes in people with known medical problems and is relevant to different specialities of medical practice. Its uptake will however depend on its acceptability to the people who will benefit from the service.

scholarly journals Pharmacist Involvement in Population Health Management for a Pediatric Managed Medicaid Accountable Care Organization

Children ◽  
2019 ◽  
Vol 6 (7) ◽  
pp. 82 ◽  
Author(s):  
Catherine Kuhn ◽  
Brigid K. Groves ◽  
Chester Kaczor ◽  
Sonya Sebastian ◽  
Ujjwal Ramtekkar ◽  
...  
Keyword(s):  
Health Care ◽  
Population Health ◽  
Health Care Providers ◽  
Health Management ◽  
Medication Management ◽  
Population Level ◽  
Care Organization ◽  
Accountable Care ◽  
Care Providers ◽  
Population Health Management

Accountable care organizations (ACOs) have emerged as an effective healthcare delivery model for managing quality and cost at a population level. Within ACOs, pharmacists are critical for the delivery of high-value health care, offering patients and health care providers medication-related training, resources, and guidance that can improve quality of care at lower costs. Partners For Kids (PFK), one of the oldest and largest pediatric ACOs in the country, has successfully leveraged pharmacists to provide population health management and medication management to promote health outcomes for individual patients and the overall population it serves. This review explores how the inclusion of pharmacists in the development and execution of various quality improvement initiatives within PFK has positively impacted outcomes for patients while also lowering overall spend. A catalog of interventions is provided to offer various ways that pharmacists can intersect as providers in the triad of patient/family, payor, and provider. By providing enhanced training and education, on-site guidance, medication management, and population-level data analysis, pharmacists are able to identify and improve inefficiencies in care. Moving forward, ongoing engagement of pharmacists in health care operations will be a necessary feature to maximize health care value.

Building an Agenda for Population Health from the Grassroots Up

2019 ◽  
pp. 261-270
Author(s):  
Tyler Norris ◽  
Ashley Hill
Keyword(s):  
Health Care ◽  
Health System ◽  
Population Health ◽  
Health Care Providers ◽  
Coming Out ◽  
Community Organizations ◽  
Leadership Role ◽  
Business Community ◽  
Care Providers

This chapter looks at the path forward to building an agenda for population health improvements. It looks at the roles of the various agents such as health care providers, health care payers, health care policymakers, health care investors, academic institutions, community organizations, and the business community. No matter what the role being played within the health system, that person or body can take the leadership role in crafting and spreading the main agenda. The role of the leader is to ask the following questions: Is there an understanding of the outcomes from current efforts? Is there clarity about what is coming out of current efforts? And if current efforts aren't generating the outcomes, then what is it going to take to do so, and how is that going to be achieved?

Putting the ‘tele’ into health-care effectively

2000 ◽  
Vol 6 (1_suppl) ◽  
pp. 113-115 ◽  
Author(s):  
Katherine Birch ◽  
Michael Rigby ◽  
Ruth Roberts
Keyword(s):  
Health Care ◽  
Quality Assurance ◽  
Health Service ◽  
Global Health ◽  
Health Care Providers ◽  
New Technologies ◽  
Care Providers ◽  
Organizational Effects ◽  
Potential Benefits ◽  
Accepted Practice

Although the introduction of new technologies has been successful and become accepted practice in many areas of industry, traditional methods have tended to prevail in health-care. Telemedicine has been adopted by enthusiasts who recognize the potential benefits of a ‘global health service’. However, the more widespread introduction of telemedicine requires considerable organizational change in the way health-care is delivered. More evaluation is required of clinical outcomes, organizational effects, benefits to health-care providers and users, and quality assurance.

Reminding and Monitoring: New Uses of Administrative Data for Preventive Care

1996 ◽  
Vol 9 (4) ◽  
pp. 30-36 ◽  
Author(s):  
Leslie L. Roos ◽  
David S. Fedson ◽  
Janice D. Roberts ◽  
Marsha M. Cohen
Keyword(s):  
Health Care ◽  
Population Health ◽  
Administrative Data ◽  
Health Care Providers ◽  
Care Delivery ◽  
Population Based ◽  
Care Providers ◽  
Improve Population Health ◽  
Single Payer ◽  
The Cost

This article illustrates how administrative data can be used to improve population health in an environment of fiscal constraint. In our universal single-payer health system, health care providers submit standardized data. This allows provinces to create health information utilities that generate population-based data that can be used for research and health care delivery. Although more study is needed to determine the cost-effectiveness of using such data to raise the rates of primary and secondary prevention, it appears that appropriately designed information systems could improve population health with relatively little additional cost.

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