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Health care reform is for the most part governmental policy that affects health care delivery in a given place. Health care reform typically attempts to:
The term managed care or managed healthcare is used in the United States to describe a group of activities intended to reduce the cost of providing health care and providing American health insurance while improving the quality of that care. It has become the predominant system of delivering and receiving American health care since its implementation in the early 1980s, and has been largely unaffected by the Affordable Care Act of 2010.
...intended to reduce unnecessary health care costs through a variety of mechanisms, including: economic incentives for physicians and patients to select less costly forms of care; programs for reviewing the medical necessity of specific services; increased beneficiary cost sharing; controls on inpatient admissions and lengths of stay; the establishment of cost-sharing incentives for outpatient surgery; selective contracting with health care providers; and the intensive management of high-cost health care cases. The programs may be provided in a variety of settings, such as Health Maintenance Organizations and Preferred Provider Organizations.
A Regional Health Information Organization, also called a Health Information Exchange Organization, is a multistakeholder organization created to facilitate a health information exchange (HIE) – the transfer of healthcare information electronically across organizations – among stakeholders of that region's healthcare system. The ultimate objective is to improve the safety, quality, and efficiency of healthcare as well as access to healthcare through the efficient application of health information technology. RHIOs are also intended to support secondary use of clinical data for research as well as institution/provider quality assessment and improvement. RHIO stakeholders include smaller clinics, hospitals, medical societies, major employers and payers.
Patient safety is a discipline that emphasizes safety in health care through the prevention, reduction, reporting and analysis of error and other types of unnecessary harm that often lead to adverse patient events. The frequency and magnitude of avoidable adverse events, often known as patient safety incidents, experienced by patients was not well known until the 1990s, when multiple countries reported significant numbers of patients harmed and killed by medical errors. Recognizing that healthcare errors impact 1 in every 10 patients around the world, the World Health Organization (WHO) calls patient safety an endemic concern. Indeed, patient safety has emerged as a distinct healthcare discipline supported by an immature yet developing scientific framework. There is a significant transdisciplinary body of theoretical and research literature that informs the science of patient safety with mobile health apps being a growing area of research.
A patient safety organization (PSO) is a group, institution, or association that improves medical care by reducing medical errors. Common functions of patient safety organizations are data collection, analysis, reporting, education, funding, and advocacy. A PSO differs from a Federally designed Patient Safety Organization (PSO), which provides health care providers in the U.S. privilege and confidentiality protections for efforts to improve patient safety and the quality of patient care delivery
Case management is a managed care technique within the health care coverage system of the United States. It involves an integrated system that manages the delivery of comprehensive healthcare services for enrolled patients. Case managers are employed in almost every aspect of health care and these employ different approaches in the control of clinical actions.
Consumer-driven healthcare (CDHC), or consumer-driven health plans (CDHP) refers to a type of health insurance plan that allows employers and/or employees to utilize pretax money to help pay for medical expenses not covered by their health plan. These plans are linked to health savings accounts (HSAs), health reimbursement accounts (HRAs), or similar medical payment accounts. Users keep any unused balance or "rollover" at the end of the year to increase future balances or to invest for future expenses. They are a high-deductible health plan which has cheaper premiums but higher out of pocket expenses, and as such are seen as a cost effective means for companies to provide health care for their employees.
The medical home, also known as the patient-centered medical home (PCMH), is a team-based health care delivery model led by a health care provider to provide comprehensive and continuous medical care to patients with a goal to obtain maximal health outcomes. It is described in the "Joint Principles" as "an approach to providing comprehensive primary care for children, youth and adults."
In the United States, health insurance helps pay for medical expenses through privately purchased insurance, social insurance, or a social welfare program funded by the government. Synonyms for this usage include "health coverage", "health care coverage", and "health benefits". In a more technical sense, the term "health insurance" is used to describe any form of insurance providing protection against the costs of medical services. This usage includes both private insurance programs and social insurance programs such as Medicare, which pools resources and spreads the financial risk associated with major medical expenses across the entire population to protect everyone, as well as social welfare programs like Medicaid and the Children's Health Insurance Program, which both provide assistance to people who cannot afford health coverage.
In the United States, direct primary care (DPC) is a type of primary care billing and payment arrangement made between patients and medical providers, without sending claims to insurance providers. It is an umbrella term, incorporating various health care delivery systems that involve direct financial relationships between patients and health care providers.
Connected health is a socio-technical model for healthcare management and delivery by using technology to provide healthcare services remotely. Connected health, also known as technology enabled care (TEC) aims to maximize healthcare resources and provide increased, flexible opportunities for consumers to engage with clinicians and better self-manage their care. It uses readily available consumer technologies to deliver patient care outside of the hospital or doctor's office. Connected health encompasses programs in telehealth, remote care and disease and lifestyle management, often leverages existing technologies such as connected devices using cellular networks and is associated with efforts to improve chronic care. However, there is an increasing blur between software capabilities and healthcare needs whereby technologists are now providing the solutions to support consumer wellness and provide the connectivity between patient data, information and decisions. This calls for new techniques to guide Connected Health solutions such as "design thinking" to support software developers in clearly identifying healthcare requirements, and extend and enrich traditional software requirements gathering techniques.
Comparative effectiveness research (CER) is the direct comparison of existing health care interventions to determine which work best for which patients and which pose the greatest benefits and harms. The core question of comparative effectiveness research is which treatment works best, for whom, and under what circumstances. Engaging various stakeholders in this process, while difficult, makes research more applicable through providing information that improves patient decision making.
Paul Grundy is an American physician known as the "godfather" of the Patient Centered Medical Home. He was named a member of the Institute of Medicine, and recipient of the Barbara Starfield Primary Care Leadership Award and the 2012 National Committee for Quality Assurance(NCQA) Quality Award.
The Improvement Science Research Network (ISRN) is a research network for academics and physicians who are conducting studies in the new medical field of improvement science.
An accountable care organization (ACO) is a healthcare organization that ties provider reimbursements to quality metrics and reductions in the cost of care. ACOs in the United States are formed from a group of coordinated health-care practitioners. They use alternative payment models, normally, capitation. The organization is accountable to patients and third-party payers for the quality, appropriateness and efficiency of the health care provided. According to the Centers for Medicare and Medicaid Services, an ACO is "an organization of health care practitioners that agrees to be accountable for the quality, cost, and overall care of Medicare beneficiaries who are enrolled in the traditional fee-for-service program who are assigned to it".
Aligning Forces for Quality is a U.S. national program of the Robert Wood Johnson Foundation aiming to lift the quality of health care in 16 targeted communities, reduce racial and ethnic disparities in those communities and provide models for national reform. Each regional Health care improvement collaborative aims to create sustainable improvements in health care quality throughout its targeted communities by 2015. To do so, the initiative fosters collaboration among multiple stakeholders in a community. Aligning Forces For Quality focuses its efforts on three main areas: Performance measurement and public reporting, consumer engagement, and quality improvement. Aligning Forces for Quality is the single largest philanthropic effort of its kind undertaken to improve the quality of U.S. health care.
Digital health is a discipline that includes digital care programs, technologies with health, healthcare, living, and society to enhance the efficiency of healthcare delivery and to make medicine more personalized and precise. It uses information and communication technologies to facilitate understanding of health problems and challenges faced by people receiving medical treatment and social prescribing in more personalised and precise ways. The definitions of digital health and its remits overlap in many ways with those of health and medical informatics.
Health care quality is a level of value provided by any health care resource, as determined by some measurement. As with quality in other fields, it is an assessment of whether something is good enough and whether it is suitable for its purpose. The goal of health care is to provide medical resources of high quality to all who need them; that is, to ensure good quality of life, cure illnesses when possible, to extend life expectancy, and so on. Researchers use a variety of quality measures to attempt to determine health care quality, including counts of a therapy's reduction or lessening of diseases identified by medical diagnosis, a decrease in the number of risk factors which people have following preventive care, or a survey of health indicators in a population who are accessing certain kinds of care.
The Center for Value-Based Insurance Design at The University of Michigan is an advocate for development, implementation and evaluation of clinically nuanced health benefit plans and payment models. Since its inception in 2005, the V-BID Center has been actively engaged in understanding the impact of value-based insurance design (V-BID) on clinical outcomes and economic efficiency in the U.S. health care system. The V-BID Center also works with employers, consumer advocates, health plans, policy leaders, and academics to promote the implementation and demonstration of value-based insurance design in health benefit plans, as well as in state and federal legislation. Co-founded by A. Mark Fendrick, MD, and Michael Chernew, PhD, the V-BID Center is based in Ann Arbor, Michigan and operates collaboratively with the University of Michigan School of Public Health, the University of Michigan Medical School, and the University of Michigan Institute for Healthcare Policy and Innovation.
Jacqueline Nwando Olayiwola is an American family physician, public health professional, author, professor, and women's empowerment leader. She is the Senior Vice President and Chief Health Equity Officer of Humana and a chair and Professor in the Department of Family Medicine at Ohio State University Wexner Medical Center. Prior to her appointment at OSU, she served as the inaugural Chief Clinical Transformation Officer for RubiconMD, an eConsult platform that improves primary care access to specialty care for underserved patients. Olayiwola is dedicated to serving marginalized patient populations and addressing the social determinants through community and technology-based infrastructures of healthcare reform. She has published articles on the use of eConsults and telehealth to provide underserved patients with primary care treatments so that they have a low cost and efficient means of reaching specialized care. Olayiwola has founded numerous non-profits and healthcare start-ups such as GIRLTALK Inc, Inspire Health Solutions LLC, and the Minority Women Professionals are MVPs Program. She has been recognized at the national and international level for her work and efforts to educate, advocate and provide healthcare to those in need. She was named Woman of the Year by the American Telemedicine Association in 2019, and received the Public Health Innovator Award from Harvard School of Public Health in 2019, as well as being named one of America's Top Family Doctors from 2007 to 2008 by the Consumers Research Council of America.
References
- ↑ "Patient-Centered 'Medical Home' Models Lag in Key Areas". The Washington Post. September 10, 2008. Retrieved 2009-02-16.
- ↑ Goldsmith, Thomas (October 12, 2008). "State's medical networks acclaimed. Community Care saves money; patients like it". The News and Observer (Raleigh, North Carolina). Retrieved 2009-02-16.[ dead link ]
- ↑ "Roundtable to hear of new system". Wichita Eagle. September 30, 2008. p. 1C. Retrieved 2009-02-16.