...HEALTHCARE DATA SETS HS420: Advanced Health Informatics 11/25/2014 HEDIS According to NCQA (2014), HEDIS is a tool used by more than 90% of America’s health plans to measure performance on important dimensions of care and service. HEDIS consists of 81 measures across 5 domains of care, there are so many plans that use HEDIS and the measures are so specifically defined it can be used to make comparisons among plans. To ensure that HEDIS stays current the National Committee of Quality Assurance (NCQA) has established a process to evolve the measurement set for each year through its committee on performance measurement. The National Committee of Quality Assurance...
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...Bodies……………………………………………………………………………...4 Literature review………………….…………………………………………………………….....4 Challenges that are experienced in achieving and maintaining accreditation…………………..…5 The role of the URAC as an Accreditation Body………………………………………………....5 How the URAC accredits healthcare institutions….........................................................................6 Quality assessment and control solutions in accreditation ……………………………………......8 Implementation of quality improvement and accreditation solutions…………………………......9 Justification…………………………………….…………………………………………………10 Summary and conclusion……………………….…...……………………………………………10 References ………………………………………………………………………………………..11 Achieving and Maintaining Accreditation in Managed Care Managed healthcare organizations and professionals encounter numerous challenges on a yearly basis in the course of offering services, whereas the state, stakeholders, and clients (patients) expect to be reassured that bodies that render managed healthcare services are well equipped to meet their demands. Accreditation is, therefore, a detailed evaluation process through which an independent professional body or authority assesses another organization’s systems, structures, and procedures to certify that it satisfies the set industry criteria and standards (Bialek, Duffy & Moran, 2009). The evaluation and accreditation processes that are conducted by bodies such as URAC help in maintaining the quality of care in organizations...
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...“Dimensions of Quality” Describe seven key “Pillars of Quality” Quality Institute of Medicine: “Quality of Care” is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge. Institute for Healthcare Improvement (IHI): Quality is turning into outcomes management, and involves minimizing unnecessary variation so that outcomes become more predictable and certain. 3 Quality Basic Principles: All work is a process The process is the main source of quality defects (versus human error) Understanding variability in processes is the key to improving quality Quality Improvement A planned, systematic approach to monitoring, analysis and improvement of performance to achieve optimal patient outcomes and patient experience. 4 Quality Improvement 1. Change for Best 1. Change for Best Achievement Achievement 2. Establish Reliability 2. Establish Reliability Differentiating innovation and quality: Innovative improvements are essentially disruptive events...
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...Abstract Accountable Care Organization is a healthcare organization characterized by a payment and care delivery mode. lt seeks to tie provider reimbursements to a quality metrics and reductions in the total cost of care for an assigned population of patients. A group of coordinated health care providers form an ACO, which then provides care to a group of patients. The ACO may use a range of payment methods, (e.g. capitation, fee-or-service with an asymmetric or symmetric shared savings). The ACO is accountable to the patients and the 3rd party payer for quality, appropriateness, and efficiency of the health care provided. The Centers for Medicare and Medicaid Services (CMS), an ACO is considered an organization of health care providers that agree to be accountable for the quality, cost, and overall care of Medicare beneficiaries who are enrolled in the traditional fee-for-service program. This paper identifies the differences between HMO’s and ACO’s but also correlates the similarities between ACO’s and Patient Center Medical Home (PCMH). The ACO’s place a degree of financial responsibility on the providers in hopes of improving care management and limiting unnecessary expenditures while continuing to provide patients freedom to select their medical services. The success and challenges of ACO are identified and explored. By increasing care coordination, ACO’s can help reduce unnecessary medical care and improve health outcomes, leading to a decrease in utilization...
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...Marketing Plan: MHS 1 Medical Home Service Keller School Of Management –Online MM522 Ben Parker Instructor Rodney Cullifer January 2011 Final Draft Marketing Plan: MHS 2 Executive Summary My plan includes a service and not necessarily a new product. The service is a complete healthcare service that is mobile and is dedicated to the treatment of diabetes in central and southeastern Ohio. Some of the services are provided by other pharmaceutical companies and some of the service is provided by current healthcare providers, but this service is educationally based and provides care to all diabetic patients. All patients will be accepted by the Mobile Healthcare Service (MHS). Private insurances will be accepted, managed care, and cash payers. But they must be referred to MHS by their primary care doctor or by the specialist such as an endocrinologist. First, I need to discuss how the service is set up and what the team will look like. The team will consist of a Nurse Practitioner, Doctor, Certified Diabetes Educator/Dietician, and Medical Assistant. This team will not be sponsored or run by the pharmaceutical companies and it will not be run by government money or grants. This service will be considered as a third party company providing additional...
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...more active partners in maintain or improving their health. - Health care practitioners: uses it as a primary means of communications among themselves. - Health Care providers and Administrators: uses the data to evaluate care, monitor the use of resources, and receive payment for services rendered. Administrators analyze financial and patient case mix information for business planning and marketing activities - Third party payers: the data become the basis for determining the appropriate payment to be made. - Utilization and case managers: uses it to coordinate care so that the patient is cared for in the most clinically cost-effective manner. - Quality of care committees: use the information as a basis for analysis, study, and evaluation of the quality of care given to the patient. - Accrediting, licensing, and certifying agencies: use the record to provide public assurance that quality health care is being provided. - Governmental agencies and public health: to determine the appropriate use of the governmental financial resources for health care facilities and educational and correctional institutions - Health information exchanges: provides patient centered care that improves quality, safety, efficiency, timeliness and accessibility - Employer: used to access job related conditions and injuries and to determine occupational hazards that may impede effective performance in the work place. - Attorney and Courts: use...
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...Running head: Post-9/11 Veterans with PTSD: A battle with smoking Proposal Paper for Post-9/11 Veterans with PTSD: A battle with smoking Morgan Mathews and Brenda Pizana The University of Texas at Arlington College of Nursing In partial fulfillment of the requirements of N5366 Principles of Research in Nursing Dr. Michelle Hampton, PhD, RN-CCRN, Clinical Faculty July 31, 2015 Pinch table Author/yr Design Sample Size Interventions Outcomes Notes Use of Learning Collaborative to Support Implementation of Integrated Care for Veterans with Posttraumatic Stress Disorder Use of Learning Collaborative to Support Implementation of Integrated Care for Veterans with Posttraumatic Stress Disorder 2014 Longitudinal, Time series Quasi- experimental study. Methodological Research Collaborative change framework using the learning collaborative model 70 staff members from 12 VA PTSD Clinics After training and development of a expert panel team, questionnaires evaluated how feasible and effective integrative care for smoking cessation using the Learning Collaborative Model. The LC model would be useful to implement integrated care to patients without interfering with treatment. The staff found it useful but difficult to communicate and meet with teams to train Unique challenges: different clinics...
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...Completion of Chapter 1 Proctor and Gamble – Focus on repeat customers * Practical satisfaction of meeting customer requirements. * Review of modern quality – Skilled craftsman on 1 to 1 basis. Blacksmith.. one on one negotiation face to face relations with customers. * Industrial Revolution – Henry Ford – Mass production. Quality once a post production review. Reactive approach. * Bell System Statistical – Shurart. * WWII Post War l 40’sand 50’s- Beming and Juran concepts fell on deaf ears. This message brought to Japan where concepts were embraced. Outperforming US counterparts. * Fast forward to 1980s… Crisis around globe. Total Quality was reactive approach to crisis. Total quality Shift in vision from reactive little q (reactive post production inspection ) to big Q. – Total Quality approach with no external department but integrated with all responsible for their own quality. Late 80’s-`987 Malcolm Baldrige Award. TQM wasn’t an integrated function at that point. Emergence of quality management - in service industries, government, health care and education. Evolution of quality to the broader concept of performance excellence Growth and adoption of Six Sigma Current and future challenge: continue to apply the principles of quality and performance excellence. Quality is a “race without a finish line”. It is ongoing and continuous. Contemporary Influences on Quality. Globalization Social Responsibility New Dimensions...
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...Introduction In Health care, quality and utilization management have been forced into the spotlight by an insatiable demand for technologically advancing services, a legal system that compels physician to order unnecessary services, and the costs that are soaring higher than ever. The inconsistent use, overuse, misuse or even under used healthcare services has created inefficiencies and value concerns that demand oversight to ensure the best care is received while utilizing resources in the most efficient manner. "The knowledgeable health reporter for the Boston Globe, Betsy Lehman, died from an overdose during chemotherapy. Willie King had the wrong leg amputated. Ben Kolb was eight years old when he died during "minor" surgery due to a drug mix-up."[i] The Institute of Medicine Committee on Quality of Health Care in America identified strategies for quality improvement through two historic reports: To Err Is Human: Building a Safer Health System and Crossing the Quality Chasm: A New Health System for the 21st Century[ii]. The IOM published the "To Err is Human" study which showed that these horrible examples (commonly referred to as "Never Events") were only the tip of the iceberg. The study found that adverse events occurred in 2.9 to 3.7 percent of every hospitalization and that over half of all adverse events had resulted from medical errors that could have been prevented. To apply these numbers across American's nearly 34 million hospital admissions in 1997...
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...5/4/09 10:39 AM Page 17 C HAPTER 59643_CH02_5289.qxd 2 Understanding Healthcare Management The prior chapter addressed growth in the health services industry and opportunities for healthcare managers. By now the reader should appreciate that formal preparation in healthcare management can pay big dividends in terms of exciting management jobs and positions with excellent career advancement. But just what do healthcare managers do? And what are their roles and responsibilities? Healthcare management is the profession that provides leadership and direction to organizations that deliver personal health services, and to divisions, departments, units, or services within those organizations. This chapter gives a comprehensive overview of healthcare management as a profession. Understanding the roles, responsibilities, and functions carried out by healthcare managers is important for those individuals considering the field to make informed decisions about the “fit.” This chapter provides a discussion of key management roles, responsibilities, and functions, as well as management positions at different levels within healthcare organizations. In addition, descriptions of supervisory level, mid-level, and senior management positions within different organizations are provided. 17 © Jones and Bartlett Publishers, LLC. NOT FOR SALE OR DISTRIBUTION. 59643_CH02_5289.qxd 18 5/4/09 C HAPTER 2 10:39 AM Page 18 U NDERSTANDING H EALTHCARE M ANAGEMENT THE NEED FOR MANAGEMENT AND...
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...CULTURAL COMPETENCE IN HEALTH CARE: EMERGING FRAMEWORKS AND PRACTICAL APPROACHES Joseph R. Betancourt Massachusetts General Hospital–Harvard Medical School Alexander R. Green and J. Emilio Carrillo New York-Presbyterian Hospital–Weill Medical College of Cornell University FIELD REPORT October 2002 Support for this research was provided by The Commonwealth Fund. The views presented here are those of the authors and should not be attributed to The Commonwealth Fund or its directors, officers, or staff. Copies of this report are available from The Commonwealth Fund by calling our toll-free publications line at 1-888-777-2744 and ordering publication number 576. The report can also be found on the Fund’s website at www.cmwf.org. CONTENTS About the Authors.......................................................................................................... iv Acknowledgments .......................................................................................................... iv Executive Summary......................................................................................................... v Introduction .................................................................................................................... 1 Findings........................................................................................................................... 3 Defining Cultural Competence ..............................................................................
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...http://www.nap.edu/catalog/9728.html We ship printed books within 1 business day; personal PDFs are available immediately. To Err Is Human: Building a Safer Health System Linda T. Kohn, Janet M. Corrigan, and Molla S. Donaldson, Editors; Committee on Quality of Health Care in America, Institute of Medicine ISBN: 0-309-51563-7, 312 pages, 6 x 9, (2000) This PDF is available from the National Academies Press at: http://www.nap.edu/catalog/9728.html Visit the National Academies Press online, the authoritative source for all books from the National Academy of Sciences, the National Academy of Engineering, the Institute of Medicine, and the National Research Council: • Download hundreds of free books in PDF • Read thousands of books online for free • Explore our innovative research tools – try the “Research Dashboard” now! • Sign up to be notified when new books are published • Purchase printed books and selected PDF files Thank you for downloading this PDF. If you have comments, questions or just want more information about the books published by the National Academies Press, you may contact our customer service department tollfree at 888-624-8373, visit us online, or send an email to feedback@nap.edu. This book plus thousands more are available at http://www.nap.edu. Copyright © National Academy of Sciences. All rights reserved. Unless otherwise indicated, all materials in this PDF File are copyrighted by the National Academy of Sciences. Distribution, posting, or copying...
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...San Francisco, California 94111 CONTRIBUTORS John Haughton, MD, MS Founder, DocSite LLC 540 Main Street Winchester, Massachusetts 01890 Peter Mongroo Director, Healthcare Industries Markets Oracle Corporation 500 Oracle Parkway Redwood Shores, California 94065 A Research Report sponsored by ViPSSM, Inc. in partnership with Med-Vantage® 2003 Table of Contents Introduction.......................................................................................................................2 Goals and Motivations behind Pay for Performance..................................................................4 Market Adoption .................................................................................................................5 Funding and Incentives .......................................................................................................7 Measuring Performance: Physicians and Hospitals..................................................................10 P4P Operations and Business Processes for Health Plans.........................................................12 Key Lessons Learned and Critical Success Factors ..................................................................14 Conclusion........................................................................................................................16 Selected Bibliography ........................................................................................................17 1 Pay...
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...STATE UNIVERSITY OF NEW YORK AT ALBANY Emanuel Medical Center Situational & Decision Analysis James T. Onisk 4/29/2012 Table of Contents Situational Analysis Appendices External Analysis Appendix A: S.W.O.T. Analysis Appendix B: External Trend/Issue Analysis Appendix C: Environmental Trends/Issues Plot Appendix D: Stakeholder Map Appendix E: Service Area Profile Appendix F: Service Area Structural Analysis Appendix G: Service Area Competitor Analysis Appendix H: Critical Success Factor Analysis Appendix I: Mapping Competitors Appendix J: Synthesizing the Analysis Internal Analysis Appendix K: Financial Analysis Appendix L: Value Chain Strengths and Weaknesses Appendix M: Value Chain Competitive Advantages Relative to Strengths Appendix N: Value Chain Competitive Disadvantages Relative to Weaknesses Appendix O: Strategic Implications of Strengths and Weaknesses References Decision Analysis Decision Analysis Appendices Appendix P: Directional Strategies Appendix Q: Adaptive Strategies Appendix R: Market Entry Strategies Appendix S: Strategic Positioning Appendix T: Value-Chain Funcations References 1 2-11 12-13 14-17 18-29 30-36 37-50 51-60 61-66 67 I-VII 68-74 75-81 82-86 87-91 92-95 96-105 VIII-XV 106-109 110-122 123-125 126-128 129-135 136 Issue Statement Emanuel Medical Center (EMC) is encountering tremendous financial troubles as it struggles to remain open as an independent general acute care hospital. Changes in federal regulations such as the implementation...
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...Strategic Planning 6 Category 3: Customer Focus 10 Category 4: Measurement, Analysis, and Knowledge Management 14 Category 5: Workforce Focus 18 Category 6: Process Management 23 Category 7: Results 7.1: Best Quality (Healthcare Outcomes) 27 7.2: Best Customer Service (Customer Focused Outcomes) 32 7.3: Best Financial Performance & Growth (Financial & Market Outcomes) 35 7.4: Best People and Workplace (Workforce Focused Outcomes) 38 7.5: Best 5 Bs (Process Effectiveness Outcomes) 41 7.6: Best 5 Bs (Leadership Outcomes) 45 GLOSSARY OF TERMS AND ABBREVIATIONS APP: Annual Planning Process 5Bs: AtlantiCare’s five “Bests” or performance excellence commitments – Best People and Workplace, Best Quality, Best Customer Service, Best Financial Performance, Best Growth ARMC : AtlantiCare Regional Medical Center ASC: Ambulatory Surgery Center ASPP: Annual Strategic Planning Process A AAAHC: Accreditation Association for Ambulatory Health Care AAI: AtlantiCare Administrators Incorporated AAP: Annual Action Plan B BFP: Best Financial Performance Big Dots: The system-level measurements or targets for each of the 5 Bs (performance excellence commitments). Business units (and their departments) have measurable action plans and goals that align with/support the Big Dots. ABCs: AtlantiCare’s Best Customer Service Standards– AtlantiCare’s customer service training program. BMI: Body Mass Index ABH:...
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