摘要:

With the article below, we introduce a new feature of theJournal of Ambulatory Care Management(JACM) that centers on the clinical value and uses of controversial clinical procedures, medical devices, and drug therapies. Health care executives have customarily left decisions about technology to clinicians. However, with health care delivery and financing systems shifting increasingly to managed care, a new role is evolving for outpatient care executives that encompasses technology management. It is not a hands-on role–you will not be fixing medical devices or making clinical decisions about individual patients–but you will be recognizing that the technologies you adopt will have a significant impact on the quality of care you deliver and the cost associated with that technology and that care. It is likely that the majority of health care executives will greet their increasing involvement in this arena with all the joy associated with learning a new computer hardware or software system, but it is also true that we must learn the tools of managing in the current health care system, even if the first steps are demanding. Health care technology for the outpatient setting is increasingly sophisticated, and there is a lot more of it as procedures continue to move outside of the hospital acute-care setting. JACM will bring you perspectives from the nation's leading technology assessment organizations, from your colleagues who use technology, from payers, from the manufacturers of medical devices and pharmaceuticals, from regulators, and from patients and their families.The first in this series is written by one of JACM's associate editors, Jeffrey Lerner, PhD, Vice President for Strategic Planning with ECRI, and his colleagues. ECRI (founded close to 30 years ago as the Emergency Care Research Institute) is widely acknowledged as the world's leading independent technology assessment organization. It is often compared toConsumer Reportsbecause it evaluates technologies on a brand and model basis, as well as taking broader looks at classes of procedures and associated technologies. ECRI is a collaborating center of the World Health Organization. Neither ECRI nor its employees have a financial interest in any health care technologies. ECRI does not accept gifts, grants, or finders' fees from medical device or pharmaceutical industries. Every employee's Internal Revenue Service returns are examined yearly to ensure that there are no investments in these industries or in managed care organizations and insurance companies.If you find this series valuable, we invite you to tell us. We welcome your recommendations on issues we should address in the future.

ISSN:0148-9917    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Deloitte & Touche LLP, in conjunction with VHA, Inc., conducts an annual environmental assessment of trends affecting the health care industry. The annual study assesses the impact of these trends on both providers and purchasers. This article focuses on specific trends from our current study that suggest the need for significant change in the way ambulatory care is delivered. The article examines 10 key trends in overview, takes a closer look at four critical areas with special impact on ambulatory care, and concludes with a discussion of how the industry is responding.

ISSN:0148-9917    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

The growth of managed care and specifically capitation will dramatically change the basis of competition for health care providers. In order for medical groups to succeed in this new environment they must be able to accept the accountability for both managing the care of populations and managing the delivery of individual encounters of care. Being held accountable for the management of populations will require at-risk medical groups to focus on developing three entirely new strategic capabilities: the assessment of health risk, the management of access, and the management of care. This article describes the analytic approach of Deloitte & Touche Consulting Group's population-based diagnostic methodology, which will enable an at-risk organization to identify opportunities for improving the management of care for specific populations and diseases. The hypotheses driving the need for these organizations to establish population-based care management capabilities stem from the plethora of empirical evidence indicating significant variation in costs, utilization, and outcomes in the practice of medicine. Applying a systematic, planned approach to caring for patients who have common, predictable health care needs will result in better outcomes and lower costs for all.

ISSN:0148-9917    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:0148-9917    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

The first step in redesigning the health care delivery process for ambulatory care begins with the patient and the business processes that support the patient. Patient-related business processes include patient access, service documentation, billing, follow-up, collection, and payment. Access is the portal to the clinical delivery and care management process. Service documentation, charge capture, and payment and collection are supporting processes to care delivery. Realigned provider networks now demand realigned patient business services to provide their members/customers/patients with improved service delivery at less cost. Purchaser mandates for cost containment, health maintenance, and enhanced quality of care have created an environment where every aspect of the delivery system, especially ambulatory care, is being judged. Business processes supporting the outpatient are therefore being reexamined for better efficiency and customer satisfaction. Many health care systems have made major investments in their ambulatory care environment, but have pursued traditional supporting business practices–such as multiple access points, lack of integrated patient appointment scheduling and registration, and multiple patient bills. These are areas that are appropriate for redesign efforts–all with the customer's needs and convenience in mind. Similarly, setting unrealistic expectations, underestimating the effort required, and ignoring the human elements of a patient-focused business service redesign effort can sabotage the very sound reasons for executing such an endeavor. Pitfalls can be avoided if a structured methodology, coupled with a change management process, are employed. Deloitte & Touche Consulting Group has been involved in several major efforts, all with ambulatory care settings to assist with the redesign of their business practices to consider the patient as the driver, instead of the institution providing the care.

ISSN:0148-9917    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

This article discusses the implications of the dramatic growth of outpatient activity in academic health care organizations, and, more broadly, in all forms of joint physician-hospital outpatient care. The authors describe several economic, operational, and regulatory factors that influence the success of ambulatory care expansion in the academic environment. A case study of the Metropolitan New York Medicaid managed care environment illustrates the impact of these factors and highlights the specific challenges confronting teaching hospitals and physicians. The attributes of ambulatory care providers that have successfully addressed these challenges are also discussed. Finally, the benefits of the model ambulatory practice structure, employed at a number of teaching institutions across the country, are explored.

ISSN:0148-9917    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Growing emphasis on ambulatory service delivery in academic medical centers has heightened interest in improving operational efficiencies, while providing an optimal educational experience for medical students and residents. One significant challenge in the academic environment is maximizing resource utilization (both physical plant and personnel), through scheduling and operational effectiveness. This article examines how academic ambulatory practices can apply operational and scheduling process redesign methodologies to improve throughput and productivity, while enhancing the educational experience for students/residents.

ISSN:0148-9917    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

New Jersey health care providers face the need to change dramatically the way health care is delivered as it enters a new era of managed care. This year, more than 24% of New Jersey's total population is enrolled in commercial managed care plans (New Jersey Department of Insurance, 1996). In addition, the state's Medicaid agency took steps to improve the delivery of health services to recipients by initiating implementation activities to transition from the traditional Medicaid program to a managed care model. Eighty-two percent of New Jersey's Aid to Families with Dependent Children (AFDC) and related populations have already been enrolled in managed care. The state plans to expand enrollment in managed care to the remaining 400,000 Medicaid beneficiaries. Communities with high Medicaid populations are challenged with the need to move through the managed care evolution at an accelerated rate.

ISSN:0148-9917    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:0148-9917    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:0148-9917    

出版商:OVID    

年代:1997

数据来源: OVID