Managed Care Essays (Examples)
Study Document
US Healthcare Reimbursement And Insurance Issues
care Insurance and Reimbursement
Medical Insurance Products and Services
Health and medical insurance represent an insurance coverage form that disburses operation and clinical treatment … insured. Such insurance may either reimburse insured individuals for the money they put into treatment for injuries or disease or may directly pay care practitioners. It is commonly a part of the compensation packages offered by organizations to their employees for attracting quality recruits (IMedPub, 2020). It … organizations to their employees for attracting quality recruits (IMedPub, 2020). It constitutes one means by which individuals in different nations pay for their care needs. When individuals hailing from poor backgrounds without any financial risk protection get sick or injured, they encounter the following difficulty: they may … from poor backgrounds without any financial risk protection get sick or injured, they encounter the following difficulty: they may either make use of care services, further impoverishing themselves by……
References
References
Araujo, M. (2020). Health and medical insurance differences: HMO, PPO, POS, EPO. Retrieved from https://www.thebalance.com/health-and-medical-insurance-2645378
Bertram, M. Y., Lauer, J. A., De Joncheere, K. D., Edejer, T., Hutubessy, R., Kieny, M. P., & Hill, S. R. (2016). Cost-effectiveness thresholds: pros and cons. Bull World Health Organ, 94, 925–930. http://dx.doi.org/10.2471/BLT.15.164418926
Dey, P., & Bach, P. B. (2019). The 6 functions of health insurance. The JAMA Forum, 321(13), 1242-1243. DOI:10.1001/jama.2019.2320
Ho, A. (2015). Health insurance. Encyclopedia of Global Bioethics. Retrieved from https://www.researchgate.net/publication/298022702_Health_Insurance
IMedPub. (2020). Health insurance. Retrieved from https://www.imedpub.com/scholarly/health-insurance-journals-articles-ppts-list.php
Maruthappu, M., Hasan, A., & Zeltner, T. (2016). Enablers and barriers in implementing integrated care. Health System & Reform, 1(4), 250-256. https://doi.org/10.1080/23288604.2015.1077301
Sekhri, N. (2000). Managed care: The US experience. Bulletin of the World Health Organization, 78(6), 830-844. Retrieved from https://www.who.int/bulletin/archives/78(6)830.pdf
Strata Decision Technology. (2020). Healthcare and hospital capital budget. Retrieved from https://www.stratadecision.com/healthcare-and-hospital-capital-budget/
Study Document
Care Plan
Case Study and care Plan: High-risk Obstetrics for Women in Rural America.
Introduction
High-risk pregnancies are a risk to the health of both the mother and her … to high-risk pregnant women living in rural America. This paper, therefore, explores the case of high-risk pregnancies in rural America and proposes a care plan that is driven by telehealth solutions.
The case for high-risk pregnancies in rural America
According to the National Institutes of Health, high-risk … driven by telehealth solutions.
The case for high-risk pregnancies in rural America
According to the National Institutes of Health, high-risk pregnancies should receive care from a special team of health care providers so as to ensure that the best possible health outcome is ensured for both the mother and the infant (National Institutes of … shortage of about 22,000 by 2050 (American College of Obstetricians and Gynecologists, 2015).
Despite the decline in the professional……
References
References
American College of Obstetricians and Gynecologists. (2015). ACOG Practice Bulletin No. 156: Obesity in pregnancy. Obstetrics and Gynecology, 126(6), e112–126.
Gallardo, A. & Martin, N. (2017, Sept. 5). Another Thing Disappearing From Rural America: Maternal Care. ProPublica. Retrieved from https://www.propublica.org/article/another-thing-disappearing-from-rural-america-maternal-care
Healy, J. (2018, July 17). It’s 4 A.M. The Baby’s Coming. But the Hospital Is 100 Miles Away. The New York Times. Retrieved from https://www.nytimes.com/2018/07/17/us/hospital-closing-missouri-pregnant.html
Hung, P., Henning-Smith, C. E., Casey, M. M., & Kozhimannil, K. B. (2017). Access to obstetric services in rural counties still declining, with 9 percent losing services, 2004–14. Health Affairs, 36(9), 1663-1671.
Lowery, C. (2018). “Chapter 6: High-Risk Obstetrics and Telehealth,” in Rheuban, K.S. & Krupinski, E.A., Understanding Telehealth. McGraw-Hill Education.
National Institutes of Health, (2017). What is a high-risk pregnancy? Retrieved from https://www.nichd.nih.gov/health/topics/pregnancy/conditioninfo/high-risk
Study Document
Design And Implementation Of Collaborative Care Model
… a low-income area and individuals who live here struggle to make ends meet. This makes it hard for them to access premium health care that is offered at private hospitals. Therefore, most of them have to rely on the community health center. Poor people have been associated … area is not conducive for physical activity. This makes people have sedentary lifestyles that contribute towards them developing chronic diseases. Access to health care is reduced and the few who are able to access the community health center have to contend with receiving substandard service. While the … the services being offered to seem lackluster. With increasing numbers of obese community members, it is vital that the community get appropriate health care and health care professionals should be able to address the increasing obesity rates within the community. A majority of the community members do not have medical … People living……
References
References
LaBelle, C. T., Han, S. C., Bergeron, A., & Samet, J. H. (2016). Office-based opioid treatment with buprenorphine (OBOT-B): statewide implementation of the Massachusetts collaborative care model in community health centers. Journal of substance abuse treatment, 60, 6-13.
Overbeck, G., Kousgaard, M. B., & Davidsen, A. S. (2018). The work and challenges of care managers in the implementation of collaborative care: A qualitative study. Journal of psychiatric and mental health nursing, 25(3), 167-175.
Sanchez, K. (2017). Collaborative care in real-world settings: barriers and opportunities for sustainability. Patient preference and adherence, 11, 71.
Smith, S. N., Almirall, D., Prenovost, K., Liebrecht, C., Kyle, J., Eisenberg, D., . . . Kilbourne, A. M. (2019). Change in Patient Outcomes After Augmenting a Low-level Implementation Strategy in Community Practices That are Slow to Adopt a Collaborative Chronic Care Model: A Cluster Randomized Implementation Trial. Medical Care.
Unützer, J., Harbin, H., Schoenbaum, M., & Druss, B. (2013). The collaborative care model: An approach for integrating physical and mental health care in Medicaid health homes. HEALTH HOME, Information Resource Center, 1-13.
Study Document
Telemedicine And Its Impact On Patient Care
Telemedicine: How does it impact patient care?
Introduction
The modern health care system is better and considerably more complex than what the situation previously was a decade and several decades ago. According to various researchers, … and considerably more complex than what the situation previously was a decade and several decades ago. According to various researchers, the modern health care system is a managed one, and it widely uses technology in contrast to previous health care systems (Conklin, 2002). The many uses of technology in the modern health care system include the use of technology for diagnosis, for minimally invasive treatments, and better monitoring of vital signs and other signs. Moreover, technology … Moreover, technology is now also being used to consult with medical experts from all over the world remotely. This has led to improved care and has enhanced patent experience.
Furthermore, many mobile applications have been invented to……
References
References
Meyers, A. J., Pontarelli, E., Dutta, S. K., Grinberg, G., & Yenumula, P. R. (2018). Telemedicine Follow-up After Bariatric Surgery. Surgery for Obesity and Related Diseases, 14(11), S168.
Tiago, M. T. B., Tiago, F., Amaral, F. E. B., & Silva, S. (2016). Healthy 3.0: Healthcare digital dimensions. In Reshaping medical practice and care with health information systems (pp. 287-322). IGI Global.
Conklin, T. P. (2002). Health care in the United States: An evolving system. Michigan Family Review, 7(1).
Board on Health Care Services; Institute of Medicine. (2012). \\\\\\\\\\\\"3The Evolution of Telehealth: Where Have We Been and Where Are We Going?\\\\\\\\\\\\" in The Role of Telehealth in an Evolving Health Care Environment: Workshop Summary. National Academies Press, Washington (DC).
Sada, A., Asaad, M., Reidt, W. S., Kellogg, T. A., Kendrick, M. L., McKenzie, T. J., & Habermann, E. B. (2019). Are In-Person Post-operative Clinic Visits Necessary to Detect Complications Among Bariatric Surgery Patients?. Obesity Surgery, 1-4.
Krupka, D. C., Sandberg, W. S., & Weeks, W. B. (2012). The impact on hospitals of reducing surgical complications suggests many will need shared savings programs with payers. Health Affairs, 31(11), 2571-2578.
Fasano, P. (2013). Transforming health care: The financial impact of technology, electronic tools, and data mining. John Wiley & Sons.
Burch, S., Gray, D., & Sharp, J. (2017). The power and potential of telehealth what health systems should know: proposed legislation in Congress offers the promise that the nation\\\\\\\\\\\\'s healthcare policy will support the expansion of telehealth, allowing hospitals and health systems to fully realize the benefits of this important emerging approach to care. Healthcare Financial Management, 71(2), 46-50.
Study Document
Evolving Practice Of Nursing And Patient Care Delivery Models
… full extent and scope of their education and training (IOM, 2010). In doing so, the belief was that this would increase access to care and provide nurses with the opportunity to practice as they were trained. O’Brien (2003) notes, after all, that the whole reason APRNs began … reason APRNs began being trained in the latter half of the 20th century was to fill the gap being left behind by primary care physicians as they left their primary care practice to go work for specialized medicine. Today, however, nurses are still bound by regulations that require them in many states to work … this indeed comes about in Oklahoma and in other states across the country, the practice of nursing will grow and change. Continuity of care, accountable care organizations (ACOs), medical homes and nurse-managed health clinics—all of these will be impacted.
By growing the field of nursing, continuity……
References
References
American Nurses Association. (2010). New care delivery models in health system reform: Opportunities for nurses and their patients. Kansas City, MO: Author.
IOM. (2010). The future of nursing. Retrieved from http://nacns.org/wp-content/uploads/2016/11/5-IOM-Report.pdf
Korda, H., & Eldridge, G. N. (2011). ACOs, PCMHs, and health care reform: nursing’s next frontier?. Policy, Politics, & Nursing Practice, 12(2), 100-103.
O’Brien, J. (2003). How nurse practitioners obtained provider status: Lessons for pharmacists. American Journal of Health-System Pharmacy, 60(22), 2301-2307.
Study Document
Change Management In Health Care
Personal Changes
A major change among RNs that challenged them and was difficult for them to make focused on implementing a transcultural care model among the nurses that required the nurses to become more educated about different cultures and how to respond to patients of these … change agents are essential for employee engagement, discuss how different perspectives and agendas impact the change, and explain how change can best be managed.
Change Management is a process that proceeds in steps, which generally consist of preparation, management, and reinforcement (NHS, 2011). The first of these … sociological components: managers must be aware of the risk of resistance and of ways to mitigate that risk. If managers in a health care setting can incorporate the views of nurses and physicians into the change process they will benefit from involving stakeholders at the earliest stages ……
References
References
Doll, G. A., Cornelison, L. J., Rath, H., & Syme, M. L. (2017). Actualizing culture change: The Promoting Excellent Alternatives in Kansas Nursing Homes (PEAK 2.0) program. Psychological services, 14(3), 307.
Joshi.(2014). Change is Constant, but Improvement is Rapid. H and HN: Hospitals and Health Networks (2014).
Kodama, Y., & Fukahori, H. (2017). Nurse managers’ attributes to promote change in their wards: A qualitative study. Nursing open, 4(4), 209-217.
Kotter’s 8 Step Change Model. (2018). Retrieved from https://www.toolshero.com/change-management/8-step-change-model-kotter/
NHS. (2011). Overview – Change Management – the Systems and Tools for Managing Change. Retrieved from https://www.england.nhs.uk/improvement-hub/wp-content/uploads/sites/44/2017/11/Overview-Change-management.pdf
Tobias, R. M. (2015). Why do so many organizational change efforts fail?. Public Manager, 44(1), 35
Study Document
A Urate Lowering Intervention
...Managed care A Urate Lowering Intervention
Hypertension speaks to a noteworthy general medical issue. Around the world, roughly one-fourth of the grown-up populace has hypertension. Epidemiological and trial studies propose a linkage between Hyperuricemia and hypertension. Hyperuricemia influences 30?45 % of patients with untreated hypertension. A much lower commonness has been accounted for in normotensives or the overall public. “Be that as it may, in the case of bringing down serum uric Acid (SUA) may lower pulse or blood pressure is an unanswered inquiry.” (Hussar, 2010, p.70). High serum urate focus is a settled causative factor for the improvement of gouty joint inflammation. There is developing enthusiasm for a job for serum urate as a contributing component for the improvement or compounding of vascular, heart, and renal illness. The relationship between serum urate levels and Blood pressure (BP) has been depicted for a long time. Proof from creature studies gives solid help……
Study Document
Ethics And Health Information
… a language that can help minimize the risk of human error is preferable.
As for databases, the most common database used in health care is the relational database (Campbell, 2004). These are the most commonly used because they allow for the tracking of patient care, such as treatments, outcomes, heart rate, and so on. The relational database can connect to various other systems already in place—i.e., they are … kept safe and secure. As Health IT.gov (2018) notes, “the use of gamification by ONC is an innovative approach aimed at educating health care providers to make more informed decisions regarding privacy and security of health information.” Training does not always have to seem like a chore ……
References
References
Campbell, R. J. (2004). Database Design: What HIM Professionals Need to Know.
Perspectives in Health Information Management 2004, 1:6 (August 4, 2004). Retrieved from http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_024637.hcsp?dDocName=bok1_024637
Crossler, R. E., & Posey, C. (2017). Robbing Peter to Pay Paul: Surrendering Privacy for Security's Sake in an Identity Ecosystem. Journal of The Association for Information Systems, 18(7), 487-515.
Donovan, F. (2018). Judge Gives Final OK to $115M Anthem Data Breach Settlement. Retrieved from https://healthitsecurity.com/news/judge-gives-final-ok-to-115m-anthem-data-breach-settlement
HealthIT.gov. (2018). Health Information Privacy, Security, and Your EHR. Retrieved from https://www.healthit.gov/providers-professionals/ehr-privacy-security
The IMIA Code of Ethics for Health Information Professionals. (n.d.). Retrieved from http://www.imia medinfo.org/new2/pubdocs/Ethics_Eng.pdf
Jackson, R. (2018). Pulling strings. Retrieved from https://iaonline.theiia.org/2018/Pages/Pulling-Strings.aspx
Prince, B. (2013). Programming Languages Susceptible to Specific Security Flaws: Report. Eweek, 12. Retrieved from https://www.eweek.com/security/programming-languages-susceptible-to-specific-security-flaws-report
Study Document
Electronic Health Records EHR
… genuine practice. EHRs likewise may give access to apparatuses like clinical choice help updates and reports that guide clinicians and groups in conveying care dependent on the best accessible proof. The paper shares the EHR platform (EPIC), discusses the challenges and barriers to electronic charting giving reasons … the thing that individuals customarily consider as interoperability. At the point when a patient appears for consideration at a health framework utilizing Epic, ‘care Everywhere’ conveys solicitations to other health frameworks, gets the standardized summary(C-CDA) and fuses the new information inside the patient's record. Furthermore, ‘care Everywhere’ can get a computerized solicitation and send the synopsis to the requesting health framework. The association that is at presents observing the … the cloud. It's imperative to put resources into EHRs that help human services advancement and incorporation utilizing benchmarks based APIs that can bolster care health’s' work process needs and select use-cases.……
References
References
Gagnon, D., Simonyan, E.K., Ghandour, G., Godin, M., Labrecque, M., Ouimet, M.R. (2016). Factors influencing electronic health record adoption by physicians: A multilevel analysis, Int J Inform Manage, 36, pp. 258-270.
Hasanain, H. (2014). Cooper Solutions to overcome technical and social barriers to electronic health records implementation in Saudi public and private hospitals, J Health Inform Dev Ctries, pp. 46-63.
Kierkegaard, P. (2019). Electronic health record: Wiring Europe\\\\'s healthcare: Computer Law & Security Review. 27 (5): 503–515.
Murphys, E.V., & Yale, J. (2014). Clinical decision support: effectiveness in improving quality processes and clinical outcomes and factors that may influence success. Biol Med; 87, pp. 187–97.
Study Document
Mayo Clinic Governance And Structure
… college that is dedicated to training medical and allied health professionals.
Mayo Clinic specializes in treating difficult cases through destination medicine and tertiary care. With a focus on caring for patients who have serious, complex illnesses. The organization operates in five states. Annually, the organization care for more than one million patients from all the 50 states and outside the country (Swensen et al., 2016). The United States News … 1950 for their discovery of cortisone.
Mayo Clinic's mission is to inspire hope and contribute to health and well-being by providing the best care to every patient through integrated clinical practice, research, and education. The needs of the patient come first at Mayo Clinic. The majority of … Clinic serves as a referral facility for smaller clinics and other hospitals and this makes these two facilities as entities within the health care community (Peterson & Morris, 2019). Being a……
References
References
Helmers, R. A., Gabrielson, S. R., & Harper, M. M. (2016). Developing a new governance structure: the Mayo Clinic experience. Physician leadership journal, 3(3), 40-46.
Helmers, R. A., & Harper, C. M. (2019). The mayo clinic model of clinical integration. Paper presented at the Healthcare.
Jensen, M. C., & Heckling, W. H. (1995). Specific and general knowledge, and organizational structure. Journal of applied corporate finance, 8(2), 4-18.
Peterson, K. S., & Morris, B. C. (2019). Creating synergy between academia and practice: the Arizona State University and Mayo Clinic Arizona model. Journal of Professional Nursing, 35(4), 305-313.
Swensen, S., Gorringe, G., Caviness, J., & Peters, D. (2016). Leadership by design: intentional organization development of physician leaders. Journal of management development.
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