摘要:

The article argues that incremental improvement of, or “tinkering” with, health care delivery is taking too long and leaves unacceptable gaps in health care quality and service. It lists five common types of quality improvement “leaps” that have proven across studies to improve the integration of care during hospital and emergency department discharge, to bring mental health and substance abuse treatment into primary care, and to allow better management of chronic diseases. It also lists five key tasks that organizations need to accomplish in order to make such leaps and then describes four ways that consumers, employers, consumer advocates, and investors force the stubborn “bullfrogs” to take a big jump forward.

ISSN:0148-9917    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

In 1998, Los Angeles County's Department of Health Services (DHS) embarked on a planning process to expand ambulatory care services for the county's 2.7 million uninsured and otherwise medically indigent residents. This planning process was novel in two ways. First, it used a quantitative, needs-based approach for resource allocation to ensure an equitable distribution of safety-net ambulatory care services across the county. Second, it used a new community-based planning paradigm that took into consideration the specific needs of each of the county's eight geographic service planning areas. Together, the evidence-based approach to planning and the community-based decision-making will ensure that DHS can more equitably provide for the needs of Los Angeles County's medically indigent residents.

ISSN:0148-9917    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

With numerous medical groups and individual practice associations (IPAs) in California now reporting operating losses—and many approaching financial insolvency—the question arises why physician organizations are in such a tenuous situation. One line of thinking is that the problem is attributable to the market dominance of the major health plans and their ability to impose actuarially unsound low capitation rates on professional providers. This article describes four other reasons for the current plight of physician organizations: (1) a physician-centric approach to IPA governance, (2) lack of qualified staff within key operating units, (3) management reporting that is insufficient to support utilization analysis and health plan negotiations, and (4) a highly charged political process for determining physician reimbursement. IPA survival will ultimately depend upon whether IPAs are perceived by their physician members and leaders as true business operations or just as another income source.

ISSN:0148-9917    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

The risk-adjusted payment model mandated for Medicare+Choice organizations by the Balanced Budget Act of 1997 has significant implications for health care organizations that offer the Medicare+Choice program. Chronic medical conditions in the ambulatory care setting will become the focus of data capture, requiring significant retooling of ambulatory care operations. Health care organizations in California currently do not have the capital available to invest in the information management tools that will be required. Private practitioners continue not to have the technology and expertise to capture the data needed to run the model. Nevertheless, the risk-adjusted payment model presents the potential to better integrate care delivery around the continuum of health care needs of the population.

ISSN:0148-9917    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Each physician group, network, or management services organization developed as part of an “integration” strategy over the past decade is unique. The current status of each of these entities is based on a variety of factors, including the local health care economy and environment, the sponsoring organization, and the entity's leadership. Much of the current news concerning integration initiatives is negative, and significant operating losses and the disillusionment of the participants have been reported. It is important to study the failures, however, for despite the unique factors impacting each one there are universal lessons to be learned in every case. This article chronicles the causes of one integrated group practice's breakup after five years of operation and the process undertaken to return the physicians to small independent practices.

ISSN:0148-9917    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Over the past two decades the California workers' compensation industry has been responding to rapidly rising medical costs. The first response was to attempt to adopt principles of managed care; the second, to increase efficiency by integrating activities, first within companies, then between companies and providers, and finally across companies providing both group health and workers' compensation. This article chronicles the integration movement, analyzes the forces driving it, and discusses how contradictory government incentives have both propelled and hindered integration.

ISSN:0148-9917    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

The National Health Service Corps (NHSC) was created in 1970 to provide primary health care clinicians for the underserved. The article includes a review of the peer-reviewed and intragovernmental literature on the NHSC program from 1971 to 1998 and also presents a current profile of the program. Despite significant increases in NHSC field strength since 1991, the 2,439 clinicians meet only 12% of the need for primary health care providers in underserved areas. While the NHSC has successfully addressed clinician diversity and retention issues, community and site development remain barriers to increasing access. Most communities in need are not ready to recruit and support clinicians. The NHSC of the next millennium must work with the neediest communities to reach the appropriate stage of readiness. Only after completing the necessary “preplacement” activities can the NHSC assist in the recruitment and placement of clinicians to increase access.

ISSN:0148-9917    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0148-9917    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0148-9917    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0148-9917    

出版商:OVID    

年代:2000

数据来源: OVID