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A valuable guide to starting and running a successful accountable care organization. Health care in America is undergoing great change. Soon, accountable care organizations—health care organizations that tie provider reimbursements to quality metrics and reductions in the cost of care—will be ubiquitous. But how do you set up an ACO? How does an ACO function? And what are the keys to creating a profitable ACO? Pathways to a Successful Accountable Care Organization will help guide you through the complicated process of establishing and running an ACO. Peter A. Gross, MD, who has firsthand experience as the chairman of a successful ACO, breaks down how he did it and describes the pitfalls he discovered along the way. In-depth essays by a group of expert authors touch on • the essential ingredients of a successful ACO • monitoring and submitting Group Practice Reporting Option quality measures • mastering your patients' responses to the Consumer Assessment of Health Plans Survey • how bundled payments and CPC+ can meld with your ACO • how MACRA and MIPS affect your ACO • the role of an ACO/CIN • the complexities of post-acute care • data analytics • engaging and integrating physician practices Dr. Gross and his colleagues are in a perfect position to guide other health care leaders through the ACO process while also providing excellent case studies for policy professionals who are interested in how their work influences health care delivery. Readers will come away with the necessary knowledge to thrive and be rewarded with cost savings. Contributors: Joshua Bennett, Allison Brennan, Glen Champlin, Kris Corwin, Guy D'Andrea, Joseph F. Damore, Mitchel Easton, Andy Edeburn, Seth Edwards, Jennifer Gasperini, Kris Gates, Shawn Griffin, Peter A. Gross, Brent Hardaway, Mark Hiller, Beth Ireton, Thomas Kloos, Jeremy Mathis, Miriam McKisic, Morey Menacker, Denise Patriaco, Elyse Pegler, John Pitsikoulis, Michael Schweitzer, Bryan F. Smith
A valuable guide to starting and running a successful accountable care organization. Health care in America is undergoing great change. Soon, accountable care organizations—health care organizations that tie provider reimbursements to quality metrics and reductions in the cost of care—will be ubiquitous. But how do you set up an ACO? How does an ACO function? And what are the keys to creating a profitable ACO? Pathways to a Successful Accountable Care Organization will help guide you through the complicated process of establishing and running an ACO. Peter A. Gross, MD, who has firsthand experience as the chairman of a successful ACO, breaks down how he did it and describes the pitfalls he discovered along the way. In-depth essays by a group of expert authors touch on • the essential ingredients of a successful ACO • monitoring and submitting Group Practice Reporting Option quality measures • mastering your patients' responses to the Consumer Assessment of Health Plans Survey • how bundled payments and CPC+ can meld with your ACO • how MACRA and MIPS affect your ACO • the role of an ACO/CIN • the complexities of post-acute care • data analytics • engaging and integrating physician practices Dr. Gross and his colleagues are in a perfect position to guide other health care leaders through the ACO process while also providing excellent case studies for policy professionals who are interested in how their work influences health care delivery. Readers will come away with the necessary knowledge to thrive and be rewarded with cost savings. Contributors: Joshua Bennett, Allison Brennan, Glen Champlin, Kris Corwin, Guy D'Andrea, Joseph F. Damore, Mitchel Easton, Andy Edeburn, Seth Edwards, Jennifer Gasperini, Kris Gates, Shawn Griffin, Peter A. Gross, Brent Hardaway, Mark Hiller, Beth Ireton, Thomas Kloos, Jeremy Mathis, Miriam McKisic, Morey Menacker, Denise Patriaco, Elyse Pegler, John Pitsikoulis, Michael Schweitzer, Bryan F. Smith
This book provides an overview of key issues with regards to implementing telemedicine services as well as an in depth overview of telemedicine in pulmonary, critical care, and sleep medicine. Topics range from specific practices to program development. Telemedicine has experienced explosive growth in recent years and yet, implementing telemedicine solutions is complex with substantial regulatory, legal, financial, logistical, and intra-organization/intra-personal barriers that must be overcome. This book provides the necessary information and guidance to address those complex issues. This book is broadly divided into two parts 1) a primer on requisite steps before embarking on telemedicine service development and 2) specific applications and examples where telemedicine is successfully utilized to improve quality of care in pulmonary, critical care, and sleep medicine. The first part includes coverage of telemedicine and finance, regulatory and legal issues, and program development. The second part delves into specifics with information on ambulatory telemedicine programs, inpatient consultations, and tele-ICU programs. All chapters are written by interprofessional authors that are leaders in the field of telemedicine with extensive knowledge of diverse telemedicine programs and robust real-world experience on the topic. This is an ideal guide for telehealth program managers, and pulmonary, critical care, and sleep medicine professionals interested in improving their telehealth practice.
In the United States, some populations suffer from far greater disparities in health than others. Those disparities are caused not only by fundamental differences in health status across segments of the population, but also because of inequities in factors that impact health status, so-called determinants of health. Only part of an individual's health status depends on his or her behavior and choice; community-wide problems like poverty, unemployment, poor education, inadequate housing, poor public transportation, interpersonal violence, and decaying neighborhoods also contribute to health inequities, as well as the historic and ongoing interplay of structures, policies, and norms that shape lives. When these factors are not optimal in a community, it does not mean they are intractable: such inequities can be mitigated by social policies that can shape health in powerful ways. Communities in Action: Pathways to Health Equity seeks to delineate the causes of and the solutions to health inequities in the United States. This report focuses on what communities can do to promote health equity, what actions are needed by the many and varied stakeholders that are part of communities or support them, as well as the root causes and structural barriers that need to be overcome.
Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation's Health was released in September 2019, before the World Health Organization declared COVID-19 a global pandemic in March 2020. Improving social conditions remains critical to improving health outcomes, and integrating social care into health care delivery is more relevant than ever in the context of the pandemic and increased strains placed on the U.S. health care system. The report and its related products ultimately aim to help improve health and health equity, during COVID-19 and beyond. The consistent and compelling evidence on how social determinants shape health has led to a growing recognition throughout the health care sector that improving health and health equity is likely to depend â€" at least in part â€" on mitigating adverse social determinants. This recognition has been bolstered by a shift in the health care sector towards value-based payment, which incentivizes improved health outcomes for persons and populations rather than service delivery alone. The combined result of these changes has been a growing emphasis on health care systems addressing patients' social risk factors and social needs with the aim of improving health outcomes. This may involve health care systems linking individual patients with government and community social services, but important questions need to be answered about when and how health care systems should integrate social care into their practices and what kinds of infrastructure are required to facilitate such activities. Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation's Health examines the potential for integrating services addressing social needs and the social determinants of health into the delivery of health care to achieve better health outcomes. This report assesses approaches to social care integration currently being taken by health care providers and systems, and new or emerging approaches and opportunities; current roles in such integration by different disciplines and organizations, and new or emerging roles and types of providers; and current and emerging efforts to design health care systems to improve the nation's health and reduce health inequities.
To provide effective service in helping people understand how they are going to be affected by health care reform and how to obtain coverage, pursue an appeal, or plan for long-term care or retirement, you need the most current information from a source you can trust - Medicare Handbook. This is the indispensable resource for clarifying Medicare's confusing rules and regulations. Prepared by an outstanding team of experts from the Center for Medicare Advocacy, it addresses issues you need to master to provide effective planning advice or advocacy services, including: Medicare eligibility rules and enrollment requirements; Medicare covered services, deductibles, and co-payments; coinsurance, premiums, penalties; coverage criteria for each of the programs; problem areas of concern for the advocate; grievance and appeals procedures. The 2020 Edition of Medicare Handbook offers expert guidance on: Medicare Enrollment and Eligibility Medicare Coverage in all Care-Settings Medicare Coverage for People with Chronic Conditions Medicare Home Health Coverage and Access to Care Prescription Drug Coverage Medicare Advantage Plans Medicare Appeals Health Care Reform And more! In addition, Medicare Handbook will help resolve the kinds of questions that arise on a regular basis, such as: How do I appeal a denial of services? What steps do I need to take in order to receive Medicare covered home health care? What are the elements of Medicare's appeal process for the denial of coverage of an item, service, or procedure? Does my state have to help me enroll in Medicare so that I can get assistance through a Medicare Savings Program? When should I sign up for a Medigap plan? If I am enrolled in Medicare, do I have to buy health insurance in the insurance marketplace created by the Affordable Care Act? Is it true that I have to show medical improvement in order to get Medicare for my nursing and therapy services? And more! The 2020 Medicare Handbook is the indispensable resource that provides: Extensive discussion and examples of how Medicare rules apply in the real world Case citations, checklists, worksheets, and other practice tools to help in obtaining coverage for clients, while minimizing research and drafting time Practice pointers and cautionary notes regarding coverage and eligibility questions when advocacy problems arise, and those areas in which coverage has often been reduced or denied And more! Previous Edition: Medicare Handbook, 2019 Edition ISBN 9781543800456
This book provides a comprehensive and systematic state-of-the science review of major primary care delivery models, how they address specific needs of older adults, and available evidence for their efficacy. Written by experts in the field, this book explores the patient-centered medical home model (PCMH) in depth and dives into the complexities of the “medical neighborhood”. It describes and analyzes primary care specifically directed toward special, complex populations, such as the Health Home for safety net patients with mental health needs, and intensive primary care for older adults. It reviews an array of primary care models related to dual eligible patients including the GRACE primary care consultation model and PACE models. It describes primary care with Advanced Practice Nurses and Physician Assistants and explores in-depth the massive effort within the VA to develop the Patient Activated Care Team (PACT), a VA form of the PCMH that also has several offshoots that address complex older veterans and veterans with severe mental illness. Finally, it illuminates rarely discussed primary care that occurs within the home and within long-term care. Throughout the entire book, experts navigate the workforce, care quality, and financing challenges of primary care for older adults. Primary Care for Older Adults is a valuable resource for clinicians, researchers, patients, caregivers and their advocates, and policy makers who have an interest in designing, promoting, and implementing high quality primary care for older adults.
The anthrax incidents following the 9/11 terrorist attacks put the spotlight on the nation's public health agencies, placing it under an unprecedented scrutiny that added new dimensions to the complex issues considered in this report. The Future of the Public's Health in the 21st Century reaffirms the vision of Healthy People 2010, and outlines a systems approach to assuring the nation's health in practice, research, and policy. This approach focuses on joining the unique resources and perspectives of diverse sectors and entities and challenges these groups to work in a concerted, strategic way to promote and protect the public's health. Focusing on diverse partnerships as the framework for public health, the book discusses: The need for a shift from an individual to a population-based approach in practice, research, policy, and community engagement. The status of the governmental public health infrastructure and what needs to be improved, including its interface with the health care delivery system. The roles nongovernment actors, such as academia, business, local communities and the media can play in creating a healthy nation. Providing an accessible analysis, this book will be important to public health policy-makers and practitioners, business and community leaders, health advocates, educators and journalists.
This volume, developed by the Observatory together with OECD, provides an overall conceptual framework for understanding and applying strategies aimed at improving quality of care. Crucially, it summarizes available evidence on different quality strategies and provides recommendations for their implementation. This book is intended to help policy-makers to understand concepts of quality and to support them to evaluate single strategies and combinations of strategies.
Advanced Practice Nursing: Essential Knowledge for the Profession, Fifth Edition is a core advanced practice text used in both Master's Level and DNP programs. This bestselling textbook is framed around the AACN's Master's Essentials as well as the Essentials for Doctoral Education featuring the most up-to-date content on each set of Essentials. Throughout the Fifth Edition the authors address the rapid changes in the health care environment with a special focus on health care finance, electronic health records, quality and safety as well as emerging roles for the advanced practice nurse. Patient care in the context of the advanced nursing role is also discussed.