Laboratory administration--capital budgeting.

PubMed

Butros, F

1997-01-01

The process of capital budgeting varies among different health-care institutions. Understanding the concept of present value of money, incremental cash flow statements, and the basic budgeting techniques will enable the laboratory manager to make the rational and logical decisions that are needed in today's competitive health-care environment.

Building social capital in healthcare organizations: thinking ecologically for safer care.

PubMed

Hofmeyer, Anne; Marck, Patricia B

2008-01-01

Research on patient safety and health human resources, 2 critical issues for 21st century healthcare, converges on similar findings. Specifically, it is apparent that along with the patients, families, and communities we serve, nurses and other healthcare professionals navigate a volatile health care system where persistent restructuring, market pressures, and workforce instability present ongoing threats to the delivery of safer care. Drawing from the fields of nursing, healthcare ethics, health systems management, and ecological restoration, we outline the role of social capital for organizational integrity, healthy workplace cultures, sustainable resource management, improved nurse retention, effective knowledge translation, and safer patient care. Nursing leaders can use ecological thinking to build the vital resource of social capital by taking concrete steps to commit the necessary human and material resources to: (1) forge relations to foster bonding, bridging and linking social capital; (2) build solidarity and trust; (3) foster collective action and cooperation; (4) strengthen communication and knowledge exchange; and (5) create capacity for social cohesion and inclusion.

Building a vertical provider system.

PubMed

Barnett, A E

1993-01-01

There is probably no geographic area in the United States in which the health care environment is more turbulent than that of Southern California. Long before President Clinton's proposals began serious national debate on health care reform, a massive provider-driven realignment of the system was occurring in that region of the country. Multispecialty medical groups have generally led the way and have acquired ever larger managed care populations through merger and acquisition of other groups and practices. Hospitals, hampered by large fixed capital bases, have struggled to reinvent themselves as cost-effective and primary care-friendly environments in order to be attractive to managed care physicians. Almost ignored in this reconfiguration has been the university teaching hospital. This article discusses one attempt to reconcile contractually an integrated, capitated, and managed care-oriented health care system with an academic medical center in a strategic alliance.

Merger & Acquisition and Capital Expenditure in Health Care.

PubMed

Ouyang, Wenjing; Hilsenrath, Peter E

2017-01-01

Investment, especially through merger and acquisition (M&A), is a leading topic of concern among health care managers. In addition, the implications of this activity for organization and market concentration are of great interest to policy makers. Using a sample of 2256 firm-year observations in the health care industry during the period from 1985 to 2011, this article provides novel evidence that managers learn from financial markets in making capital expenditure (CAPEX) and M&A investment decisions. Within the industry, managers in the Drugs subsector are most likely to do so, whereas managers in the Medical Equipment and Supplies are least likely to do so. We find informative stock prices improve firm financial performance. This article highlights the importance of financial markets for real economic activity in the health care industry.

Merger & Acquisition and Capital Expenditure in Health Care

PubMed Central

Ouyang, Wenjing; Hilsenrath, Peter E.

2017-01-01

Investment, especially through merger and acquisition (M&A), is a leading topic of concern among health care managers. In addition, the implications of this activity for organization and market concentration are of great interest to policy makers. Using a sample of 2256 firm-year observations in the health care industry during the period from 1985 to 2011, this article provides novel evidence that managers learn from financial markets in making capital expenditure (CAPEX) and M&A investment decisions. Within the industry, managers in the Drugs subsector are most likely to do so, whereas managers in the Medical Equipment and Supplies are least likely to do so. We find informative stock prices improve firm financial performance. This article highlights the importance of financial markets for real economic activity in the health care industry. PMID:28220717

Capitation: strategies for success with managed care contracts.

PubMed

Kuklierus, A

1997-01-01

With enrollments in HMOs increasing at double digit rates, independent practice associations, integrated medical groups, hospitals and specialty networks are experiencing a substantial increase in the share of their business paid for through capitation. Experience has shown that once one contract is signed, many are sure to follow. Providers must make sure each contract signed is financially sound for the organization. Then they must be able to manage and monitor contracts long after the ink is dry. This column provides a brief overview ad list of pointers for organizations moving into the managed care arena.

Capital finance and ownership conversions in health care.

PubMed

Robinson, J C

2000-01-01

This paper analyzes the for-profit transformation of health care, with emphasis on Internet start-ups, physician practice management firms, insurance plans, and hospitals at various stages in the industry life cycle. Venture capital, conglomerate diversification, publicly traded equity, convertible bonds, retained earnings, and taxable corporate debt come with forms of financial accountability that are distinct from those inherent in the capital sources available to nonprofit organizations. The pattern of for-profit conversions varies across health sectors, parallel with the relative advantages and disadvantages of for-profit and nonprofit capital sources in those sectors.

Health-Based Capitation Risk Adjustment in Minnesota Public Health Care Programs

PubMed Central

Gifford, Gregory A.; Edwards, Kevan R.; Knutson, David J.

2004-01-01

This article documents the history and implementation of health-based capitation risk adjustment in Minnesota public health care programs, and identifies key implementation issues. Capitation payments in these programs are risk adjusted using an historical, health plan risk score, based on concurrent risk assessment. Phased implementation of capitation risk adjustment for these programs began January 1, 2000. Minnesota's experience with capitation risk adjustment suggests that: (1) implementation can accelerate encounter data submission, (2) administrative decisions made during implementation can create issues that impact payment model performance, and (3) changes in diagnosis data management during implementation may require changes to the payment model. PMID:25372356

Moral Economy and Moral Capital in the Community of Clinical Practice.

PubMed

Jaye, Chrystal; Young, Jessica; Egan, Tony; Williamson, Martyn

2018-03-01

This New Zealand study used focused ethnography to explore the activities of communities of clinical practice (CoCP) in a community-based long-term conditions management program within a large primary health care clinic. CoCP are the informal vehicles by which patient care was delivered within the program. Here, we describe the CoCP as a micro-level moral economy within which values such as trust, respect, authenticity, reciprocity, and obligation circulate as a kind of moral capital. As taxpayers, citizens who become patients are credited with moral capital because the public health system is funded by taxes. This moral capital can be paid forward, accrued, banked, redeemed, exchanged, and forfeited by patients and their health care professionals during the course of a patient's journey. The concept of moral capital offers another route into the "black box" of clinical work by providing an alternative theoretic for explaining the relational aspects of patient care.

Crispin: capital requirements and reinsurance protect against insolvency.

PubMed

Crispin, C

2001-12-01

Charles Crispin is president of Evergreen Re, a managed care consulting firm with expertise in the reinsurance industry. Before Joining Evergreen Re, Crispin served as a consultant to the managed care industry. He is a member of the American Association of Integrated Delivery Systems, Glen Allen, Virginia, and the Provider Excess Loss Association, Princeton, New Jersey. Crispin recently talked with HFM about risk-based capital requirements for health plans and the Impact these solvency guidelines could have on healthcare providers.

Measuring human capital cost through benchmarking in health care environment.

PubMed

Kocakülâh, Mehmet C; Harris, Donna

2002-01-01

Each organization should seek to maximize its human capital investments, which ultimately lead to increased profits and asset efficiency. Service companies utilize less capital equipment and more human productivity, customer service, and/or delivery of service as the product. With the measurement of human capital, one can understand what is happening, exercise some degree of control, and make positive changes. Senior management lives or dies by the numbers and if Human Resources (HR) really wants to be a strategic business partner, HR must be judged by the same standards as everyone else in the health care organization.

Planning equipment acquisitions.

PubMed

Sadock, J M

1995-08-01

As the mire of healthcare reform continues to grow, many providers are developing an insatiable appetite for alternatives to the way they currently do business. For some, solutions come in the form of repackaging the same old stuff. Others have jumped recklessly into every managed, capitated, or reformed idea that has come along. Old-school thinkers are still awaiting government direction. Providers of quality healthcare face increasing demands on their shrinking capital funds. An aging population, indigent care, AIDS patients, medical waste disposal, nursing shortages, declining reimbursement, increasing labor costs, and the federal healthcare reform threat have negatively affected cash flow. Though previous cost-plus reimbursement encouraged wasteful spending, the threat of healthcare reform has already caused providers and suppliers alike to work together to cut costs even without government mandates. The impact has been the closure of over 600 facilities nationwide in the past ten years. More than 70,000 acute care hospital beds have been lost from the US healthcare system. Many healthcare facilities have merged into managed care systems, integrated delivery networks, and regional alliances whose costs can be consolidated and controlled. At the same time, new services and profit centers are also being created to increase revenue. A healthcare moves into alternative care environments--home care, ambulatory care, diagnostic testing--these providers need more capital equipment to serve an increased patient load. Coupled with an aging installed base of technology in the acute care environment, healthcare managers face an ever-growing need for capital equipment and creative financing programs to meet longer payment options.(ABSTRACT TRUNCATED AT 250 WORDS)

Financial capital and intellectual capital in physician practice management.

PubMed

Robinson, J C

1998-01-01

Medical groups need financial resources yet most retain no earnings and have no reserves. Physician practice management (PPM) companies have recognized the need for investment and the scarcity of indigenous capital in the physician sector and are rushing to fill the void. Resources are being contributed by venture capitalists, bond underwriters, private investors, pharmaceutical manufacturers, health plans, hospital systems, and public equity markets. The potential contribution of PPM firms is to nurture the intellectual capital of leading physician organizations and diffuse it throughout the health care system. The risk is that short-term financial imperatives will impede necessary long-term investments.

Integrated care management: aligning medical call centers and nurse triage services.

PubMed

Kastens, J M

1998-01-01

Successful integrated delivery systems must aggressively design new approaches to managing patient care. Implementing a comprehensive care management model to coordinate patient care across the continuum is essential to improving patient care and reducing costs. The practice of telephone nursing and the need for experienced registered nurses to staff medical call centers, nurse triage centers, and outbound telemanagement is expanding as the penetration of full-risk capitated managed care contracts are signed. As health systems design their new care delivery approaches and care management models, medical call centers will be an integral approach to managing demand for services, chronic illnesses, and prevention strategies.

Using a social capital framework to enhance measurement of the nursing work environment.

PubMed

Sheingold, Brenda Helen; Sheingold, Steven H

2013-07-01

To develop, field test and analyse a social capital survey instrument for measuring the nursing work environment. The concept of social capital, which focuses on improving productive capacity by examining relationships and networks, may provide a promising framework to measure and evaluate the nurse work environment in a variety of settings. A survey instrument for measuring social capital in the nurse work environment was developed by adapting the World Bank's Social Capital - Integrated Questionnaire (SC-IQ). Exploratory factor analysis and multiple regression analyses were applied to assess the properties of the instrument. The exploratory factor analysis yielded five factors that align well with the social capital framework, while reflecting unique aspects of the nurse work environment. The results suggest that the social capital framework provides a promising context to assess the nurse work environment. Further work is needed to refine the instrument for a diverse range of health-care providers and to correlate social capital measures with quality of patient care. Social capital measurement of the nurse work environment has the potential to provide managers with an enhanced set of tools for building productive capacity in health-care organisations and achieving desired outcomes. © 2013 John Wiley & Sons Ltd.

Bonding and bridging social capital in the recovery of severe mental illness: a synthesis of qualitative research.

PubMed

Salehi, Asiyeh; Ehrlich, Carolyn; Kendall, Elizabeth; Sav, Adem

2018-05-11

Social networks are known to have a major influence on the recovery journey of people with severe mental illness (SMI). To understand the role of bonding and bridging social capital in the recovery process following SMI and to identify the barriers that prevent social networks from being mobilized. A review of major electronic databases for qualitative studies from 2006 to 2015 (41 papers) was undertaken for thematic synthesis. The main themes for bonding social capital included: a buffer for isolation and loneliness, variations depending on illness stages, balance in relationships and connections as a source of self-management. Main themes for bridging social capital comprised: feeling powerless and excluded from community/health care, social care beyond the illness, social care barriers and social inclusion through community groups. All those involved in the management of SMI must be aware of how social support networks hinder or contribute to recovery. People with SMI need opportunities to form reciprocal relationships and sustain supportive networks that can assist them to endure the challenges presented by SMI.

Integrated delivery systems focus on service delivery after capitation efforts stall.

PubMed

2005-03-01

Integrated delivery systems focus on service delivery after capitation efforts stall. Integrated delivery systems are going through changes that are focusing the provider organizations more on delivering care than managing risk, says Dean C. Coddington, one of the leading researchers into capitated organizations and a senior consultant with McManis Consulting in Denver.

Those conversion blues.

PubMed

Forgione, D A

1999-01-01

With the ever-increasing market penetration of capitated payment systems throughout health care markets, average payment rates for health services have dropped correspondingly. At the same time, the added competitive pressures from managed care organizations have served to increase the demand for new capital investment in information systems, lower cost facilities, and innovative modes for delivering all types of health care services. As a result, many nonprofit health care organizations have converted, or have attempted to convert, to for-profit status in an effort to gain access to the public equity capital markets. As hospitals, Blue Cross and Blue Shield organizations, and other nonprofit health care organizations across the U.S. seek to convert to for-profit status, they are finding the path is not easy. Access to capital, operating efficiencies, and the need to accelerate movement into new markets are offset by public benefit obligations, potential private inurement, and significant political cost issues. The bottom line is whether the conversion will be structured to both protect the public interest and allow the health care organization the flexibility and access to capital it needs in order to continue as a viable, competitive organization into the next millennium.

Practice management companies improve practices' financial position.

PubMed

Dupell, T

1997-11-01

To maintain control over healthcare delivery and financial decisions, as well as increase access to capital markets, some group practices are forming their own physician practice management companies. These companies should be organized to balance the expectations of physicians with the values of capital markets. This organization should include retained earnings, financial reporting in accordance with generally accepted accounting principles (GAAP), predictable earnings and cash flow, physician ownership and leadership, and incentives for high-quality management. Three large, primary care and multispecialty clinics that merged to form a new physician practice management company increased their access to capital markets and improved their overall financial position, which will help them achieve long-term survival.

Assessing healthcare market trends and capital needs: 1996-2000.

PubMed

Coile, R C

1995-08-01

An analysis of recent data suggests several significant trends for the next five years, including a continuation of market-based reform, increases in managed care penetration, growth of Medicare and Medicaid health maintenance organizations, and erosion of hospital profits. A common response to these trends is to create integrated delivery systems, which can require significant capital investment. The wisest capital investment strategy may be to avoid asset-based integration in favor of "virtual integration," which emphasizes coordination through patient-management agreements, provider incentives, and information systems, rather than investment in large number of facilities.

The integrated supplier: key to cost management and multi-franchise capitation contracting.

PubMed

Schuweiler, R C

1996-05-01

Capitation...most healthcare providers do not work under it, comprehend it, or even want it, yet supply capitation contracting seminars are popping up everywhere creating the feeling that the bandwagon is leaving, and it might be time to get on board. Not true. Supply capitation is not for all organizations. Capitation contracting is not easy and there are not many successful models to help the uninitiated. If a panacea is sought for reducing supply costs, capitation is only one component of a systematic strategy to reduce materiel costs. This article suggests a direction using the Group Health Materiel Management (Group Health Cooperative of Puget Sound, WA) experience as a point of reference. It advocates a systematic approach that focuses on expense reduction in: cost of goods, holding cost of inventory, labor cost associated with all materiel processes, distribution cost (transportation and par stock pick, pack, and replenishment), product utilization, variation in product standards, and waste stream byproducts. At Group Health (GH) these issues are primarily addressed through the use of: information systems, supplier certification/selection processes, group purchasing compliance, supply channel management, supply capitation contracting programs, standardization, and utilization management. Because of managed care organizational structure, Group Health Cooperative supply capitation contracting, as performed at GH, is discussed not as a quick fix solution but in the spirit of sharing our experience with others who may be considering it as a cost savings tactic in the context of a broad-based materiel management strategy. This article highlights the experiences of GH beginning with materiel management's business process assumptions toward multiple-franchise supply capitation.

Thinking strategically about capitation.

PubMed

Boland, P

1997-05-01

All managed care stakeholders--health plan members, employers, providers, community organizations, and government entitites--share a common interest in reducing healthcare costs while improving the quality of care health plan members receive. Although capitation is a usually thought of primarily as a payment mechanism, it can be a powerful tool providers and health plans can use to accomplish these strategic objectives and others, such as restoring and maintaining the health of plan members or improving a community's health status. For capitation to work effectively as a strategic tool, its use must be tied to a corporate agenda of partnering with stakeholders to achieve broader strategic goals. Health plans and providers must develop a partnership strategy in which each stakeholder has well-defined roles and responsibilities. The capitation structure must reinforce interdependence, shift focus from meeting organizational needs to meeting customer needs, and develop risk-driven care strategies.

Chronic Care Management evolves towards Integrated Care in Counties Manukau, New Zealand.

PubMed

Rea, Harry; Kenealy, Tim; Wellingham, John; Moffitt, Allan; Sinclair, Gary; McAuley, Sue; Goodman, Meg; Arcus, Kim

2007-04-13

Despite anecdotes of many chronic care management and integrated care projects around New Zealand, there is no formal process to collect and share relevant learning within (but especially between) District Health Boards (DHBs). We wish to share our experiences and hope to stimulate a productive exchange of ongoing learning. We define chronic care management and integrated care, then summarise current theory and evidence. We describe national policy development (relevant to integrated care, since 2000) including the New Zealand Health Strategy, the NZ Primary Care Strategy, the development of Primary Health Organisations (PHOs), capitation payments, Care Plus, and Services to Improve Access funding. We then describe chronic care management in Counties Manukau, which evolved both prior to and during the international refinement of theory and evidence and the national policy development and implementation. We reflect on local progress to date and opportunities for (and barriers to) future improvements, aided by comparative reflections on the United Kingdom (UK). Our most important messages are addressed as follows: To policymakers and funders--a fragile culture change towards teamwork in the health system is taking place in New Zealand; this change needs to be specifically and actively supported. To PHOs--general practices need help to align their internal (within-practice) financial signals with the new world of capitation and integrated care. To primary and secondary care doctors, nurses, and other carers - systematic chronic care management and integrated care can improve patient quality of life; and if healthcare structures and systems are properly managed to support integration, then healthcare provider professional and personal satisfaction will improve.

Risk-adjusted capitation: recent experiences in The Netherlands.

PubMed

van de Ven, W P; van Vliet, R C; van Barneveld, E M; Lamers, L M

1994-01-01

The market-oriented health care reforms taking place in the Netherlands show a clear resemblance to the proposals for managed competition in U.S. health care. In both countries good risk adjustment mechanisms that prevent cream skimming--that is, that prevent plans from selecting the best health risks--are critical to the success of the reforms. In this paper we present an overview of the Dutch reforms and of our research concerning risk-adjusted capitation payments. Although we are optimistic about the technical possibilities for solving the problem of cream skimming, the implementation of good risk-adjusted capitation is a long-term challenge.

Measuring the value of groundwater and other forms of natural capital

PubMed Central

Fenichel, Eli P.; Abbott, Joshua K.; Bayham, Jude; Boone, Whitney; Haacker, Erin M. K.; Pfeiffer, Lisa

2016-01-01

Valuing natural capital is fundamental to measuring sustainability. The United Nations Environment Programme, World Bank, and other agencies have called for inclusion of the value of natural capital in sustainability metrics, such as inclusive wealth. Much has been written about the importance of natural capital, but consistent, rigorous valuation approaches compatible with the pricing of traditional forms of capital have remained elusive. We present a guiding quantitative framework enabling natural capital valuation that is fully consistent with capital theory, accounts for biophysical and economic feedbacks, and can guide interdisciplinary efforts to measure sustainability. We illustrate this framework with an application to groundwater in the Kansas High Plains Aquifer, a rapidly depleting asset supporting significant food production. We develop a 10-y time series (1996−2005) of natural capital asset prices that accounts for technological, institutional, and physical changes. Kansas lost approximately $110 million per year (2005 US dollars) of capital value through groundwater withdrawal and changes in aquifer management during the decade spanning 1996–2005. This annual loss in wealth is approximately equal to the state’s 2005 budget surplus, and is substantially more than investments in schools over this period. Furthermore, real investment in agricultural capital also declined over this period. Although Kansas’ depletion of water wealth is substantial, it may be tractably managed through careful groundwater management and compensating investments in other natural and traditional assets. Measurement of natural capital value is required to inform management and ongoing investments in natural assets. PMID:26858431

Measuring the value of groundwater and other forms of natural capital.

PubMed

Fenichel, Eli P; Abbott, Joshua K; Bayham, Jude; Boone, Whitney; Haacker, Erin M K; Pfeiffer, Lisa

2016-03-01

Valuing natural capital is fundamental to measuring sustainability. The United Nations Environment Programme, World Bank, and other agencies have called for inclusion of the value of natural capital in sustainability metrics, such as inclusive wealth. Much has been written about the importance of natural capital, but consistent, rigorous valuation approaches compatible with the pricing of traditional forms of capital have remained elusive. We present a guiding quantitative framework enabling natural capital valuation that is fully consistent with capital theory, accounts for biophysical and economic feedbacks, and can guide interdisciplinary efforts to measure sustainability. We illustrate this framework with an application to groundwater in the Kansas High Plains Aquifer, a rapidly depleting asset supporting significant food production. We develop a 10-y time series (1996-2005) of natural capital asset prices that accounts for technological, institutional, and physical changes. Kansas lost approximately $110 million per year (2005 US dollars) of capital value through groundwater withdrawal and changes in aquifer management during the decade spanning 1996-2005. This annual loss in wealth is approximately equal to the state's 2005 budget surplus, and is substantially more than investments in schools over this period. Furthermore, real investment in agricultural capital also declined over this period. Although Kansas' depletion of water wealth is substantial, it may be tractably managed through careful groundwater management and compensating investments in other natural and traditional assets. Measurement of natural capital value is required to inform management and ongoing investments in natural assets.

[Competencies of the nurse in the management of cognitive and capital knowledge].

PubMed

Ruthes, Rosa Maria; Cunha, Isabel Cristina Kowal Olm

2009-01-01

The article presents a review of nurse's management competencies and the practical management of knowledge and the human capital and the applicability of the management for competencies. Globalization and competitiveness makes health organizations to search adaptative forms to the transformations of the management. For the nurse it is expected to consider solutions nursing team related to health organizations problems. The management of the intellectual capital must take care that the personnel is applying the knowing in benefit of the organization and the professional growth. If it will not have necessary competences for generalized application of knowledge, this is useless. The nurses must be prepared to evaluate technological, organizational and human resources and to develop competencies, knowledge, abilities, attitudes, and values to plan, to organize, to direct, to control the knowledge in the organizations.

Longitudinal evaluation of physician payment reform and team-based care for chronic disease management and prevention.

PubMed

Kiran, Tara; Kopp, Alexander; Moineddin, Rahim; Glazier, Richard H

2015-11-17

We evaluated a large-scale transition of primary care physicians to blended capitation models and team-based care in Ontario, Canada, to understand the effect of each type of reform on the management and prevention of chronic disease. We used population-based administrative data to assess monitoring of diabetes mellitus and screening for cervical, breast and colorectal cancer among patients belonging to team-based capitation, non-team-based capitation or enhanced fee-for-service medical homes as of Mar. 31, 2011 (n = 10 675 480). We used Poisson regression models to examine these associations for 2011. We then used a fitted nonlinear model to compare changes in outcomes between 2001 and 2011 by type of medical home. In 2011, patients in a team-based capitation setting were more likely than those in an enhanced fee-for-service setting to receive diabetes monitoring (39.7% v. 31.6%, adjusted relative risk [RR] 1.22, 95% confidence interval [CI] 1.18 to 1.25), mammography (76.6% v. 71.5%, adjusted RR 1.06, 95% CI 1.06 to 1.07) and colorectal cancer screening (63.0% v. 60.9%, adjusted RR 1.03, 95% CI 1.02 to 1.04). Over time, patients in medical homes with team-based capitation experienced the greatest improvement in diabetes monitoring (absolute difference in improvement 10.6% [95% CI 7.9% to 13.2%] compared with enhanced fee for service; 6.4% [95% CI 3.8% to 9.1%] compared with non-team-based capitation) and cervical cancer screening (absolute difference in improvement 7.0% [95% CI 5.5% to 8.5%] compared with enhanced fee for service; 5.3% [95% CI 3.8% to 6.8%] compared with non-team-based capitation). For breast and colorectal cancer screening, there were no significant differences in change over time between different types of medical homes. The shift to capitation payment and the addition of team-based care in Ontario were associated with moderate improvements in processes related to diabetes care, but the effects on cancer screening were less clear. © 2015 Canadian Medical Association or its licensors.

Today's CIO: catalyst for managed care change.

PubMed

Sanchez, P

1997-05-01

As the impact of managed care increases and capitation becomes all pervasive, healthcare providers' attention to cost control will intensify. For integrated delivery networks (IDNs) to be competitive, today's CIO must leverage managed care as a catalyst for change, and use a sophisticated information system toolset as the means to an integrated end. An area many CIOs target for fast results and maximum cost savings in resource management. This article reviews how Dick Escue, chief information officer at Baptist Memorial Health Care Corporation (Memphis, TN), uses electronic information management systems to integrate and conserve the resources of Baptist's widespread healthcare organization.

The Trade-Offs of Developing a Case Management Model for Chronically Mentally Ill People.

ERIC Educational Resources Information Center

Belcher, John R.

1993-01-01

Addresses role of case management in care of chronically mentally ill persons. Notes that case management can be effective if designed so that services match client needs and service costs are measured accurately. Contends that profit-maximizing nature of U.S. health care system makes some form of capitation likely in design of case management…

The relationship between social capital and quality management systems in European hospitals: a quantitative study.

PubMed

Hammer, Antje; Arah, Onyebuchi A; Dersarkissian, Maral; Thompson, Caroline A; Mannion, Russell; Wagner, Cordula; Ommen, Oliver; Sunol, Rosa; Pfaff, Holger

2013-01-01

Strategic leadership is an important organizational capability and is essential for quality improvement in hospital settings. Furthermore, the quality of leadership depends crucially on a common set of shared values and mutual trust between hospital management board members. According to the concept of social capital, these are essential requirements for successful cooperation and coordination within groups. We assume that social capital within hospital management boards is an important factor in the development of effective organizational systems for overseeing health care quality. We hypothesized that the degree of social capital within the hospital management board is associated with the effectiveness and maturity of the quality management system in European hospitals. We used a mixed-method approach to data collection and measurement in 188 hospitals in 7 European countries. For this analysis, we used responses from hospital managers. To test our hypothesis, we conducted a multilevel linear regression analysis of the association between social capital and the quality management system score at the hospital level, controlling for hospital ownership, teaching status, number of beds, number of board members, organizational culture, and country clustering. The average social capital score within a hospital management board was 3.3 (standard deviation: 0.5; range: 1-4) and the average hospital score for the quality management index was 19.2 (standard deviation: 4.5; range: 0-27). Higher social capital was associated with higher quality management system scores (regression coefficient: 1.41; standard error: 0.64, p=0.029). The results suggest that a higher degree of social capital exists in hospitals that exhibit higher maturity in their quality management systems. Although uncontrolled confounding and reverse causation cannot be completely ruled out, our new findings, along with the results of previous research, could have important implications for the work of hospital managers and the design and evaluation of hospital quality management systems.

The Relationship between Social Capital and Quality Management Systems in European Hospitals: A Quantitative Study

PubMed Central

Hammer, Antje; Arah, Onyebuchi A.; DerSarkissian, Maral; Thompson, Caroline A.; Mannion, Russell; Wagner, Cordula; Ommen, Oliver; Sunol, Rosa; Pfaff, Holger

2013-01-01

Background Strategic leadership is an important organizational capability and is essential for quality improvement in hospital settings. Furthermore, the quality of leadership depends crucially on a common set of shared values and mutual trust between hospital management board members. According to the concept of social capital, these are essential requirements for successful cooperation and coordination within groups. Objectives We assume that social capital within hospital management boards is an important factor in the development of effective organizational systems for overseeing health care quality. We hypothesized that the degree of social capital within the hospital management board is associated with the effectiveness and maturity of the quality management system in European hospitals. Methods We used a mixed-method approach to data collection and measurement in 188 hospitals in 7 European countries. For this analysis, we used responses from hospital managers. To test our hypothesis, we conducted a multilevel linear regression analysis of the association between social capital and the quality management system score at the hospital level, controlling for hospital ownership, teaching status, number of beds, number of board members, organizational culture, and country clustering. Results The average social capital score within a hospital management board was 3.3 (standard deviation: 0.5; range: 1-4) and the average hospital score for the quality management index was 19.2 (standard deviation: 4.5; range: 0-27). Higher social capital was associated with higher quality management system scores (regression coefficient: 1.41; standard error: 0.64, p=0.029). Conclusion The results suggest that a higher degree of social capital exists in hospitals that exhibit higher maturity in their quality management systems. Although uncontrolled confounding and reverse causation cannot be completely ruled out, our new findings, along with the results of previous research, could have important implications for the work of hospital managers and the design and evaluation of hospital quality management systems. PMID:24392027

Underwriting: a key to healthy capitation agreements.

PubMed

Dameron, T H; Fessler, J C

1996-09-01

In some markets, healthcare providers in integrated delivery systems have been assuming full-risk capitated contracts. Some of these contracts have been profitable, but others have produced inconsistent financial results. These results may reflect inadequate underwriting practices. For providers and HMO insurers to establish financially successful capitation agreements, they must develop and audit an underwriting process to evaluate the health risk of the population entering the managed care system.

Public-Sector Managed Care for Children's Mental Health Services: Stakeholders' Perspectives. Symposium.

ERIC Educational Resources Information Center

Stangl, Dalene K.; Tweed, Dan L.; Farmer, Betsy; Langmeyer, David; Stelle, Lynn; Behar, Lenore B.; Gagliardi, Julia; Burns, Barbara J.

This paper presents contributions at a symposium about Carolina Alternatives (CA), a North Carolina program that blends capitated financing with public sector managed care for mental health and substance abuse services for children and youth eligible for Medicaid. The symposium focused on stakeholders' perspectives and on expenditure patterns of…

Healthcare organizational change: implications for access to care and its measurement.

PubMed Central

Miller, R. H.

1998-01-01

OBJECTIVES: To summarize evidence from peer-reviewed literature on access to care for vulnerable HMO enrollee populations; to discuss the potential effect of recent HMO and physician organization changes on access to care and its measurement. STUDY DESIGN: Review and summary of peer-reviewed literature for two HMO populations: those with chronic conditions and diseases, and those subject to discrimination due to income, color, or ethnic background. I also reviewed and summarized literature on three major changes in capitated organizations (HMOs and capitated physician organizations) that could affect access to care for vulnerable populations, and summarized findings from healthcare manager interviews conducted for several recent research projects on health system change. PRINCIPAL FINDINGS: Although mixed, there are enough negative results to raise some concerns about access to care for HMO enrollees with chronic conditions and diseases. Several emerging organizational changes have the potential to change access to care for the vulnerable HMO enrollees. The shift in cost-cutting from fragmented clinical management of specific services at a point in time toward more integrated clinical management of all services for specific types of patients across time may improve access to care, as may increased efforts to attract and retain HMO enrollees. The increased importance of capitated provider organizations within the health system may restrict access in some ways, and expand access in others. CONCLUSIONS: Organizational changes can affect both access to care and its measurement. More research is needed on the effects of these changes on access to care and quality of care. For researchers examining access to care for vulnerable HMO enrollee populations, these changes create challenges to determine the most appropriate measures of access to care, and the most appropriate organizations and organizational characteristics to measure. RELEVANCE TO CLINICAL PRACTICE, MANAGEMENT, AND/OR POLICY: Changes in market competition are leading to organizational changes that affect access to care for vulnerable HMO enrollee populations. Public and/or private policies that improve measurement and reporting can affect market competition and improve access to care. PMID:9685111

38 CFR 61.13 - Rating criteria for capital grant applications.

Code of Federal Regulations, 2010 CFR

2010-07-01

... decisions that affect their lives; (2) Establishing a clear link between the innovation(s) and its proposed... care, case management, and other care services. (Authority: 38 U.S.C. 501, 2002, 2011, 2012, 2061, 2064...

Impact of managed care on physician organizational behavior.

PubMed

Reece, R L

1999-01-01

This article examines how physicians act, react, and organize when managed care forces them to consolidate into larger groups and business corporations. Physicians have experimented with ownership by hospitals or business corporations to gain capital, management skills, and information systems. Now they're moving toward physician-owned groups with "outsourcing" of administrative and information system functions. The mood, movement, and momentum of physicians, in short, is toward integrated physician organizations bound together by information that amplifies on their core competencies and capacities to deliver care.

Nurse work engagement impacts job outcome and nurse-assessed quality of care: model testing with nurse practice environment and nurse work characteristics as predictors

PubMed Central

Van Bogaert, Peter; van Heusden, Danny; Timmermans, Olaf; Franck, Erik

2014-01-01

Aim: To explore the mechanisms through which nurse practice environment dimensions, such as nurse–physician relationship, nurse management at the unit level and hospital management and organizational support, are associated with job outcomes and nurse-assessed quality of care. Mediating variables included nurse work characteristics of workload, social capital, decision latitude, as well as work engagement dimensions of vigor, dedication and absorption. Background: Understanding how to support and guide nurse practice communities in their daily effort to answer complex care most accurate, alongside with the demand of a stable and healthy nurse workforce, is challenging. Design: Cross-sectional survey. Method: Based on earlier empirical findings, a structural equation model, designed with valid measurement instruments, was tested. The study population included registered acute care hospital nurses (N = 1201) in eight hospitals across Belgium. Results: Nurse practice environment dimensions predicted nurses’ ratings of job outcome variables as well as quality of care. Features of nurses’ work characteristics, e.g., perceived workload, decision latitude, social capital, and the three dimension of work engagement, played mediating roles between nurse practice environment and outcomes. A revised model, using various fit measures, explained 60% of job outcomes and 47% of nurse-assessed quality of care. Conclusion: The findings in this study show that nurse work characteristics as workload, decision latitude, and social capital, alongside with nurse work engagement (e.g., vigor, dedication, and absorption) influence nurses’ perspective of their nurse practice environment, job outcomes, and quality of care. The results underline aspects to considerate for various stakeholders, such as executives, nurse managers, physicians, and staff nurses, in setting up and organizing health care services. PMID:25431563

Nurse work engagement impacts job outcome and nurse-assessed quality of care: model testing with nurse practice environment and nurse work characteristics as predictors.

PubMed

Van Bogaert, Peter; van Heusden, Danny; Timmermans, Olaf; Franck, Erik

2014-01-01

To explore the mechanisms through which nurse practice environment dimensions, such as nurse-physician relationship, nurse management at the unit level and hospital management and organizational support, are associated with job outcomes and nurse-assessed quality of care. Mediating variables included nurse work characteristics of workload, social capital, decision latitude, as well as work engagement dimensions of vigor, dedication and absorption. Understanding how to support and guide nurse practice communities in their daily effort to answer complex care most accurate, alongside with the demand of a stable and healthy nurse workforce, is challenging. Cross-sectional survey. Based on earlier empirical findings, a structural equation model, designed with valid measurement instruments, was tested. The study population included registered acute care hospital nurses (N = 1201) in eight hospitals across Belgium. Nurse practice environment dimensions predicted nurses' ratings of job outcome variables as well as quality of care. Features of nurses' work characteristics, e.g., perceived workload, decision latitude, social capital, and the three dimension of work engagement, played mediating roles between nurse practice environment and outcomes. A revised model, using various fit measures, explained 60% of job outcomes and 47% of nurse-assessed quality of care. The findings in this study show that nurse work characteristics as workload, decision latitude, and social capital, alongside with nurse work engagement (e.g., vigor, dedication, and absorption) influence nurses' perspective of their nurse practice environment, job outcomes, and quality of care. The results underline aspects to considerate for various stakeholders, such as executives, nurse managers, physicians, and staff nurses, in setting up and organizing health care services.

Managing Debt and Capital Investments: A Toolbox for Private Colleges and Universities

ERIC Educational Resources Information Center

Townsley, Michael K.

2008-01-01

All private colleges and universities make strategic capital investments and consider the use of debt to fund those investments. From the commonplace purchase of photocopiers to the construction of new academic buildings or dormitories, investment decisions that yield long-term financial benefits must follow on the heels of careful analysis. To…

Diabetes self-management in a low-income population: impacts of social support and relationships with the health care system

PubMed Central

Vest, Bonnie M; Kahn, Linda S; Danzo, Andrew; Tumiel-Berhalter, Laurene; Schuster, Roseanne C; Karl, Renée; Taylor, Robert; Glaser, Kathryn; Danakas, Alexandra; Fox, Chester H

2014-01-01

Objectives This article reports on results of a qualitative study of social supports and institutional resources utilized by individuals living with diabetes in a high-poverty urban setting. The goal was to examine how access to social capital among low-income populations facilitates and impedes their self-efficacy in diabetes self-management. Methods Semi-structured interviews were conducted with 34 patients with diabetes from a safety net primary care practice in Buffalo, New York. Results Facilitators and barriers to successful self-management were identified in three broad areas: (1) the influence of social support networks; (2) the nature of the doctor-patient relationship; and (3) the nature of patient-health care system relationship. Patients' unmet needs were also highlighted across these three areas. Discussion Participants identified barriers to effective diabetes self-management directly related to their low-income status, such as inadequate insurance, and mistrust of the medical system. It may be necessary for patients to activate social capital from multiple social spheres to achieve the most effective diabetes management. PMID:23585634

Capital Ideas for Facilities Management.

ERIC Educational Resources Information Center

Golding, Stephen T.; Gordon, Janet; Gravina, Arthur

2001-01-01

Asserting that just like chief financial officers, higher education facilities specialists must maximize the long-term performance of assets under their care, describes strategies for strategic facilities management. Discusses three main approaches to facilities management (insourcing, cosourcing, and outsourcing) and where boards of trustees fit…

Understanding the relationship of maternal health behavior change and intervention strategies in a Nicaraguan NGO network.

PubMed

Valadez, Joseph J; Hage, Jerald; Vargas, William

2005-09-01

Few studies of community interventions examine independent effects of investments in: (1) capital (i.e., physical, human and social capital), and (2) management systems (e.g., monitoring and evaluation systems (M&E)) on maternal and child health behavior change. This paper does this in the context of an inter-organizational network. In Nicaragua, international non-governmental organizations (NGOs) and local NGOs formed the NicaSalud Federation. Using Lot Quality Assurance Sampling (LQAS), 14 member organizations took baselines measures of maternal safe motherhood and child health behavior indicators during November 1999 and August 2000, respectively, and final evaluation measures in December 2001. In April 2002, retrospective interviews were conducted with supervisors and managers in the 14 organizations to explore changes made to community health strategies, factors associated with the changes, and impacts they attributed to participating in NicaSalud. Physical capital (density of health huts), human capital (density and variety of paramedical personnel) and social capital (density of health committees) were associated with pregnant women attending antenatal care (ANC) 3+ times, and/or retaining ANC cards. The variety of paramedic personnel was also associated with women making post-partum visits to clinics. Physical capital (density of health huts) and social capital (density of health committees and mothers' clubs) were associated with child diarrhea case management indicators. One safe motherhood indicator (delivery of babies by a clinician) was not associated with intervention strategies. At the management level, NicaSalud's training of members to use LQAS for M&E was associated with the number of strategic and tactical changes they subsequently made to interventions (organizational learning). Organizational learning was related to changes in maternal and child health behaviors of the women (including changes in the proportion using post-partum care). As the latter result would not have occurred without NicaSalud, we conclude that this inter-organizational network provided added value by instigating organizational learning.

Nursing intellectual capital theory: testing selected propositions.

PubMed

Covell, Christine L; Sidani, Souraya

2013-11-01

To test the selected propositions of the middle-range theory of nursing intellectual capital. The nursing intellectual capital theory conceptualizes nursing knowledge's influence on patient and organizational outcomes. The theory proposes nursing human capital, nurses' knowledge, skills and experience, is related to the quality of patient care and nurse recruitment and retention of an inpatient care unit. Two factors in the work environment, nurse staffing and employer support for nurse continuing professional development, are proposed to influence nursing human capital's association with patient and organizational outcomes. A cross-sectional survey design. The study took place in 2008 in six Canadian acute care hospitals. Financial, human resource and risk data were collected from hospital departments and unit managers. Clearly specified empirical indicators quantified the study variables. The propositions of the theory were tested with data from 91 inpatient care units using structural equation modelling. The propositions associated with the nursing human capital concept were supported. The propositions associated with the employer support for nurse continuing professional development concept were not. The proposition that nurse staffing's influences on patient outcomes was mediated by the nursing human capital of an inpatient unit, was partially supported. Some of the theory's propositions were empirically validated. Additional theoretical work is needed to refine the operationalization and measurement of some of the theory's concepts. Further research with larger samples of data from different geographical settings and types of hospitals is required to determine if the theory can withstand empirical scrutiny. © 2013 Blackwell Publishing Ltd.

Improving state Medicaid contracts and plan practices for children with special needs.

PubMed

Fox, H B; McManus, M A

1998-01-01

The rapid transition of state Medicaid beneficiaries into fully capitated managed care plans requires a special focus on children with chronic or disabling conditions, who often depend on numerous pediatric physicians and other specialty services for health care and related services. Because managed care arrangements for this population are growing in popularity nationwide, it is important that states craft managed care contracts to address the unique needs of children with complex physical, developmental, and mental health problems. Based on the research reported in this article, in-depth interviews with state Medicaid agency staff, interviews with medical directors and administrators of managed care plans serving Medicaid recipients, and input from experts in pediatrics and managed care, a set of recommendations is made for tailoring managed care contracts to meet the needs of this vulnerable group of children. Six contracting elements that should be adopted by state Medicaid agencies include (1) clarifying the specificity of pediatric benefits, (2) defining appropriate pediatric provider capacity requirements, (3) developing a medical necessity standard specific to children, (4) identifying pediatric quality-of-care measures, (5) setting appropriate pediatric capitation rates, and (6) creating incentives for high-quality pediatric care. Nine approaches that should be adopted by managed care practices interested in providing high-quality care for children with special needs also are identified. These include (1) ensuring that assigned primary care providers have appropriate training and experience, (2) offering support systems for primary care practices, (3) providing specialty consultation for primary care providers, (4) establishing arrangements for the comanagement of primary and specialty pediatric services, (5) arranging for comprehensive care coordination, (6) establishing flexible service authorization policies, (7) implementing provider profiling systems that adjust for pediatric case mix, (8) creating financial incentives for serving children with special needs, and (9) encouraging family involvement in plan operations. Implementing these changes to managed care contracting could have a major impact on the quality and comprehensiveness of health care received by children with special needs. Successful implementation, however, requires strong support from both state Medicaid agencies and the managed care plans dedicated to serving this population.

Implications of the method of capital cost payment on the weighted average cost of capital.

PubMed Central

Boles, K E

1986-01-01

The author develops a theoretical and mathematical model, based on published financial management literature, to describe the cost of capital structure for health care delivery entities. This model is then used to generate the implications of changing the capital cost reimbursement mechanism from a cost basis to a prospective basis. The implications are that the cost of capital is increased substantially, the use of debt must be restricted, interest rates for borrowed funds will increase, and, initially, firms utilizing debt efficiently under cost-basis reimbursement will be restricted to the generation of funds from equity only under a prospective system. PMID:3525468

Organizational intellectual capital and the role of the nurse manager: A proposed conceptual model.

PubMed

Gilbert, Jason H; Von Ah, Diane; Broome, Marion E

Nurse managers must leverage both the human capital and social capital of the teams they lead in order to produce quality outcomes. Little is known about the relationship between human capital and social capital and how these concepts may work together to produce organizational outcomes through leadership of nurses. The purpose of this article was to explore the concepts of human capital and social capital as they relate to nursing leadership in health care organizations. Specific aims included (a) to synthesize the literature related to human capital and social capital in leadership, (b) to refine the conceptual definitions of human capital and social capital with associated conceptual antecedents and consequences, and (c) to propose a synthesized conceptual model guiding further empirical research of social capital and human capital in nursing leadership. A systematic integrative review of leadership literature using criteria informed by Whittemore and Knafl (2005) was completed. CINAHL Plus with Full Text, Academic Search Premier, Business Source Premier, Health Business FullTEXT, MEDLINE, and PsychINFO databases were searched for the years 1995 to 2016 using terms "human capital," "social capital," and "management." Analysis of conceptual definitions, theoretical and conceptual models, antecedents and consequences, propositions or hypotheses, and empirical support for 37 articles fitting review criteria resulted in the synthesis of the proposed Gilbert Conceptual Model of Organizational Intellectual Capital. The Gilbert Conceptual Model of Organizational Intellectual Capital advances the propositions of human capital theory and social capital theory and is the first model to conceptualize the direct and moderating effects that nurse leaders have on the human capital and social capital of the teams they lead. This model provides a framework for further empirical study and may have implications for practice, organizational policy, and education related to nursing leadership. Copyright © 2017 Elsevier Inc. All rights reserved.

The (Bio)Politicization of Neuroscience in Australian Early Years Policies: Fostering Brain-Resources "as" Human Capital

ERIC Educational Resources Information Center

Millei, Zsuzsa; Joronen, Mikko

2016-01-01

At the present, human capital theory (HCT) and neuroscience reasoning are dominant frameworks in early childhood education and care (ECEC) worldwide. Popular since the 1960s, HCT has provided an economic understanding of human beings and offered strategies to manage the population with the promise of bringing improvements to nations. Neuroscience…

Mergers, networking, and vertical integration: managed care and investor-owned hospitals.

PubMed

Brown, M

1996-01-01

This article links the forces of managed care and investor-owned firms as major factors driving the industry toward consolidation into vertically integrated, merged firms, often financed with investor capital. This relentless pressure to build regional systems of health services has transformed the industry from a charitable, community orientation to one of business, market shares, and profits.

Vertical integration and organizational networks in health care.

PubMed

Robinson, J C; Casalino, L P

1996-01-01

This paper documents the growing linkages between primary care-centered medical groups and specialists and between physicians and hospitals under managed care. We evaluate the two alternative forms of organizational coordination: "vertical integration," based on unified ownership, and "virtual integration," based on contractual networks. Excess capacity and the need for investment capital are major short-term determinants of these vertical versus virtual integration decisions in health care. In the longer term, the principal determinants are economies of scale, risk-bearing ability, transaction costs, and the capacity for innovation in methods of managing care.

Career stress and female managers' health in Taiwan's hospitals: a multilevel model approach.

PubMed

Chen, Duan-Rung; Lin, Yeh-Yun; Chung, Kuo-Piao

2008-01-01

This study investigates how perception-induced stress (barrier) and social capital (facilitator) affect the health of female managers. On the basis of the responses of 229 valid questionnaires of middle- and high-level female managers in large-scale hospitals, using a multilevel data analysis approach, this study investigates how perception-induced stress and social capital influence self-reported poor health of female managers. Analysis results indicate that all 3 perception-induced stresses (i.e., promotion-related procedural justice, promotion rate, and work-family conflict) and 2 social capital variables (i.e., mentor-assisted promotion and higher ranking mentor in other departments) are significantly associated with the health of female mangers. Factors involving the career success of women also affect their health. Health care organizations expecting to benefit from the long-term contribution of female elites must promote organizational equity and more heavily emphasize flexible work schedules, family-friendly policies, and perception management practices. In addition, adequately designed mentorship practices can greatly benefit female managers.

Medicaid and Financing of Health Care for Children in Foster Care: Findings from a National Survey. Health Services for Children in Foster Care. Number 1

ERIC Educational Resources Information Center

Inkelas, Moira; Halfon, Neal

2002-01-01

In recent years, state Medicaid programs have implemented significant change and innovation in delivering health and behavioral health services. Prepaid capitated financing and the provider networks created by Medicaid managed care expansions have altered systems of medical and mental/behavioral health. Most children in foster care receive…

The effect of reimbursement on medical decision making: do physicians alter treatment in response to a managed care incentive?

PubMed

Melichar, Lori

2009-07-01

The empirical literature that explores whether physicians respond to financial incentives has not definitively answered the question of whether physicians alter their treatment behavior at the margin. Previous research has not been able to distinguish that part of a physician response that uniformly alters treatment of all patients under a physician's care from that which affects some, but not all of a physician's patients. To explore physicians' marginal responses to financial incentives while accounting for the selection of physicians into different financial arrangements where others could not, I use data from a survey of physician visits to isolate the effect that capitation, a form of reimbursement wherein physicians receive zero marginal revenue for a range of physician provided services, has on the care provided by a physician. Fixed effects regression results reveal that physicians spend less time with their capitated patients than with their non-capitated patients.

Comparison of primary care models in the prevention of cardiovascular disease - a cross sectional study

PubMed Central

2011-01-01

Background Primary care providers play an important role in preventing and managing cardiovascular disease. This study compared the quality of preventive cardiovascular care delivery amongst different primary care models. Methods This is a secondary analysis of a larger randomized control trial, known as the Improved Delivery of Cardiovascular Care (IDOCC) through Outreach Facilitation. Using baseline data collected through IDOCC, we conducted a cross-sectional study of 82 primary care practices from three delivery models in Eastern Ontario, Canada: 43 fee-for-service, 27 blended-capitation and 12 community health centres with salary-based physicians. Medical chart audits from 4,808 patients with or at high risk of developing cardiovascular disease were used to examine each practice's adherence to ten evidence-based processes of care for diabetes, chronic kidney disease, dyslipidemia, hypertension, weight management, and smoking cessation care. Generalized estimating equation models adjusting for age, sex, rurality, number of cardiovascular-related comorbidities, and year of data collection were used to compare guideline adherence amongst the three models. Results The percentage of patients with diabetes that received two hemoglobin A1c tests during the study year was significantly higher in community health centres (69%) than in fee-for-service (45%) practices (Adjusted Odds Ratio (AOR) = 2.4 [95% CI 1.4-4.2], p = 0.001). Blended capitation practices had a significantly higher percentage of patients who had their waistlines monitored than in fee-for-service practices (19% vs. 5%, AOR = 3.7 [1.8-7.8], p = 0.0006), and who were recommended a smoking cessation drug when compared to community health centres (33% vs. 16%, AOR = 2.4 [1.3-4.6], p = 0.007). Overall, quality of diabetes care was higher in community health centres, while smoking cessation care and weight management was higher in the blended-capitation models. Fee-for-service practices had the greatest gaps in care, most noticeably in diabetes care and weight management. Conclusions This study adds to the evidence suggesting that primary care delivery model impacts quality of care. These findings support current Ontario reforms to move away from the traditional fee-for-service practice. Trial Registration ClinicalTrials.gov: NCT00574808 PMID:22008366

Does capitation affect the delivery of oral healthcare and access to services? Evidence from a pilot contact in Northern Ireland.

PubMed

Hill, Harry; Birch, Stephen; Tickle, Martin; McDonald, Ruth; Donaldson, Michael; O'Carolan, Donncha; Brocklehurst, Paul

2017-03-06

In May 2009, the Northern Ireland government introduced General Dental Services (GDS) contracts based on capitation in dental practices newly set up by a corporate dental provider to promote access to dental care in populations that had previously struggled to secure service provision. Dental service provision forms an important component of general health services for the population, but the implications of health system financing on care delivered and the financial cost of services has received relatively little attention in the research literature. The aim of this study is to evaluate the policy effect capitation payment in recently started corporate practices had on the delivery of primary oral healthcare in Northern Ireland and access to services. We analysed the policy initiative in Northern Ireland as a natural experiment to find the impact on healthcare delivery of the newly set up corporate practices that use a prospective capitation system to remunerate primary care dentists. Data was collected from GDS claim forms submitted to the Business Services Organisation (BSO) between April 2011 and October 2014. Health and Social Care Board (HSCB) practices operating within a capitation system were matched to a control group, who were remunerated using a retrospective fee-for-service system. No evidence of patient selection was found in the HSCB practices set up by a corporate provider and operated under capitation. However, patients were less likely to visit the dentist and received less treatment when they did attend, compared to those belonging to the control group (P < 0.05). The extent of preventive activity offered and the patient payment charge revenue did not differ between the two practice groups. Although remunerating NHS primary care dentists in newly set up corporate practices using a prospective capitation system managed costs within healthcare, there is evidence that this policy may have reduced access to care of registered patients.

[Managed care in Latin America: transnationalization of the health sector in the context of reform].

PubMed

Iriart, C; Merhy, E E; Waitzkin, H

2000-01-01

This article presents the results of the comparative research project "Managed Care in Latin America: Its Role in Health Reform". The project was conducted by teams in Argentina, Brazil, Chile, Ecuador, and the United States. The study's objective was to analyze the process by which managed care is exported, especially from the United States, and how managed care is adopted in Latin American countries. Our research methods included qualitative and quantitative techniques. Adoption of managed care reflects transnationalization of the health sector. Our findings demonstrate the entrance of large multinational financial capital into the private insurance and health services sectors and their intention of participating in the administration of government institutions and medical/social security funds. We conclude that this basic change involving the slow adoption of managed care is facilitated by ideological changes with discourses accepting the inexorable nature of public sector reform.

The Future of Responder Family Preparedness: The New Normal

DTIC Science & Technology

2013-12-01

includes “emergency management, public health, clinical care , public works, and other skilled support personnel (such as equipment operators) that...injured family members who are in need of the care of the trooper are given first priority during these times, and management often advises the trooper...response to a potential biological incident in the National Capital Region (NCR) and found that family preparedness would be a determining factor in

Real estate strategies for 2005.

PubMed

Dunbar, Donald R

2005-05-01

Today's healthcare real estate strategies involve: assessing and prioritizing capital availability for building projects, carefully planning and implementing the process for the project Making beneficial decisions regarding facility management and maintenance.

Principal-agent theory: a framework for improving health care reform in Tennessee.

PubMed

Sekwat, A

2000-01-01

Using a framework based on principal-agent theory, this study examines problems faced by managed care organizations (MCOs) and major health care providers under the state of Tennessee's current capitation-based managed care programs called TennCare. Based on agency theory, the study proposes a framework to show how an effective collaborative relationship can be forged between the state of Tennessee and participating MCOs which takes into account the major concerns of third-party health care providers. The proposed framework further enhances realization of the state's key health care reform goals which are to control the rising costs of health care delivery and to expand health care coverage to uninsured and underinsured Tennesseans.

Racial comparisons of health care and glycemic control for African American and white diabetic adults in an urban managed care organization.

PubMed

Gary, Tiffany L; McGuire, Maura; McCauley, Jeanne; Brancati, Frederick L

2004-01-01

The excess risk of diabetic complications in African Americans may be due to poor glycemic control arising from suboptimal use and/or quality of diabetes-related health care. However, little is known about racial differences in these factors, particularly in urban populations. We conducted a cross-sectional study using medical claims and encounter data on 1,106 adults with diabetes aged > or =30 years who were members of an urban managed care organization in capitated health plans. We examined health care and routine hemoglobin A(1c) (HbA(1c)) testing in a biracial cohort for 12 months. We then followed individuals for an additional 12 months, using a retrospective cohort design, to determine how this health care predicted subsequent emergency room visits. On average, compared with their white counterparts, African Americans had fewer primary care visits (85% vs. 91% with four or more visits) and fewer HbA(1c) tests (56% vs. 68% with two or more HbA(1c) tests) (all P < 0.05). Likewise, in the subset who underwent one or more HbA(1c) measurement (n = 855), African Americans displayed poorer glycemic control (HbA(1c) 9.1 +/- 2.9%) than whites (8.5 +/- 2.2%; P = 0.001). In multivariate analyses, racial differences in visit frequency and HbA(1c) testing were attenuated by adjustment for age, sex, and type of capitated plan and did not remain statistically significant. The relationship of health care to subsequent emergency room visits differed by race; in African Americans, fewer primary care visits and HbA(1c) tests predicted greater risk of emergency room visits. Even in a capitated, managed care setting, urban African Americans with diabetes are less likely than their white counterparts to undergo routine primary care visits and laboratory testing and are more likely to have suboptimal glycemic control. Differences in age, sex, and insurance type seemed to explain some of the disparities. Future research should determine the individual contributions of physician, patient, and system factors to the racial disparities in health care.

Some early lessons from the rise of managed behavioral health care in the United States.

PubMed

Schowalter, J E

1998-01-01

In the 1990s the United States has, because of an unacceptable surge in health care costs, made a revolutionary shift of the reimbursement process from fee-for-service to managed care's restricted, discounted and capitated payment approaches. Mental health care has for 150 years largely been subsidized by tax supported hospitals and clinics. Federal and state governments have recently instead begun to direct much of their monies to for-profit national managed mental health care companies. While efficiency has improved and the steep rise in costs has been eased, the major drawback of this change is a too enthusiastic focus on corporate profits. Since on the whole managed care organizations do not reinvest profits into medical education or research and may pull out of the health care business once the business is no longer so profitable, clinicians and academicians must become more successful in urging politicians and the citizenry to better manage managed care.

Improving equity in the provision of primary health care: lessons from decentralized planning and management in Namibia.

PubMed Central

Bell, Ruth; Ithindi, Taathi; Low, Anne

2002-01-01

This paper draws lessons from a review of primary health care services in Windhoek, the capital of Namibia, undertaken by a regional health management team. The review was carried out because of perceived increases in workload and inadequate staffing levels, arising from the rapid expansion of the city associated with inward migration. A survey of the utilization of government clinics was used to develop a more equitable allocation of primary health care services between localities. The survey revealed disparities between patterns of utilization of the services and the allocation of staff: the poorer localities were relatively underprovided. Decisions made centrally on resource allocation had reinforced the inequities. On the basis of the results of the review, the regional health management team redistributed nursing and medical staff and argued for a shift in the allocation of capital expenditure towards the poorer communities. The review demonstrates the potential for regional and provincial health management teams to make effective assessments of the needs of their populations and to promote the equitable delivery of primary health care services. In order to achieve this they need not only to become effective managers, but also to develop population-based planning skills and the confidence and authority to influence the allocation of resources between and within their regions and provinces. PMID:12219160

Trend analysis of key solvency ratios for health plans in Medicaid managed care.

PubMed

McCue, Michael J

2013-01-01

The focus of this article is to assess the solvency of health plans that manage Medicaid members across key plan traits, specifically Medicaid dominant or plans with more than 75 percent Medicaid members, and plans owned by publicly traded companies, and sponsored by health care providers. The study accessed National Association of Insurance Commissioners (NAIC) financial data and computed key solvency ratios for 117 Medicaid health plans over a five-year time trend from 2007 to 2011. A mean test compared the mean values for each year and for the entire study period on risk-based capital (RBC), cash-flow margin and debt to total capital ratios across these plan traits. For all years except 2008 Medicaid dominant plans had a lower RBC ratio for all four out of five years. Cash-flow margin ratio for Medicaid dominant plans was only lower in 2011 than non-Medicaid dominant plans. From 2007 to 2010, debt to total capital was higher for plans owned by publicly traded companies than non-publicly traded companies. Given the potential for an expanding Medicaid market, Medicaid health plans have reduced their risk of insolvency by increasing the RBC over time and reducing their debt capital. However between 2010 and 2011 cash-flow margin ratio decreased by almost 180 basis points for Medicaid dominant plans.

Customer centered health care: why managed care organizations must capitalize on new technology to build brands and customer loyalty.

PubMed

Fell, D

1998-01-01

Now, more than ever, health care organizations are desperately trying to reach out to customers and establish stronger relationships that will generate increased loyalty and repeat business. As technology, like the Internet and related mediums, allow us to do a better job of managing information and communication, health care executives must invest the time and resources necessary to bring these new advances into the day-to-day operations of their businesses. Those that do will have a head start in building their brand and their customer loyalty.

Comprehensive nursing case management. An advanced practice model.

PubMed

Taylor, P

1999-01-01

Under managed care and capitated reimbursement systems, case management is a core strategy for providing high-quality, cost-effective care by decreasing fragmentation, enhancing quality, ensuring efficient use of resources, and containing costs. Although case management is used in various areas of the healthcare arena, it suffers from a lack of consensus regarding its definition, essential components, and appropriate application. The purpose of this paper is to examine the components and limitations of existing case management models, outline the competencies of an effective case manager, and present a model of advanced practice nursing case management that focuses on a continuum of care that integrates medical and psychosocial resources to promote optimal clinical fiscal outcomes and enables patients to work as partners with the healthcare team in facilitating and maintaining their physical and emotional well-being.

Catholic healthcare's future. Ten models for competition and capitation.

PubMed

Zuckerman, A M; Coile, R C

1997-01-01

In the next five years, Catholic providers must select strategies that will involve affiliations, acquisitions, and consolidations with Catholic and non-Catholic partners. At least 10 options are available to meet the long-term trends of managed care, competition, and capitation. Vertical integration allows comprehensive patient care. Multisponsor management can help religious institutes expand their market share. Systems and one-hospital sponsors can affiliate their facilities to form Catholic networks. Community-based not-for-profit networks can include both Catholic and non-Catholic organizations bound by contracts and joint ventures. Joint ventures provide the benefits of integration to Catholic providers, who must be willing to commit substantial capital to create HMOs and other networks with non-Catholic partners. Acquisition of facilities and regional and statewide expansion can strengthen a Catholic system's market position in the face of declining acute care hospital services. Catholic/non-Catholic mergers risk consolidating and closing facilities but need not erase Catholic identity. Cooperation between affiliation and merger, or "co-opetition," involves creating new legal territory for Catholic/non-Catholic consolidation. Divestiture may be an ultimate strategy, but Catholic sponsors must proceed with caution in their dealings with plentiful buyers. Catholic facilities and systems are joining with Catholic Charities, other providers, and local agencies to create networks.

Factors Affecting Plan Choice and Unmet Need among Supplemental Security Income Eligible Children with Disabilities

PubMed Central

Mitchell, Jean M; Gaskin, Darrell J

2005-01-01

Objective To evaluate factors affecting plan choice (partially capitated managed care [MC] option versus the fee-for-service [FFS] system) and unmet needs for health care services among children who qualified for supplemental security income (SSI) because of a disability. Data Sources We conducted telephone interviews during the summer and fall of 2002 with a random sample of close to 1,088 caregivers of SSI eligible children who resided in the District of Columbia. Research Design We employed a two-step procedure where we first estimated plan choice and then constructed a selectivity correction to control for the potential selection bias associated with plan choice. We included the selectivity correction, the dummy variable indicating plan choice and other exogenous regressors in the second stage equations predicting unmet need. The dependent variables in the second stage equations include: (1) having an unmet need for any service or equipment; (2) having an unmet need for physician or hospital services; (3) having an unmet need for medical equipment; (4) having an unmet need for prescription drugs; (5) having an unmet need for dental care. Principal Findings More disabled children (those with birth defects, chronic conditions, and/or more limitations in activities of daily living) were more likely to enroll in FFS. Children of caregivers with some college education were more likely to opt for FFS, whereas children from higher income households were more prone to enroll in the partially capitated MC plan. Children in FFS were 9.9 percentage points more likely than children enrolled in partially capitated MC to experience an unmet need for any type of health care services (p<.01), while FFS children were 4.5 percentage points more likely than partially capitated MC enrollees to incur a medical equipment unmet need (p<.05). FFS children were also more likely than partially capitated MC enrollees to experience unmet needs for prescription drugs and dental care, however these differences were only marginally significant. Conclusions We speculate that the case management services available under the MC option, low Medicaid FFS reimbursements and provider availability account for some of the differences in unmet need that exist between partially capitated MC and FFS enrollees. PMID:16174139

The Relationship between Social Capital in Hospitals and Physician Job Satisfaction

PubMed Central

Ommen, Oliver; Driller, Elke; Köhler, Thorsten; Kowalski, Christoph; Ernstmann, Nicole; Neumann, Melanie; Steffen, Petra; Pfaff, Holger

2009-01-01

Background Job satisfaction in the hospital is an important predictor for many significant management ratios. Acceptance in professional life or high workload are known as important predictors for job satisfaction. The influence of social capital in hospitals on job satisfaction within the health care system, however, remains to be determined. Thus, this article aimed at analysing the relationship between overall job satisfaction of physicians and social capital in hospitals. Methods The results of this study are based upon questionnaires sent by mail to 454 physicians working in the field of patient care in 4 different German hospitals in 2002. 277 clinicians responded to the poll, for a response rate of 61%. Analysis was performed using three linear regression models with physician overall job satisfaction as the dependent variable and age, gender, professional experience, workload, and social capital as independent variables. Results The first regression model explained nearly 9% of the variance of job satisfaction. Whereas job satisfaction increased slightly with age, gender and professional experience were not identified as significant factors to explain the variance. Setting up a second model with the addition of subjectively-perceived workload to the analysis, the explained variance increased to 18% and job satisfaction decreased significantly with increasing workload. The third model including social capital in hospital explained 36% of the variance with social capital, professional experience and workload as significant factors. Conclusion This analysis demonstrated that the social capital of an organisation, in addition to professional experience and workload, represents a significant predictor of overall job satisfaction of physicians working in the field of patient care. Trust, mutual understanding, shared aims, and ethical values are qualities of social capital that unify members of social networks and communities and enable them to act cooperatively. PMID:19445692

Starting up the upstarts.

PubMed

Greene, J

1997-12-20

Venture capitalists pour $1 billion a year into health care--and that investment may be the most overlooked indicator of new business opportunities. Signs show that companies focused on consolidation and cost-cutting are off the A list for risk capital. Instead, venture capitalists are targeting start-ups that save money on the front lines by truly managing care.

Matching physician compensation plans to capitation levels.

PubMed

Kennedy, K M; Buckley, M P

1997-09-01

As managed care penetration increases, physician compensation plans need to reflect the current transition from fee-for-service to capitated payment. In choosing the compensation structure that will be most beneficial to the success of the group practice and secure physician buy-in, practices need to assess their mission, goals, and corporate culture. They also need to assess their percentage of capitation to total revenues and develop, when necessary, new compensation pools that reward physicians for a variety of behaviors, such as increased productivity and utilization control. Compensation plans should be fair, flexible, and simple to understand and administer.

Efficiency, new equity capital enable systems to compete.

PubMed

Brown, M; McCool, B P

1985-01-01

Because of limited cash, sponsors of some community and religious hospitals have sought to sell or lease their institutions to a not-for-profit (NFP) system or to a for-profit system. A number of national alliances address the capital formation problem of NFP institutions. Until now they have been almost exclusively concerned with acquiring less costly debt. Without new equity capital, market influence is difficult to obtain. Even well-managed voluntary systems face a serious threat from well-capitalized investor-owned systems. Increased competition among hospitals and physicians will force future advantages to those who have capital. It will also restrict funding of certain programs and services by voluntary enterprises. In anticipation of this, various forms of partnerships have developed with investor-owned systems. To regain the initiative as the premier sponsors of health care, religious and other voluntary systems must go beyond merely competing in their markets to acquiring weaker institutions. They also must revitalize private giving and excel in efficiency to offset threats from ambulatory, day-care operations and from high-technology hospitals. Structural changes in the industry can be predicted, including the following: The trend toward integration for production, financing, and marketing will continue. Public market equity capital will be increasingly used to finance medical practice. Hospitals that sell their equity values will establish service foundations. National alliances will continue, but strictly local systems will maintain operation. Investor-owned systems will move increasingly into high-technology tertiary care.

Value-based formulas for purchasing. PEHP's designated service provider program: value-based purchasing through global fees.

PubMed

Emery, D W

1997-01-01

In many circles, managed care and capitation have become synonymous; unfortunately, the assumptions informing capitation are based on a flawed unidimensional model of risk. PEHP of Utah has rejected the unidimensional model and has therefore embraced a multidimensional model of risk that suggests that global fees are the optimal purchasing modality. A globally priced episode of care forms a natural unit of analysis that enhances purchasing clarity, allows providers to more efficiently focus on the Marginal Rate of Technical Substitution, and conforms to the multidimensional reality of risk. Most importantly, global fees simultaneously maximize patient choice and provider cost consciousness.

Technology management: case study of an integrated health system.

PubMed

Dahl, D H; McFarlan, T K

1994-12-01

Technology management has assumed a role of vital importance in today's health care environment. Capital reserves and operating income have been stretched by pervasive and expensive technologies, while overall reimbursement has been reduced. It is imperative for hospitals to develop and consistently use technology management processes that begin prior to a technology's introduction in the hospital and continue throughout its life cycle. At Samaritan Health System (SHS), an integrated health care delivery system based in Phoenix, technology management provides tools to improve decision making and assist in the system's integration strategy as well as control expenses. SHS uses a systemwide technology-specific plan to guide acquisition and/or funding decisions. This plan describes how particular technologies can help achieve SHS' organizational goals such as promoting system integration and/or improving patient outcomes while providing good economic value. After technologies are targeted in this systemwide plan they are prioritized using a two-stage capital prioritization process. The first stage of the capital prioritization process considers the quantitative and qualitative factors critical for equitable capital distribution across the system. The second stage develops a sense of ownership among the parties that affect and are affected by the allocation at a facility level. This process promotes an efficient, effective, equitable, and defensible approach to resource allocation and technology decision making. Minimizing equipment maintenance expenditures is also an integral part of technology management at SHS. The keys to reducing maintenance expenditures are having a process in place that supports a routine fiscal evaluation of maintenance coverage options and ensuring that manufacturers are obligated to provide critical maintenance resources at the time of equipment purchase. Maintenance service options under consideration in this report include full-service contracts with the manufacturer, insurance coverage, time and materials, and independent service vendors/in-house support. Careful consideration of all the ramifications of each option is warranted because there are substantial cost differences among these methods. At SHS, technology management efforts resulted in equipment purchases and maintenance negotiations representing savings of more than $1.5 million in a single year. SHS undertakes an intensive review of purchases and maintenance expenditures, using the techniques described in this report, with the objective of reducing expenses by 10% per year. This report describes the technology management methods that SHS uses to achieve these results.

Impact of HMO ownership on management processes and utilization outcomes.

PubMed

Ahern, M; Molinari, C

2001-05-01

To examine the effects of health maintenance organization (HMO) ownership characteristics on selected utilization outcomes and management processes affecting utilization. We used 1995 HMO data from the American Association of Health Plans. Using regression analysis, we examined the relation between HMO utilization (hospital discharges, days, and average length of stay; cardiac catheterization procedures; and average cost of outpatient prescriptions) and the structural characteristics of HMOs: ownership type (insurance company, hospital, physician, independent, and national managed care company), HMO size, for-profit status, model type, geographic region, and payer mix. HMO ownership type is significantly associated with medical management processes, including risk sharing by providers, risk sharing by consumers, and other management strategies. Relative to hospital-owned HMOs, insurance company-owned HMOs have fewer hospital discharges, fewer hospital days, and longer lengths of stay. National managed care organization-owned HMOs have fewer cardiac catheterizations and lower average outpatient prescription costs. Independently owned HMOs have more cardiac catheterizations. For-profit HMOs have lower prescription costs. Relative to hospital-owned HMOs, insurance company-owned HMOs are more likely to use hospital risk sharing and provider capitation and less likely to use out-of-pocket payments for hospital use and a closed formulary. National managed care organization-owned HMOs are less likely to use provider capitation, out-of-pocket payments for hospital use, catastrophic case management, and hospital risk sharing. Physician-hospital-owned HMOs are less likely to use catastrophic case management. For-profit HMOs are more likely to use hospital risk sharing and catastrophic case management. HMO ownership type affects utilization outcomes and management strategies.

Ownership, competition, and the adoption of new technologies and cost-saving practices in a fixed-price environment.

PubMed

Hirth, R A; Chernew, M E; Orzol, S M

2000-01-01

Advances in medical technology have been implicated as the primary cause of rising health care expenditures. It is not yet known whether the increasing prevalence of managed care mechanisms, particularly capitation, will change substantially incentives for acquiring and using cost-increasing innovations. We examined the decisions of dialysis units (a set of providers that has faced capitation and real decreases in payment for several decades) with respect to use of cost-increasing technologies that enhance quality of care, cost-cutting practices that reduce quality of care, and amenities desired by patients that are unrelated to quality of care. We found that the dialysis payment system does not appear to have blocked access to a number of new, quality-enhancing technologies that were developed in the 1980s. However, facilities made adjustments along other valuable margins to facilitate adoption of these technologies; use of new technologies varied with numerous facility, regulatory, and case-mix characteristics including ownership, chain membership, size, market competition, and certificate of need programs. Interestingly, the trade-offs made by for-profit and nonprofit facilities when faced with fixed prices appeared quite different. For-profits tended to deliver lower technical quality of care but more amenities, while nonprofits favored technical quality of care over amenities. Our findings may have implications for the response of other types of health care providers to capitation and increasing economic constraints.

Financial risk sharing with providers in health maintenance organizations, 1999.

PubMed

Gold, Marsha R; Lake, Timothy; Hurley, Robert; Sinclair, Michael

2002-01-01

The transfer of financial risk from health maintenance organizations (HMOs) to providers is controversial. To provide timely national data on these practices, we conducted a telephone survey in 1999 of a multi-staged probability sample of HMOs in 20 of the nation's 60 largest markets, accounting for 86% of all HMO enrollees nationally. Among those sampled, 82% responded. We found that HMOs' provider networks with physicians, hospitals, skilled nursing homes, and home health agencies are complex and multi-tiered Seventy-six percent of HMOs in our study use contracts for their HMO products that involve global, professional services, or hospital risk capitation to intermediate entities. These arrangements account for between 24.5 million and 27.4 million of the 55.9 million commercial and Medicare HMO enrollees in the 60 largest markets. While capitation arrangements are particularly common in California, they are more common elsewhere than many assume. The complex layering of risk sharing and delegation of care management responsibility raise questions about accountability and administrative costs in managed care. Do complex structures provide a way to involve providers more directly in managed care, or do they diffuse authority and add to administrative costs?

Competencies for health management practice: a practitioner's perspective.

PubMed

Wenzel, F J; Grady, R; Freedman, T J

1995-01-01

The current health care environment will require executive leadership with a new set of management competencies to effectively lead and manage the various components of a restructured health care delivery system. The traditional management skills of planning, organizing, directing, controlling, and staffing resources will remain relevant, but the true measure of professional success will be the development of conceptual skills. This means the ability to look at the health care enterprise as a whole, and recognize how changes in the environment shape your strategic mission, goals, and objectives. The successful health care leader will have a demonstrated ability to apply these conceptual skills to the development of information systems and integrated networks that position their organization to accept capitated risks. This paper examines the United States and Canadian health care systems from the perspective of both the more traditional hospital and the emerging medical care organizations. New importance of the team approach to leadership and management and all that entails is stressed.

Designing HIGH-COST medicine: hospital surveys, health planning, and the paradox of progressive reform.

PubMed

Perkins, Barbara Bridgman

2010-02-01

Inspired by social medicine, some progressive US health reforms have paradoxically reinforced a business model of high-cost medical delivery that does not match social needs. In analyzing the financial status of their areas' hospitals, for example, city-wide hospital surveys of the 1910s through 1930s sought to direct capital investments and, in so doing, control competition and markets. The 2 national health planning programs that ran from the mid-1960s to the mid-1980s continued similar strategies of economic organization and management, as did the so-called market reforms that followed. Consequently, these reforms promoted large, extremely specialized, capital-intensive institutions and systems at the expense of less complex (and less costly) primary and chronic care. The current capital crisis may expose the lack of sustainability of such a model and open up new ideas and new ways to build health care designed to meet people's health needs.

[Different forms of payment systems for dental services and their impact on care].

PubMed

Sória, Marina Lara; Bordin, Ronaldo; da Costa Filho, Luiz Cesar

2002-01-01

The Brazilian dental care sector is facing a paradoxical crisis characterized by a surplus of dentists and a large contingent of people lacking dental care, thus highlighting the need to improve management strategies. One necessary step is to analyze the various payment schemes for dental services. This paper reviews two important approaches, fee for service and capitation, and considers the impacts and consequences of payment strategies on the dental care system.

Looking Through a Social Lens: Conceptualising Social Aspects of Knowledge Management for Global Health Practitioners

PubMed Central

Limaye, Rupali J.; Sullivan, Tara M.; Dalessandro, Scott; Jenkins, Ann Hendrix

2017-01-01

Knowledge management plays a critical role in global health. Global health practitioners require knowledge in every aspect of their jobs, and in resource-scarce contexts, practitioners must be able to rely on a knowledge management system to access the latest research and practice to ensure the highest quality of care. However, we suggest that there is a gap in the way knowledge management is primarily utilized in global health, namely, the systematic incorporation of human and social factors. In this paper, we briefly outline the evolution of knowledge management and then propose a conceptualization of knowledge management that incorporates human and social factors for use within a global health context. Our conceptualization of social knowledge management recognizes the importance of social capital, social learning, social software and platforms, and social networks, all within the context of a larger social system and driven by social benefit. We then outline the limitations and discuss future directions of our conceptualization, and suggest how this new conceptualization is essential for any global health practitioner in the business of managing knowledge. Significance for public health Managing knowledge is essential for improving population health outcomes. Global health practitioners at all levels of the health system are bombarded with information related to best practices and guideline changes, among other relevant information to provide the best quality of care. Knowledge management, or the act of effectively using knowledge, has yet to capitalize on the power of social connections within the context of global health. While social elements have been incorporated into knowledge management activities, we suggest that systematically integrating key concepts that leverage social connections, such as social systems, social capital, social learning, and social software, will yield greater benefit with regard to health outcomes. As such, we outline a new conceptualization of knowledge management, focusing on the social aspects of the practice, and posit that such an approach can further the impact of global health interventions and is crucial for global health practitioners. PMID:28480173

Willingness to participate in accountable care organizations: health care managers' perspective.

PubMed

Wan, Thomas T H; Demachkie Masri, Maysoun; Ortiz, Judith; Lin, Blossom Y J

2014-01-01

This study examines how health care managers responded to the accountable care organization (ACO). The effect of perceived benefits and barriers of the commitment to develop a strategic plan for ACOs and willingness to participate in ACOs is analyzed, using organizational social capital, health information technology uses, health systems integration and size of the health networks, geographic factors, and knowledge about ACOs as predictors. Propensity score matching and analysis are used to adjust the state and regional variations. When the number of perceived benefits is greater than the number of perceived barriers, health care managers are more likely to reveal a stronger commitment to develop a strategic plan for ACO adoption. Health care managers who perceived their organizations as lacking leadership support or commitment, financial incentives, and legal and regulatory support to ACO adoption were less willing to participate in ACOs in the future. Future research should gather more diverse views from a larger sample size of health professionals regarding ACO participation. The perspective of health care managers should be seriously considered in the adoption of an innovative health care delivery system. The transparency on policy formulation should consider multiple views of health care managers.

Construction and Application of a Refined Hospital Management Chain.

PubMed

Lihua, Yi

2016-01-01

Large scale development was quite common in the later period of hospital industrialization in China. Today, Chinese hospital management faces such problems as service inefficiency, high human resources cost, and low rate of capital use. This study analyzes the refined management chain of Wuxi No.2 People's Hospital. This consists of six gears namely, "organizational structure, clinical practice, outpatient service, medical technology, and nursing care and logistics." The gears are based on "flat management system targets, chief of medical staff, centralized outpatient service, intensified medical examinations, vertical nursing management and socialized logistics." The core concepts of refined hospital management are optimizing flow process, reducing waste, improving efficiency, saving costs, and taking good care of patients as most important. Keywords: Hospital, Refined, Management chain

Developing a managed care delivery system in New York State for Medicaid recipients with HIV.

PubMed

Feldman, I; Cruz, H; DeLorenzo, J; Hidalgo, J; Plavin, H; Whitaker, J

1999-11-01

In the state of New York, models of care known as HIV Special Needs Plans (HIV SNPs) are being developed to meet the unique health and medical needs of Medicaid recipients with HIV. Establishing managed care plans for the 80,000 to 100,000 HIV-infected Medicaid recipients residing in the state has required considerable effort, including distributing planning grants to solicit information and recommendations regarding program and fiscal policy; convening a workgroup to facilitate discussions between the state and the provider and consumer communities; conducting a longitudinal survey to assess the impact of managed care on persons with HIV; and developing a longitudinal, person-based, encounter-level database representing the clinical and service utilization histories of more than 100,000 patients for state fiscal years 1990 to 1996. The key fiscal issues identified and discussed were capitation rates, initial capitalization levels, and risk-adjustment mechanisms. Other pertinent issues included the importance of a benefits package supporting a comprehensive, integrated continuum of state-of-the-art services; marketing and enrollment; attention to provider and consumer training and education needs; and interdependence of financial reimbursement and benefits packages. From our experience in New York State, we conclude that a successful model of Medicaid managed care for persons with HIV should build on the existing infrastructure of services, using a collaborative process among government agencies, healthcare providers, and HIV/AIDS consumer communities. A future challenge lies in the implementation of the HIV SNP model and evaluation of its soundness and ability to ensure quality healthcare services.

Strategic planning futurists need to be capitation-specific and epidemiological.

PubMed

Kurtenbach, J; Warmoth, T

1995-09-01

Strategic planning has always been a proposition of envisioning an organization's future state, then working backward, quarter by quarter, year by year, to plot a course of action. The surer the vision, the surer the course. In our burgeoning capitated environment, the successful provider will clarify a singular vision: to manage health care for a defined population. The key will be to understand the changing needs of covered lives and to prepare the organization to serve those needs. Gone are the days when mere responsiveness to market needs and preferences could secure a hospital's competitive advantage. Nimble, surefooted, practically clairvoyant--the emerging health care leader will listen to reliable epidemiologic information and custom-design its future. Timing is everything. Depending only your market's readiness for capitation, epidemiologic research and planning techniques may not prove critical to your organization for five to seven years. Good thing, too, because a few years may be just the head start many hospitals and health care systems need. Now is the time to lay the groundwork, to cultivate new planning techniques that will work under capitation, and to jettison any outdated modes of strategic thinking. Assemble all the talent and knowledge you need, then give your best minds ample room to do their work.

Technology assessment and requirements analysis: a process to facilitate decision making in picture archiving and communications system implementation.

PubMed

Radvany, M G; Chacko, A K; Richardson, R R; Grazdan, G W

1999-05-01

In a time of decreasing resources, managers need a tool to manage their resources effectively, support clinical requirements, and replace aging equipment in order to ensure adequate clinical care. To do this successfully, one must be able to perform technology assessment and capital equipment asset management. The lack of a commercial system that adequately performed technology needs assessment and addressed the unique needs of the military led to the development of an in-house Technology Assessment and Requirements Analysis (TARA) program. The TARA is a tool that provides an unbiased review of clinical operations and the resulting capital equipment requirements for military hospitals. The TARA report allows for the development of acquisition strategies for new equipment, enhances personnel management, and improves and streamlines clinical operations and processes.

Capitation and risk adjustment in health care financing: an international progress report.

PubMed

Rice, N; Smith, P C

2001-01-01

In every system of health care, capitation payments have become the accepted tool used by health care purchasers in much of the developed world to determine prospective budgets. The policy prescription of capitation is perceived to address both equity objectives (of great importance in publicly funded systems of health care) and efficiency objectives (the dominant concern in competitive insurance markets). An examination of the current state of the art in 20 countries outside the United States in which health care capitation has been implemented confirms that capitation has assumed central importance within diverse systems of health care. In practice, however, the setting of capitation payments has been heavily constrained to date by poor data availability and unsatisfactory analytic methodology.

Does care matter? Care capital and mothers’ time to paid employment

PubMed Central

Hogan, Dennis

2014-01-01

The aim of this study is to introduce the concept of care capital and provide an example of its application in the context of childcare and maternal employment using the currently most suitable American data. We define care capital as the nexus of available, accessible, and experienced resources for care. The American setting is an ideal context to investigate the linkages between child care capital and maternal employment as the patterns of child care use tend to be more diverse compared to other national contexts. In the presented application of care capital, we examine mothers’ entry to paid employment during the first 36 weeks following a birth, and its association with the experience of non-parental child care use before labour force entry. Using data from the Early Childhood Longitudinal Survey—Birth Cohort (N = 10,400 mothers), results from discrete-time hazard models show that use of non-parental child care prior to employment is independently and positively associated with entry into maternal employment. This finding applies both to first-time mothers (n = 3,800) and to mothers of multiple children (n = 6,600). Although data currently available for investigating child care capital are limited with regard to care availability and access, our results suggests that childcare availability, access, and use, understood as a form of capital alongside economic and human capital, should be considered in future studies of maternal employment. PMID:25346617

Does care matter? Care capital and mothers' time to paid employment.

PubMed

Loft, Lisbeth Trille G; Hogan, Dennis

2014-09-01

The aim of this study is to introduce the concept of care capital and provide an example of its application in the context of childcare and maternal employment using the currently most suitable American data. We define care capital as the nexus of available, accessible, and experienced resources for care. The American setting is an ideal context to investigate the linkages between child care capital and maternal employment as the patterns of child care use tend to be more diverse compared to other national contexts. In the presented application of care capital, we examine mothers' entry to paid employment during the first 36 weeks following a birth, and its association with the experience of non-parental child care use before labour force entry. Using data from the Early Childhood Longitudinal Survey-Birth Cohort ( N = 10,400 mothers), results from discrete-time hazard models show that use of non-parental child care prior to employment is independently and positively associated with entry into maternal employment. This finding applies both to first-time mothers ( n = 3,800) and to mothers of multiple children ( n = 6,600). Although data currently available for investigating child care capital are limited with regard to care availability and access, our results suggests that childcare availability, access, and use, understood as a form of capital alongside economic and human capital, should be considered in future studies of maternal employment.

The worth of land use: a GIS-emergy evaluation of natural and human-made capital.

PubMed

Mellino, Salvatore; Buonocore, Elvira; Ulgiati, Sergio

2015-02-15

Natural systems make their natural capital and ecosystem services available to human economy. A careful analysis of the interplay between natural and human-made capital is needed to prevent natural capital being overexploited for present economic benefits, affecting lifestyles and wellbeing of future generations. In this study, the emergy synthesis is used to evaluate the natural and the human-made capital of Campania region (southern Italy) by accounting for the environmental support directly and indirectly provided by nature to resource generation. Furthermore, geographic information system (GIS) models are integrated with the emergy accounting procedure to generate maps of the spatial patterns of both natural and human-made capital distribution. Regional storages of natural and human-made capital are identified and evaluated in emergy units (seJ). The human-made capital of the Campania region (6.29E+24seJ) results to be about 11 times higher than the natural capital (5.69E+23seJ) due to the past and present exploitation of the natural resources needed to generate it over time. Moreover, by overlaying the total natural capital map and the total human-made capital map with a map of the protected areas within the region, only the 19% of the regional natural capital appears to be concentrated within protected areas, while most of it (81%) is concentrated outside. These findings suggest that the conservation of natural resources is also necessary outside protected areas by means of suitable policies, directives and investments. The human-made capital is mainly concentrated (88%) inside non-protected areas and interacts with the local natural capital. A management of the interactions between the two categories of wealth is crucial to prevent that the growth of human-made storages degrades the natural ecosystems and the environment. The proposed emergy-GIS framework reveals to be a useful tool for environmental planning and resource management aimed to conserve and protect the regional environmental heritage. Copyright © 2014 Elsevier B.V. All rights reserved.

Breaking rural health care paradigms leads to collaboration. Interview by Donald E. Johnson.

PubMed

Knoble, J K

1993-05-01

Strategic planning in a rural community is a challenge. Trying to predict the impact of federal health care reforms while undertaking a 30 million dollar capital construction campaign to consolidate two deteriorating hospitals into one new medical center could have been a nightmare. Health Care Strategic Management publisher Donald E.L. Johnson and Eastern New Mexico Medical Center president and chief executive officer James K. Knoble discuss the challenges of federal health care reforms and rural health care administration, and explore potential opportunities for collaboration and integration.

New Zealand's health providers in an emerging market.

PubMed

Malcolm, L; Barnett, P

1994-01-01

Services have almost completely replaced hospitals as the organisational units in the reformed New Zealand health care system. Within the secondary service provider sector service management, the decentralisation of general management to budget-holding clinical groupings has been an important factor in achieving a population focus, cost containment, accountability and integration. It is being further developed within the 23 newly formed Crown health enterprises (CHEs), the main providers of secondary, hospital and related services. The CHEs are evolving roles beyond a narrow definition of 'providers', taking initiatives to collaborate with other providers, or rejecting those elements of competition that might interfere with effective local co-ordination of services. Service management is also being extended to the demand-driven, fee-for-service primary care sector, where inflation-adjusted expenditure over the last decade has grown at more than 6%, compared with zero growth in the capitation-financed secondary sector. This is being achieved in both general practice and community budget-holder groupings through what might be called managed primary health care. The current health reform process has also created four regional health authorities (RHAs), responsible, within capped and capitated budgets, for the fully integrated purchasing of services from both primary and secondary providers. The success of these innovative arrangements, which could be of international significance, will depend upon the quality of the developing relationships between providers and their purchasing RHAs.

Four nurse entrepreneurs: what motivated them to start their own businesses.

PubMed

Roggenkamp, S D; White, K R

1998-01-01

In an environment of change, innovators or entrepreneurs emerge to develop new methods and processes of delivering health care in a way that lowers the overall costs of care while improving outcomes. This qualitative study looks at the factors that motivate nurse entrepreneurs as well as the characteristics of nurse entrepreneurs and their business ventures. The rationale for health care managers to capitalize on nurse entrepreneurship is discussed as an effective method of strategic adaptation.

Bullet Train.

ERIC Educational Resources Information Center

Galagan, Patricia A.

1999-01-01

Knowledge Universe is a conglomerate that includes an assortment of training companies, a chain of child-care centers, a knowledge-management consulting business, and an educational toy maker. KU's mission includes building human capital from birth to post-retirement, providing lifelong learning opportunities, and helping businesses use the power…

Social capital and antenatal depression among Chinese primiparas: A cross-sectional survey.

PubMed

Zhou, Chi; Ogihara, Atsushi; Chen, Hao; Wang, Weijue; Huang, Liu; Zhang, Baodan; Zhang, Xueni; Xu, Liangwen; Yang, Lei

2017-11-01

The aim of this study is to investigate the associations between social capital and antenatal depression among Chinese primiparas. A cross-sectional design was used and a questionnaire survey was conducted with 1471 participants using the intercept method at the provincial hospital in Zhejiang in 2016. Antenatal depression was evaluated using the Edinburgh Postnatal Depression Scale (EPDS) and social capital was assessed by the Chinese version of Social Capital Assessment Questionnaire (C-SCAQ). The prevalence of antenatal depression was assessed among Chinese primiparas in their third trimesters. The antenatal depression prevalence among sub-groups with lower social trust (ST), social reciprocity (SR), social network (SN), and social participation (SP) were significantly higher than those among higher score sub-groups. In the fully adjusted model, primiparas' antenatal depression was significantly associated with ST, SR, SN, and SP. Compared to the structural social capital, the cognitive social capital was a more crucial dimension to the prevalence of antenatal depression. For future community pregnancy health care management programs in China, it might be beneficial to add more social capital related intervention. Copyright © 2017 Elsevier B.V. All rights reserved.

An economic analysis of health plan conversions: are they in the public interest?

PubMed

Beaulieu, Nancy Dean

2004-01-01

Over the last decade, managed-care companies have been consolidating on both a regional and national scale. More recently, nonprofit health plans have been converting to for-profit status, and this conversion has frequently occurred as a step to facilitate merger or acquisition with a for-profit company. Some industry observers attribute these managed-care marketplace trends to an industry shakeout resulting from increased competition in the sector. At the same time, these perceived competitive pressures have led to questions about the long-run viability of nonprofit health plans. Furthermore, some industry and government leaders believe that some nonprofits are already conducting themselves like for-profit health plans and question the state premium tax exemption ordinarily accorded to such plans. This paper examines related health policy issues through the lens of a case study of the proposed conversion of the CareFirst Blue Cross Blue Shield company to a for-profit public-stock company and its merger with the Wellpoint Corporation. Company executives and board members argued that CareFirst lacked access to sufficient capital and faced serious threats to its viability as a financially healthy nonprofit health care company. They also argued that CareFirst and its beneficiaries would benefit from merger through enhanced economies of scale and product-line extensions. Critics of the proposed conversion and merger raised concerns about the adverse impacts on access to care, coverage availability, quality of care, safety-net providers, and the cost of health insurance. Analyses demonstrate that CareFirst wields substantial market power in its local market, that it is unlikely to realize cost savings through expanded economies of scale, and that access to capital concerns are largely driven by the perceived need for further expansion through merger and acquisition. Although it is impossible to predict future changes in quality of care for CareFirst, analyses suggest that quality appears to be somewhat lower in for-profit national managed-care companies. Additional research is needed to assess the viability of true nonprofits, the potential effects of nonprofits and for-profit national managed-care plans on the evolution of local insurance and provider markets, and methods for effective oversight of nonprofit health plans.

Does capitation matter? Impacts on access, use, and quality.

PubMed

Zuvekas, Samuel H; Hill, Steven C

2004-01-01

Provider capitation may constrain costs, but it also may reduce access and quality of care. We examine the impacts of capitating the usual source of care of enrollees in health maintenance organizations (HMOs). We account for the endogeneity of capitation and other characteristics using generalized methods of moments (GMM) estimation on a sample from the Medical Expenditure Panel Survey for 1996 and 1997. Being organized as a group/staff HMO generally has stronger impact on access and quality than capitation. Capitation by itself may increase access to consumers' usual sources of care, improve primary preventive care, and reduce coordination, but estimates with GMM were not statistically significant.

High Levels Of Capitation Payments Needed To Shift Primary Care Toward Proactive Team And Nonvisit Care.

PubMed

Basu, Sanjay; Phillips, Russell S; Song, Zirui; Bitton, Asaf; Landon, Bruce E

2017-09-01

Capitated payments in the form of fixed monthly payments to cover all of the costs associated with delivering primary care could encourage primary care practices to transform the way they deliver care. Using a microsimulation model incorporating data from 969 US practices, we sought to understand whether shifting to team- and non-visit-based care is financially sustainable for practices under traditional fee-for-service, capitated payment, or a mix of the two. Practice revenues and costs were computed for fee-for-service payments and a range of capitated payments, before and after the substitution of team- and non-visit-based services for low-complexity in-person physician visits. The substitution produced financial losses for simulated practices under fee-for-service payment of $42,398 per full-time-equivalent physician per year; however, substitution produced financial gains under capitated payment in 95 percent of cases, if more than 63 percent of annual payments were capitated. Shifting to capitated payment might create an incentive for practices to increase their delivery of team- and non-visit-based primary care, if capitated payment levels were sufficiently high. Project HOPE—The People-to-People Health Foundation, Inc.

Designing HIGH-COST Medicine Hospital Surveys, Health Planning, and the Paradox of Progressive Reform

PubMed Central

2010-01-01

Inspired by social medicine, some progressive US health reforms have paradoxically reinforced a business model of high-cost medical delivery that does not match social needs. In analyzing the financial status of their areas’ hospitals, for example, city-wide hospital surveys of the 1910s through 1930s sought to direct capital investments and, in so doing, control competition and markets. The 2 national health planning programs that ran from the mid-1960s to the mid-1980s continued similar strategies of economic organization and management, as did the so-called market reforms that followed. Consequently, these reforms promoted large, extremely specialized, capital-intensive institutions and systems at the expense of less complex (and less costly) primary and chronic care. The current capital crisis may expose the lack of sustainability of such a model and open up new ideas and new ways to build health care designed to meet people's health needs. PMID:20019312

Europe sees mixed results from public-private partnerships for building and managing health care facilities and services.

PubMed

Barlow, James; Roehrich, Jens; Wright, Steve

2013-01-01

Prompted in part by constrained national budgets, European governments are increasingly partnering with the private sector to underwrite the costs of constructing and operating public hospitals and other health care facilities and delivering services. Through such public-private partnerships, governments hope to avoid up-front capital expenditure and to harness private-sector efficiencies, while private-sector partners aim for a return on investment. Our research indicates that to date, experience with these partnerships has been mixed. Early models of these partnerships-for example, in which a private firm builds a hospital and carries out building maintenance, which we term an "accommodation-only" model-arguably have not met expectations for achieving greater efficiencies at lower costs. Newer models described in this article offer greater opportunities for efficiency gains but are administratively harder to set up and manage. Given the shortages in public capital for new infrastructure, it seems likely that the attractiveness of these partnerships to European governments will grow.

Strategic acquisitions by academic medical centers: the Jefferson experience as operational paradigm.

PubMed

Schwartz, G F; Stone, C T

1991-01-01

As capital investments in the health care industry have changed in popularity, mergers and acquisitions of and by hospitals have created supersystems of health care that are based on the assumption that economies of scale offer greater protection from a variety of forces. The acquisition of West Park (Jefferson Park) Hospital by Thomas Jefferson University and the infusion of Jefferson management into Methodist Hospital have provided the institution with unique opportunities to broaden its population base for acute care admissions and to permit greater diversification within the entire health care market.

Provider Network Development under the Department of Defense Coordinated Care Program: A Methodology for Primary Care Network Development and Its Implementation in the San Antonio Service Area

DTIC Science & Technology

1993-04-01

for using out-of- network benefits . * A gatekeeper physician controls access to the network and is paid on a capitated or discounted fee- for-service...Model ...................... 84 Figure 10. Organization Under Managed Care/HMO Concept ............... 94 APPENDIX 1. Benefit Under CCP 2. Group Model...increases, yet our health indicators have not improved (e.g., infant mortality, adult mortality, morbidity, or life expectancy). The aging population, the

Management of medical technology: case study of a major acute hospital.

PubMed

Brown, Ian; Smale, Andrew

2007-01-01

This paper presents results of a Capital Equipment Management Plan undertaken at a major acute hospital in Australia. By classifying existing equipment using a threshold replacement value into Major and Minor items, detailed planning information was collected for 527 items of Major equipment representing 80% of the hospital's total equipment stock. A number of meaningful views of this significant asset base are presented, and a prioritisation method used to provide recommendations for future equipment replacement and acquisition for a 5 year planning period. The survey work to identify and document actual equipment items provides a convincing argument for the funding levels required for capital equipment replacement and acquisition, and evidence for the extent of technology reliance in modern health care facilities.

Capitation of Medicare: Quality Care or Third-Class Care for the Poor.

ERIC Educational Resources Information Center

Wintringham, Karen

Experience gathered to date confirms that capitation of Medicare does not necessarily decrease quality of health care and may in fact encourage an improvement in health care quality. Incentives inherent in capitated reimbursement are threefold. First, practitioners, by not receiving more payment for more service, are discouraged from providing…

Your scarcest resource.

PubMed

Mankins, Michael; Brahm, Chris; Caimi, Gregory

2014-05-01

Most companies have elaborate procedures for managing capital. They require a compelling business case for any new capital investment. They set hurdle rates. They delegate authority carefully, prescribing spending limits for each level. An organization's time, by contrast, goes largely unmanaged. Bain & Company, with which all three authors are associated, used innovative people analytics tools to examine the time budgets of 17 large corporations. It discovered that companies are awash in e-communications; meeting time has skyrocketed; real collaboration is limited; dysfunctional meeting behavior is on the rise; formal controls are rare; and the consequences of all this are few. The authors outline eight practices for managing organizational time. Among them are: Make meeting agendas clear and selective; create a zero-based time budget; require business cases for all initiatives; and standardize the decision process. Some forward-thinking companies bring as much discipline to their time budgets as to their capital budgets. As a result, they have Liberated countless hours of previously unproductive time for executives and employees, fueling innovation and accelerating profitable growth.

Provider-sponsored HMOs: make, buy, or joint venture?

PubMed

Clay, S B

1997-03-01

Providers can sponsor their own HMOs in one of three ways: by creating their own HMO, by joint venturing with an existing HMO, or by purchasing an existing HMO. When selecting the best option, providers must consider various market conditions. Managed care penetration in the area, potential competitive responses of existing HMOs, market demand, provider reputation, and provider marketing ability will all influence the feasibility of each option. Providers also must examine their own organizational identity, their ability to raise the necessary capital to start an HMO, their managed care expertise and risk contracting experience, and their information systems capabilities.

ROI (return on investment): its role in voluntary hospital planning.

PubMed

Cleverley, W

1990-01-01

Return on investment is the primary financial criterion used to evaluate the desirability of capital investment in investor-owned firms. Voluntary health care firms need to examine more carefully their return-on-investment levels. The potential loss of capital cost payment in the Medicare program and the removal of tax-exempt financing would raise the effective cost of capital to voluntary health care firms significantly. Many health care providers might find that they are no longer going concerns if capital costs increase much more.

Nursing intellectual capital theory: implications for research and practice.

PubMed

Covell, Christine L; Sidani, Souraya

2013-05-31

Due to rising costs of healthcare, determining how registered nurses and knowledge resources influence the quality of patient care is critical. Studies that have investigated the relationship between nursing knowledge and outcomes have been plagued with conceptual and methodological issues. This has resulted in limited empirical evidence of the impact of nursing knowledge on patient or organizational outcomes. The nursing intellectual capital theory was developed to assist with this area of inquiry. Nursing intellectual capital theory conceptualizes the sources of nursing knowledge available within an organization and delineates its relationship to patient and organizational outcomes. In this article, we review the nursing intellectual capital theory and discuss its implications for research and practice. We explain why the theory shows promise for guiding research on quality work environments and how it may assist with administrative decision-making related to nursing human resource management and continuing professional development.

42 CFR 460.26 - Submission and evaluation of waiver requests.

Code of Federal Regulations, 2010 CFR

2010-10-01

... monitoring of the PACE organization. (c) Requirements related to the following principles may not be waived... application to become a PACE organization may submit a waiver request. The entity must submit its waiver... interdisciplinary team approach to care management and service delivery. (4) Capitated, integrated financing that...

42 CFR 460.26 - Submission and evaluation of waiver requests.

Code of Federal Regulations, 2011 CFR

2011-10-01

... monitoring of the PACE organization. (c) Requirements related to the following principles may not be waived... application to become a PACE organization may submit a waiver request. The entity must submit its waiver... interdisciplinary team approach to care management and service delivery. (4) Capitated, integrated financing that...

Lifelong Learning through Labor/Management Cooperation: Building the Workforce of the Future

ERIC Educational Resources Information Center

Alexander, Constance; Goldberg, Marshall

2011-01-01

Throughout the 1970's and 80's, rapidly advancing technologies, mergers and acquisitions, industry deregulation, emergence of new capital markets, and the shift to an increasingly competitive, global marketplace sparked new training needs for workers. In aerospace, auto, health care, steel, telecommunications and transportation industries, unions…

Capitation and enhanced fee-for-service models for primary care reform: a population-based evaluation

PubMed Central

Glazier, Richard H.; Klein-Geltink, Julie; Kopp, Alexander; Sibley, Lyn M.

2009-01-01

Background Primary care reform in Ontario, Canada, included the initiation of a blended capitation model in 2001–2002 and an enhanced fee-for-service model in 2003. Both models involve patient rostering, incentives for preventive care and requirements for after-hours care. We evaluated practice characteristics and patterns of care under both models. Methods Using administrative data, we identified physicians belonging to either the capitation or the enhanced fee-for-service group throughout the period from Sept. 1, 2005, to Aug. 31, 2006, and their enrolled patients. Practices were stratified by location (urban v. rural). We compared the groups in terms of practice characteristics and patterns of care, including comprehensiveness of care, continuity of care, after-hours care, visits to the emergency department and uptake of new patients. Results Patients in the capitation and enhanced fee-for-service practices had similar demographic characteristics. Patients in capitation practices had lower morbidity and comorbidity indices. Comprehensiveness and continuity of care were similar between the 2 groups. Compared with patients in enhanced fee-for-service practices, those in capitation practices had less after-hours care (adjusted rate ratio [RR] 0.68, 95% confidence interval [CI] 0.61–0.75) and more visits to emergency departments (adjusted RR 1.20, 95% CI 1.15–1.25). Overall, physicians in the capitation group enrolled fewer new patients than did physicians in the enhanced fee-for-service group (37.0 v. 52.0 per physician); the same was true of new graduates (60.3 v. 72.1 per physician). Interpretation Physicians enrolled in the capitation model had different practice characteristics than those in the enhanced fee-for-service model. These characteristics appeared to be pre-existing and not due to enrolment in a new model. Although the capitation model provides an alternative to fee-for-service practice, its characteristics should be the focus of future policy development and research. PMID:19468106

Managing integrated oncology treatment in virtual networks.

PubMed

Stanicki, Verena; Becker, Matthias; Böckmann, Britta

2015-01-01

Interdisciplinary and intersectoral coordinated healthcare management based on Clinical Practice Guidelines is essential to achieve high quality in oncological networks. The objective of our research project is to create a cookbook, which can be used by oncological networks as a template. The cookbook is based on guideline-compliant care processes. To develop these care processes, the three S3-guidelines breast, colon and prostate carcinoma have been formalized. The thus-obtained platform-independent process fragments were transformed into an underlying metamodel, which is based on HL7 and can be used for modeling clinical pathways. Additional, qualitative guided interviews were chosen to capitalize on the experts' (e.g. chief residents, resident specialists) wide knowledge and experience in oncological health care management. One of these use cases (tumor board scheduling) is developed for a healthcare management platform which is linked to a national electronic case record. The projected result of our approach is a cookbook which shows, how the treatment can be controlled by interdisciplinary and intersectoral care processes in an oncological network.

Informal care and the self-management partnership: implications for Australian health policy and practice.

PubMed

Essue, Beverley M; Jowsey, Tanisha; Jeon, Yun-Hee; Mirzaei, Masoud; Pearce-Brown, Carmen L; Aspin, Clive; Usherwood, Tim P

2010-11-01

The Serious and Continuing Illness Policy and Practice Study (SCIPPS) aims to improve the care and support for patients with chronic illness and their family carers. Here we describe the carers' contribution to the self-management partnership and discuss the policy and practice implications that are relevant to improving the support available for informal care in Australia. A secondary analysis of SCIPPS data. Fourteen carers of patients between 45 and 85 years with chronic heart failure, chronic obstructive pulmonary disease and diabetes were conveniently sampled from western Sydney and the Australian Capital Territory. Semi-structured interviews were conducted. Data were analysed using qualitative content analysis. Key roles that carers perform in the self-management partnership included: home helper; lifestyle coach; advocate; technical care manager; and health information interpreter. Two negative consequences of juggling these roles included: self-neglect and conflict. Rigid eligibility criteria limit carers' access to essential support programs which underestimates and undervalues their contributions to the self-management partnership. Support services should focus on the development of practical skills to perform the caregiving roles. In addition, health professionals require support to work more effectively with carers to minimise the conflict that can overshadow the care and self-management partnership.

A qualitative study on the attributes of nurses' workplace social capital in Japan.

PubMed

Norikoshi, Kensuke; Kobayashi, Toshio; Tabuchi, Keiji

2018-01-01

To identify attributes of nurses' workplace social capital in Japan. Much attention has been paid to nurses' workplace social capital to improve the quality of the work environment; however, few studies are available on the attributes of nurses' workplace social capital. Semi-structured interviews were conducted with 32 nurses at seven hospitals. Nurses reported on the attributes of workplace social capital, such as characteristics facilitating individual positive action in an organisation, which were qualitatively analysed using the Kawakita Jiro method. The attributes of nurses' workplace social capital were organised into six groups: affirmation; exchange of appreciation; unrestricted information sharing; ability to trust; access to the strength; and altruistic reciprocity. The attributes of nurses' workplace social capital included a social structure that allowed nurses to make full use of their abilities both vertically and horizontally and were supported by a sense of security. In particular, newly emerged exchange of appreciation and altruistic reciprocity were important for nurses in Japan in building cooperative relationships with others. Managing human relationships, such as exchange of appreciation and altruistic reciprocity, in clinical settings based on nurses' workplace social capital may promote positive emotions in the organisation, positive ideas among staff and cooperative teamwork, which may lead to high-quality patient care. © 2017 John Wiley & Sons Ltd.

The informatics of health care reform.

PubMed Central

Masys, D R

1996-01-01

Health care in the United States has entered a period of economic upheaval. Episodic, fee-for-service care financed by indemnity insurance is being replaced by managed care financed by fixed-price, capitated health plans. The resulting focus on reducing costs, especially in areas where there is competition fueled by oversupply of health services providers and facilities, poses new threats to the livelihood of medical libraries and medical librarians but also offers new opportunities. Internet services, consumer health education, and health services research will grow in importance, and organizational mergers will provide librarians with opportunities to assume new roles within their organizations. PMID:8938325

Savings estimate for a Medicare insured group

PubMed Central

Birnbaum, Howard; Holland, Stephen K.; Lenhart, Gregory; Reilly, Helena L.; Hoffman, Kevin; Pardo, Dennis P.

1991-01-01

Estimates of the savings potential of a managed-care program for a Medicare retiree population in Michigan under a hypothetical Medicare insured group (MIG) are presented in this article. In return for receiving an experience-rated capitation payment, a MIG would administer all Medicare and employer complementary benefits for its enrollees. A study of the financial and operational feasibility of implementing a MIG for retirees of a national corporation involving an analysis of 1986 claims data finds that selected managed-care initiatives implemented by a MIG would generate an annual savings of 3.8 percent of total (Medicare plus complementary) expenditures. Although savings are less than the 5 percent to be retained by Medicare, this finding illustrates the potential for savings from managed-care initiatives to Medicare generally and to MIGs elsewhere, where savings may be greater if constraints are less restrictive. PMID:10113700

Reilly pulls it together with care

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kiesche, E.S.

1992-12-09

Reilly Industries (Indianapolis) has changed strategic planning procedures to incorporate Responsible Care into its business plans. Each of the company's business units budgets for Responsible Care and reports quarterly on progress in implementing the codes, says Jacqueline Fernette, corporate communications coordinator and Responsible Care coordinator. The company's goal is to achieve full implementation by the end of 1997. In Reilly's 1993 budget, 20% of capital is directed at Responsible Care, says president Robert McNeeley. We hold unit managers responsible for planning Responsible Care within their businesses and reporting on them on a quarterly basis, says McNeeley. The firm makes pyridine,more » coal tar, potash and related chemicals, and specialized esters, and posts annual in the $250 million-$300 million range. Reilly has seven plants and 900 employees. Incorporating Responsible Care into the strategic business plan required a fair amount of administrative work to make sure that all business unit managers understood the concepts and were working in comparable terms, says McNeeley. We needed to bring the managers up to speed in six codes, so there was a training aspect to it.« less

Decision support systems and the healthcare strategic planning process: a case study.

PubMed

Lundquist, D L; Norris, R M

1991-01-01

The repertoire of applications that comprises health-care decision support systems (DSS) includes analyses of clinical, financial, and operational activities. As a whole, these applications facilitate developing comprehensive and interrelated business and medical models that support the complex decisions required to successfully manage today's health-care organizations. Kennestone Regional Health Care System's use of DSS to facilitate strategic planning has precipitated marked changes in the organization's method of determining capital allocations. This case study discusses Kennestone's use of DSS in the strategic planning process, including profiles of key DSS modeling components.

Cultural health capital and the interactional dynamics of patient-centered care

PubMed Central

Dubbin, Leslie A.; Chang, Jamie Suki; Shim, Janet K.

2014-01-01

As intuitive and inviting as it may appear, the concept of patient-centered care has been difficult to conceptualize, institutionalize and operationalize. Informed by Bourdieu's concepts of cultural capital and habitus, we employ the framework of cultural health capital to uncover the ways in which both patients' and providers' cultural resources, assets, and interactional styles influence their abilities to mutually achieve patient-centered care. Cultural health capital is defined as a specialized collection of cultural skills, attitudes, behaviors and interactional styles that are valued, leveraged, and exchanged by both patients and providers during clinical interactions. In this paper, we report the findings of a qualitative study conducted from 2010 to 2011 in the Western United States. We investigated the various elements of cultural health capital, how patients and providers used cultural health capital to engage with each other, and how this process shaped the patient-centeredness of interactions. We find that the accomplishment of patient-centered care is highly dependent upon habitus and the cultural health capital that both patients and providers bring to health care interactions. Not only are some cultural resources more highly valued than others, their differential mobilization can facilitate or impede engagement and communication between patients and their providers. The focus of cultural health capital on the ways fundamental social inequalities are manifest in clinical interactions enables providers, patients, and health care organizations to consider how such inequalities can confound patient-centered care. PMID:23906128

Ethical issues in managed care for the obstetrician and gynecologist.

PubMed

Finnerty, J J; Pinkerton, J A

1998-08-01

The practice of medicine is now managed. Of this there is no doubt. The individual physician is placed in an ever-increasingly vulnerable position. He or she must cope with a myriad of contractual arrangements with strange concepts such as "withholds," "capitation," "covered lives," "limited liability on the part of the managed care organization;" "outcomes analysis," "practice guidelines," and, last but not least, "gag rules." Patients are being denied care that the physician may consider, if not essential, at least most desirable. On the one hand, the physician must serve a fiduciary obligation to the patient and act as the patient's advocate; on the other hand, the physician's income may be proportionally dependent on limiting the extent of the patient's access to unlimited care. The physician may be limited by restrictions imposed by the managed care organization as to what disclosures he or she may make to the patient regarding limitations of care. We will explore these issues from an ethical perspective and attempt to offer some insights on the basis of a review of the comments of many knowledgeable commentators on this topic, and we will explore the virtues that physicians will need to rely on to come to grips with the dilemmas they will face in the future with managed care.

42 CFR 422.382 - Minimum net worth amount.

Code of Federal Regulations, 2010 CFR

2010-10-01

... amount equal to the sum of— (i) Eight percent of annual health care expenditures paid on a non-capitated basis to non-affiliated providers; and (ii) Four percent of annual health care expenditures paid on a capitated basis to non-affiliated providers plus annual health care expenditures paid on a non-capitated...

42 CFR 422.382 - Minimum net worth amount.

Code of Federal Regulations, 2011 CFR

2011-10-01

... amount equal to the sum of— (i) Eight percent of annual health care expenditures paid on a non-capitated basis to non-affiliated providers; and (ii) Four percent of annual health care expenditures paid on a capitated basis to non-affiliated providers plus annual health care expenditures paid on a non-capitated...

42 CFR 422.382 - Minimum net worth amount.

Code of Federal Regulations, 2012 CFR

2012-10-01

... amount equal to the sum of— (i) Eight percent of annual health care expenditures paid on a non-capitated basis to non-affiliated providers; and (ii) Four percent of annual health care expenditures paid on a capitated basis to non-affiliated providers plus annual health care expenditures paid on a non-capitated...

42 CFR 422.382 - Minimum net worth amount.

Code of Federal Regulations, 2013 CFR

2013-10-01

... amount equal to the sum of— (i) Eight percent of annual health care expenditures paid on a non-capitated basis to non-affiliated providers; and (ii) Four percent of annual health care expenditures paid on a capitated basis to non-affiliated providers plus annual health care expenditures paid on a non-capitated...

A combined nurse-pharmacist managed pain clinic: joint venture of public and private sectors.

PubMed

Hadi, Muhammad Abdul; Alldred, David Phillip; Briggs, Michelle; Closs, S José

2012-02-01

Chronic pain has become one of the most prevalent problems in primary care. The management of chronic pain is complex and often requires a multidisciplinary approach. The limited capacity of general practitioners to manage chronic pain and long waiting time for secondary care referrals further add to the complexity of chronic pain management. Restricted financial and skilled human capital make it hard for healthcare systems across the world to establish and maintain multidisciplinary pain clinics, in spite of their documented effectiveness. Affordability and accessibility to such multidisciplinary pain clinics is often problematic for patients. The purpose of this paper is to share our experience and relevant research evidence of a community based combined nurse-pharmacist managed pain clinic. The pain clinic serves as an example of public-private partnership in healthcare.

Veterans Health Administration: Management Attention Is Needed to Address Systemic, Long standing Human Capital Challenges

DTIC Science & Technology

2016-12-01

Effort through Strategic Human Capital Management , GAO-04-85 (Washington, D.C.: Oct. 20, 2003); and A Model of Strategic Human Capital Management , GAO...Washington, D.C.: Jan. 30, 2015). 60See GAO-15-290 for the most recent update on strategic human capital management . VHA Reports Critical HR Competency...systems to obtain and process information to meet operational needs.71 Likewise, our prior work on strategic human capital management notes that high

Reforming the Military Health Care System

DTIC Science & Technology

1988-01-01

Population Model and its Application ," International Journal of Health Services, vol. 10, no. 4 (1980). 7. "Understanding Variations in the Use of... Financial Management (November 1986), pp. 26- 34. 21. Based on the following multiple regression equation: OP/NOR= 0.51 + 0.35x(POP/NOR)-6.84x(CIV/NORxPOP) (t...Military Beneficiary Health Care Survey 95 B Actual and Expected Admission Rates 99 C The Statistical Model of Family Use 103 D The Capitation Budgeting

The Association of Workplace Social Capital With Work Engagement of Employees in Health Care Settings: A Multilevel Cross-Sectional Analysis.

PubMed

Fujita, Sumiko; Kawakami, Norito; Ando, Emiko; Inoue, Akiomi; Tsuno, Kanami; Kurioka, Sumiko; Kawachi, Ichiro

2016-03-01

The aim of the study was to examine the cross-sectional multilevel association between unit-level workplace social capital and individual-level work engagement among employees in health care settings. The data were collected from employees of a Japanese health care corporation using a questionnaire. The analyses were limited to 440 respondents from 35 units comprising five or more respondents per unit. Unit-level workplace social capital was calculated as an average score of the Workplace Social Capital Scale for each unit. Multilevel regression analysis with a random intercept model was conducted. After adjusting for demographic variables, unit-level workplace social capital was significantly and positively associated with respondents' work engagement (P < 0.001). The association remained significant after additionally adjusting for individual-level perceptions of workplace social capital (P < 0.001). Workplace social capital might exert a positive contextual effect on work engagement of employees in health care settings.

Transfer of risk: "right to sue" legislation and managed care organization stock performance.

PubMed

Weeks, W B; Nells, T; Wallace, A E

2001-01-01

We examined whether Congress's consideration of legislation that gave consumers the right to sue managed care organizations impacted the performance of these companies' stocks relative to that of the market. For each company examined, the total return related to such legislation was negative and substantially lower than that expected from the market model; losses in market value were from 17 percent to 48 percent for individual companies and 22 percent for a capitalization-weighted portfolio. The study suggests that equity markets responded to the proposed legislation quickly and that the impact of proposed legislation is felt through loss of market value and increased corporate risk.

Health promotion in supplementary health care: outsourcing, microregulation and implications for care.

PubMed

Silva, Kênia Lara; Sena, Roseni Rosângela; Rodrigues, Andreza Trevenzoli; Araújo, Fernanda Lopes; Belga, Stephanie Marques Moura Franco; Duarte, Elysângela Dittz

2015-01-01

to analyze health promotion programs in the supplementary health care. This was a multiple case study with a qualitative approach whose data were obtained from interviews with coordinators of providers contracted by the corporations of health insurance plans in Belo Horizonte, Minas Gerais. The data were submitted to Critical Discourse Analysis. Home care has been described as the main action in the field of health promotion transferred to the providers, followed by management of patients and cases, and the health education.groups. The existence of health promotion principles is questionable in all programs. Outsourcing is marked by a process with a division between cost and care management. Implications of this process occur within admission and interventions on the needs of the beneficiaries. Statements revealed rationalization of cost, restructuring of work, and reproduction of the dominant logic of capital accumulation by the health insurance companies.

Gendered Capital: Emotional Capital and Mothers' Care Work in Education

ERIC Educational Resources Information Center

O'Brien, Maeve

2008-01-01

This paper is concerned with the inequalities experienced by mothers in the performance of educational care work for their children. It is argued that the caring work carried out by mothers at transfer to second-level schooling is shaped by their ability to activate the significant resource of emotional capital; a gendered resource involving…

The impact of structural empowerment and psychological capital on competence among Chinese baccalaureate nursing students: A questionnaire survey.

PubMed

Liao, Rui-xue; Liu, Yan-hui

2016-01-01

Competence in nursing has been increasingly addressed. However, studies from the international literature have demonstrated that graduate nurses are not ready and they are not competent to provide safe and effective nursing care. Therefore, it is important to assess nursing students' competence and to explore the relevant factors for improving nursing students' competence and the quality of nursing care. The purpose of this paper is to investigate the influence of structural empowerment (an environmental resource) and psychological capital (an intrapersonal resource) on baccalaureate nursing students' competence. The study was designed as a cross-sectional survey. A total of 300 senior baccalaureate nursing students in China practicing in five major tertiary teaching hospitals were invited to participate in the current survey. A total of 286 students completed the survey and were evaluated statistically. Thus, the response rate was 95.3%. The results of the study indicate that nursing students have medium-high levels of competence, and medium-high levels of structural empowerment and psychological capital. Students with perceived higher levels of structure empowerment and psychological capital were more likely to achieve higher levels of competence. Structural empowerment and psychological capital were significantly and positively correlated with students' competence. The findings implicate that nursing managers and educators should not only promote interventions to enhance competence of baccalaureate nursing students but also focus on creating a supportive clinical learning environment and strengthen their positive intrapersonal resource. Copyright © 2015 Elsevier Ltd. All rights reserved.

The relationship between nurse practice environment, nurse work characteristics, burnout and job outcome and quality of nursing care: a cross-sectional survey.

PubMed

Van Bogaert, Peter; Kowalski, Christoph; Weeks, Susan Mace; Van Heusden, Danny; Clarke, Sean P

2013-12-01

To explore the mechanisms through which nurse practice environment dimensions are associated with job outcomes and nurse-assessed quality of care. Mediating variables tested included nurse work characteristics of workload, social capital, decision latitude, as well as burnout dimensions of emotional exhaustion, depersonalization, and personal accomplishment. Acute care hospitals face daily challenges to their efforts to achieve nurse workforce stability, safety, and quality of care. A body of knowledge shows a favourably rated nurse practice environment as an important condition for better nurse and patient outcome variables; however, further research initiatives are imperative for a clear understanding to support and guide the practice community. Cross-sectional survey. Grounded on previous empirical findings, a structural equation model designed with valid measurement instruments was tested. The study population was registered acute care nurses (N=1201) in two independent hospitals and one hospital group with six hospitals in Belgium. Nurse practice environment dimensions predicted job outcome variables and nurse ratings of quality of care. Analyses were consistent with features of nurses' work characteristics including perceived workload, decision latitude, and social capital, as well as three dimension of burnout playing mediating roles between nurse practice environment and outcomes. A revised model adjusted using various fit measures explained 52% and 47% of job outcomes and nurse-assessed quality of care, respectively. The study refines understanding of the relationship between aspects of nursing practice in order to achieve favourable nursing outcomes and offers important concepts for managers to track in their daily work. The findings of this study indicate that it is important for clinicians and leaders to consider how nurses are involved in decision-making about care processes and tracking outcomes of care and whether they are able to work with physicians, superiors, peers, and subordinates in a trusting environment based on shared values. The involvement of nurse managers at the unit level is especially critical because of associations with nurse work characteristics such as decision latitude and social capital and outcome variables. Further practice and research initiatives to support nurses' involvement in decision-making process and interdisciplinary teamwork are recommended. Copyright © 2013 Elsevier Ltd. All rights reserved.

5 CFR 250.203 - Agency responsibilities.

Code of Federal Regulations, 2014 CFR

2014-01-01

.... These human capital goals and objectives must address each of the human capital management systems... management on its overall mission performance. (2) Human capital accountability system. This system provides... Management Report to OPM. The human capital accountability system must: (i) Be formal and documented; (ii) Be...

5 CFR 250.203 - Agency responsibilities.

Code of Federal Regulations, 2012 CFR

2012-01-01

.... These human capital goals and objectives must address each of the human capital management systems... management on its overall mission performance. (2) Human capital accountability system. This system provides... Management Report to OPM. The human capital accountability system must: (i) Be formal and documented; (ii) Be...

5 CFR 250.203 - Agency responsibilities.

Code of Federal Regulations, 2013 CFR

2013-01-01

.... These human capital goals and objectives must address each of the human capital management systems... management on its overall mission performance. (2) Human capital accountability system. This system provides... Management Report to OPM. The human capital accountability system must: (i) Be formal and documented; (ii) Be...

How Do Social Capital and HIV/AIDS Outcomes Geographically Cluster and Which Sociocontextual Mechanisms Predict Differences Across Clusters?

PubMed

Ransome, Yusuf; Dean, Lorraine T; Crawford, Natalie D; Metzger, David S; Blank, Michael B; Nunn, Amy S

2017-09-01

Place of residence has been associated with HIV transmission risks. Social capital, defined as features of social organization that improve efficiency of society by facilitating coordinated actions, often varies by neighborhood, and hypothesized to have protective effects on HIV care continuum outcomes. We examined whether the association between social capital and 2 HIV care continuum outcomes clustered geographically and whether sociocontextual mechanisms predict differences across clusters. Bivariate Local Moran's I evaluated geographical clustering in the association between social capital (participation in civic and social organizations, 2006, 2008, 2010) and [5-year (2007-2011) prevalence of late HIV diagnosis and linkage to HIV care] across Philadelphia, PA, census tracts (N = 378). Maps documented the clusters and multinomial regression assessed which sociocontextual mechanisms (eg, racial composition) predict differences across clusters. We identified 4 significant clusters (high social capital-high HIV/AIDS, low social capital-low HIV/AIDS, low social capital-high HIV/AIDS, and high social capital-low HIV/AIDS). Moran's I between social capital and late HIV diagnosis was (I = 0.19, z = 9.54, P < 0.001) and linkage to HIV care (I = 0.06, z = 3.274, P = 0.002). In multivariable analysis, median household income predicted differences across clusters, particularly where social capital was lowest and HIV burden the highest, compared with clusters with high social capital and lowest HIV burden. The association between social participation and HIV care continuum outcomes cluster geographically in Philadelphia, PA. HIV prevention interventions should account for this phenomenon. Reducing geographic disparities will require interventions tailored to each continuum step and that address socioeconomic factors such as neighborhood median income.

Human capital strategy: talent management.

PubMed

Nagra, Michael

2011-01-01

Large organizations, including the US Army Medical Department and the Army Nurse Corps, are people-based organizations. Consequently, effective and efficient management of the human capital within these organizations is a strategic goal for the leadership. Over time, the Department of Defense has used many different systems and strategies to manage people throughout their service life-cycle. The current system in use is called Human Capital Management. In the near future, the Army's human capital will be managed based on skills, knowledge, and behaviors through various measurement tools. This article elaborates the human capital management strategy within the Army Nurse Corps, which identifies, develops, and implements key talent management strategies under the umbrella of the Corps' human capital goals. The talent management strategy solutions are aligned under the Nurse Corps business strategy captured by the 2008 Army Nurse Corps Campaign Plan, and are implemented within the context of the culture and core values of the organization.

76 FR 72462 - Bandon Capital Management, LLC and Northern Lights Fund Trust; Notice of Application

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-23

... SECURITIES AND EXCHANGE COMMISSION [Investment Company Act Release No. 29864; 812-13936] Bandon Capital Management, LLC and Northern Lights Fund Trust; Notice of Application November 17, 2011. AGENCY... Capital Management, LLC (``Bandon Capital'' or the ``Adviser'') and Northern Lights Fund Trust (the...

Variation in outpatient mental health service utilization under capitation.

PubMed

Chou, Ann F; Wallace, Neal; Bloom, Joan R; Hu, Teh-Wei

2005-03-01

To improve the financing of Colorado's public mental health system, the state designed, implemented, and evaluated a pilot program that consisted of three reimbursement models for the provision of outpatient services. Community mental health centers (CMHCs), the primary providers of comprehensive mental health services to Medicaid recipients in Colorado, had to search for innovative ways to provide cost-effective services. This study assessed outpatient service delivery to Medicaid-eligible consumers under this program. This paper is among the first to study variations in the delivery of specific types of outpatient mental health services under capitated financing systems. This study uses claims data (1994-1997) from Colorado's Medicaid and Mental Health Services Agency. The fee-for-service (FFS) model served as the comparison model. Two capitated models under evaluation are: (i) direct capitation (DC), where the state contracts with a non-profit entity to provide both the services and administers the capitated financing, and (ii) managed behavioral health organization (MBHO), which is a joint venture between a for-profit company who manages the capitated financing and a number of non-profit entities who deliver the services. A sample of severely mentally ill patients who reported at least one inpatient visit was included in the analysis. Types of outpatient services of interest are: day-treatment visits, group therapy, individual therapy, medication monitoring, case management, testing, and all other services. Comparisons were set up to examine differences in service utilization and cost between FFS and each of the two capitated models, using a two-part model across three time periods. Results showed differences in service delivery among reimbursement models over time. Capitated providers had higher initial utilization in most outpatient service categories than their FFS counterparts and as a result of capitation, outpatient services delivered under these providers decreased to converge to the FFS pattern. Findings also suggest substitution between group therapy and individual psychotherapy. Overall, more service integration was observed and less complex service packages were provided post capitation. IMPLICATION FOR HEALTH CARE PROVISION AND POLICIES: Financing models and organizational arrangements have an impact on mental health service delivery. Changes in utilization and costs of specific types of outpatient services reflect the effects of capitation. Understanding the mechanism for these changes may lead to more streamlined service delivery allowing extra funding for expanding the range of cost-effective treatment alternatives. These changes pose implications for improving the financing of public mental health systems, coordination of mental health services with other healthcare and human services, and provision of services through a more efficient financing system.

Factors associated with lease financing in the hospital industry.

PubMed

McCue, Michael J

2007-01-01

In contrast to capital leases, which are reported on the balance sheet as debt, operating leases are a form of off-balance sheet financing only reported in the notes to the financial statement and have limited disclosure requirements. Following the perpetuity method of corporate finance, this study developed a capitalized operating lease value for hospitals. Evaluating the substitutability between lease and debt financing, the findings show a marginal displacement of debt by lease financing. Assessing the relationship of market, mission, operating, and financial factors on lease financing for all short-term, acute-care hospitals across the United States, the results indicate that investor-owned hospital management companies and hospitals located in CON markets are less likely to lease and that smaller hospitals with fewer unoccupied beds, higher proportion of government payers, low liquidity, and lower capital expenditures are more likely to lease.

Evaluation of the Medicaid Competition Demonstrations

PubMed Central

Freund, Deborah A.; Rossiter, Louis F.; Fox, Peter D.; Meyer, Jack A.; Hurley, Robert E.; Carey, Timothy S.; Paul, John E.

1989-01-01

In 1983, the Health Care Financing Administration funded a multiyear evaluation of Medicaid demonstrations in six States. The alternative delivery systems represented by the demonstrations contained a number of innovative features, most notably capitation, case management, limitations on provider choice, and provider competition. Implementation and operation issues as well as demonstration effects on utilization and cost of care, administrative costs, rate setting, biased selection, quality of care, and access and satisfaction were evaluated. Both primary and secondary data sources were used in the evaluation. This article contains an overview and summary of evaluation findings on the effects of the demonstrations. PMID:10313460

Practice, clinical management, and financial arrangements of practicing generalists.

PubMed

Keating, Nancy L; Landon, Bruce E; Ayanian, John Z; Borbas, Catherine; Guadagnoli, Edward

2004-05-01

To describe the practice settings, financial arrangements, and management strategies experienced by generalist physicians and identify factors associated with reporting pressure to limit referrals, pressure to see more patients, and career dissatisfaction. Cross-sectional mail survey. Six hundred nineteen generalist physicians (62% response rate) caring for managed care patients in 3 Minnesota health plans during 1999. Twenty-six percent of physicians reported pressure to limit referrals. In adjusted analyses, female physicians and those who were board certified acted as gatekeepers for most of their patients, received incentives based on performance reports and quality profiles, and received direct income from capitation, and were more likely than others to report this pressure (all P <.05). Sixty-two percent reported pressure to see more patients. In adjusted analyses, this pressure was more frequent among physicians in practices owned by health systems, those using physician extenders, and among physicians paid by salary with performance adjustment or those receiving at least some capitation (all P <.05). One-quarter (24%) of physicians were dissatisfied with their career in medicine. In adjusted analyses, physicians reporting pressure to limit referrals (risk ratio, 1.12; 95% confidence interval, 1.01 to 1.19) and those reporting pressure to see more patients (risk ratio, 1.37; 95% confidence interval, 1.08 to 1.66) were more likely to be dissatisfied than other physicians. Pressures to limit referrals and to see more patients are common, particularly among physicians paid based on productivity or capitation, and they are associated with career dissatisfaction. Whether future changes in practice arrangements or compensation strategies can decrease such physician-reported pressures, and ultimately improve physician satisfaction, will be an important area for future study.

Reporting intellectual capital in health care organizations: specifics, lessons learned, and future research perspectives.

PubMed

Veltri, Stefania; Bronzetti, Giovanni; Sicoli, Graziella

2011-01-01

This article analyzes the concept of intellectual capital (IC) in the health sector sphere by studying the case of a major nonprofit research organization in this sector, which has for some time been publishing IC reports. In the last few years, health care organizations have been the object of great attention in the implementation and transfer of managerial models and tools; however, there is still a lack of attention paid to the strategic management of IC as a fundamental resource for supporting and enhancing performance improvement dynamics. The main aim of this article is to examine the IC reporting model used by the Center of Molecular Medicine (CMM), a Swedish health organization which is an outstanding benchmark in reporting its IC. We also consider the specifics of IC reporting for health organizations, the lessons learned by analyzing CMM's IC reporting, and future perspectives for research.

The association between managed care enrollments and potentially preventable hospitalization among adult Medicaid recipients in Florida

PubMed Central

2014-01-01

Background The intent of adopting managed care plans is to improve access to health care services while containing costs. To date, there have been a number of studies that examine the relationship between managed care and access to health care. However, the results from previous studies have been inconsistent. Specifically, previous studies did not demonstrate a clear benefit of Medicaid managed care. In this study we have examine whether Medicaid managed care is associated with the probabilities of preventable hospitalizations. This study also analyzes the spillover effect of Medicaid managed care into Medicaid patients in traditional FFS plans and the interaction effects of other patient- and county-level variables on preventable hospitalizations. Methods The study included 254,321 Medicaid patients who were admitted to short-term general hospital in the 67 counties in Florida. Using 2008 hospital inpatient discharge data for working-age adult Medicaid enrollees (18-64 years) in Florida, we conduct multivariate logistic regression analyses to identify possible factors associated with preventable hospitalizations. The first model includes patient- and county-level variables. Then, we add interaction terms between Medicaid HMO and other variables such as race, rurality, market-level factors, and resource for primary care. Results The results show that Medicaid HMO patients are more likely to be hospitalized for ambulatory care sensitive conditions (ACSCs) (OR = 1.30; CI = 1.21, 1.40). We also find that market structure (i.e., competition) is significantly associated with preventable hospitalizations. However, our study does not support that there are spillover effects of Medicaid managed care on preventable hospitalizations for other Medicaid recipients. We find that interactions between Medicaid managed care and race, rurality and market structure are significant. Conclusions The results of our study show that the Medicaid managed care program in Florida was associated with an increase in potentially preventable hospitalizations for Medicaid enrollees. The results suggest that lower capitation rate has been associated with a greater likelihood of preventable hospitalizations for Medicaid managed care patients. Our findings also indicate that increased competition in the Medicaid managed care market has no clear benefit in Medicaid managed care patients. PMID:24916077

76 FR 56363 - Capital Project Management

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-13

...-0030] RIN 2132-AA92 Capital Project Management AGENCY: Federal Transit Administration (FTA), DOT... current FTA rule for project management oversight into a discrete set of managerial principles for sponsors of major capital projects; enable FTA to more clearly identify the necessary management capacity...

Contrasting RCC, RVU, and ABC for managed care decisions. A case study compares three widely used costing methods and finds one superior.

PubMed

West, T D; Balas, E A; West, D A

1996-08-01

To obtain cost data needed to improve managed care decisions and negotiate profitable capitation contracts, most healthcare provider organizations use one of three costing methods: the ratio-of-costs-to-charges method, the relative value unit method, or the activity-based costing method. Although the ratio-of-costs to charges is used by a majority of provider organizations, a case study that applied these three methods in a renal dialysis clinic found that the activity-based costing method provided the most accurate cost data. By using this costing method, healthcare financial managers can obtain the data needed to make optimal decisions regarding resource allocation and cost containment, thus assuring the longterm financial viability of their organizations.

Competitive strategy in turbulent healthcare markets: an analysis of financially effective teaching hospitals.

PubMed

Langabeer, J

1998-01-01

As the healthcare marketplace, characterized by declining revenues and heavy price competition, continues to evolve toward managed care, teaching hospitals are being forced to act more like traditional industrial organizations. Profit-oriented behavior, including emphases on market strategies and competitive advantage, is now a necessity if these hospitals are going to survive the transition to managed care. To help teaching hospitals evaluate strategic options that maximize financial effectiveness, this study examined the financial and operating data for 100 major U.S. teaching hospitals to determine relationships among competitive strategy, market environment, and financial return on invested capital. Results should help major hospitals formulate more effective strategies to combat environmental turbulence.

76 FR 67400 - Capital Project Management

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-01

...-0030] RIN 2132-AA92 Capital Project Management AGENCY: Federal Transit Administration (FTA), DOT... extending the comment period on its proposed rule for Capital Project Management to December 2, 2011, to...) proposing to transform the current FTA rule for project management oversight into a discrete set of...

Access to health care and community social capital.

PubMed

Hendryx, Michael S; Ahern, Melissa M; Lovrich, Nicholas P; McCurdy, Arthur H

2002-02-01

To test the hypothesis that variation in reported access to health care is positively related to the level of social capital present in a community. The 1996 Household Survey of the Community Tracking Study, drawn from 22 metropolitan statistical areas across the United States (n = 19,672). Additional data for the 22 communities are from a 1996 multicity broadcast media marketing database, including key social capital indicators, the 1997 National Profile of Local Health Departments survey, and Interstudy, American Hospital Association, and American Medical Association sources. The design is cross-sectional. Self-reported access to care problems is the dependent variable. Independent variables include individual sociodemographic variables, community-level health sector variables, and social capital variables. Data are merged from the various sources and weighted to be population representative and are analyzed using hierarchical categorical modeling. Persons who live in metropolitan statistical areas featuring higher levels of social capital report fewer problems accessing health care. A higher HMO penetration rate in a metropolitan statistical area was also associated with fewer access problems. Other health sector variables were not related to health care access. The results observed for 22 major U.S. cities are consistent with the hypothesis that community social capital enables better access to care, perhaps through improving community accountability mechanisms.

Linking case management and community development.

PubMed

Austin, Carol D; McClelland, Robert W; Gursansky, Di

2006-01-01

Case management, in various forms, is now institutionalized as a core part of policy and programs designed to deliver home- and community-based services to older adults. The case management role, in theory, requires attention to both client and system goals, although in practice the system goals that have received most attention have been gatekeeping and resource allocation. While case managers have been admonished to find and develop resources in the community, this has primarily taken the form of including informal services in individual client care plans. What has been missing is focused attention to the potential of the community as a nurturing environment with the capacity to support older adults and their caregivers. Sustainable care for older adults cannot be achieved by formal service and family support alone. This article proposes the creation of linkages between case managers, who build the service arrangements for older people, and community developers, who are responsible for building community capacity and social capital. It is argued that this linkage is essential for establishing the foundations of a caring community with the capacity to support older people.

An innovative national health care waste management system in Kyrgyzstan.

PubMed

Toktobaev, Nurjan; Emmanuel, Jorge; Djumalieva, Gulmira; Kravtsov, Alexei; Schüth, Tobias

2015-02-01

A novel low-cost health care waste management system was implemented in all rural hospitals in Kyrgyzstan. The components of the Kyrgyz model include mechanical needle removers, segregation using autoclavable containers, safe transport and storage, autoclave treatment, documentation, recycling of sterilized plastic and metal parts, cement pits for anatomical waste, composting of garden wastes, training, equipment maintenance, and management by safety and quality committees. The gravity-displacement autoclaves were fitted with filters to remove pathogens from the air exhaust. Operating parameters for the autoclaves were determined by thermal and biological tests. A hospital survey showed an average 33% annual cost savings compared to previous costs for waste management. All general hospitals with >25 beds except in the capital Bishkek use the new system, corresponding to 67.3% of all hospital beds. The investment amounted to US$0.61 per capita covered. Acceptance of the new system by the staff, cost savings, revenues from recycled materials, documented improvements in occupational safety, capacity building, and institutionalization enhance the sustainability of the Kyrgyz health care waste management system. © The Author(s) 2015.

Capital investment strategies in health care systems.

PubMed

Reiter, K L; Smith, D G; Wheeler, J R; Rivenson, H L

2000-01-01

Capital investment decisions are among the most important decisions made by firms. They determine the firm's capacity for providing services and commit the firm's cash for an extended period of time. Interviews with chief financial officers of leading health care systems reveal capital investment strategies that generally follow the recommendations of modern finance theory. Still, there is substantial variation in capital budgeting techniques, methods of risk adjustment, and the importance of qualitative considerations in investment decision making. There is also variation in delegation of investment decision making to operating units and methods of performance evaluation. Health care systems face the same challenges as other organizations in developing and implementing capital investment strategies that use consistent methods for evaluation of projects that have inconsistent aims and outcomes.

Accountable care organizations may have difficulty avoiding the failures of integrated delivery networks of the 1990s.

PubMed

Burns, Lawton R; Pauly, Mark V

2012-11-01

Accountable care organizations are intended to improve the quality and lower the cost of health care through several mechanisms, such as disease management programs, care coordination, and aligning financial incentives for hospitals and physicians. Providers employed several of these mechanisms in forming the integrated delivery networks of the 1990s. The networks failed, however, because of heavy financial losses stemming from hospitals' purchase of physician practices and their inability to align incentives, garner capitated contracts, and develop the infrastructure to manage risk. Although the current mechanisms underlying accountable care organizations continue to evolve, whether and how they will have an impact on quality and costs remains open to question. Care coordination and information technology are proving more complicated and expensive to implement than anticipated, providers may lack the ability to implement these mechanisms, and primary care providers are in short supply. As in the 1990s, success depends on targeting specific populations, such as people with multiple chronic conditions who need and may benefit from coordinated care.

The Opportunities and Challenges of the State-owned Exploration Companies Confronting the Prosperous Mineral Industry

NASA Astrophysics Data System (ADS)

Gao, Bangfei; Xie, Hui

The stated-owned exploration companies (SOEC), of state-owned enterprises background, go for profits as well as national and social responsibility. The SOEC play significant roles in commercial mineral exploration by taking advantage of their brands, strong financial backing and operation capability to integrate the capital and technology. Since the disadvantage of backwardness, the SOEC have to deal with multiple problems, such as high costs of mineral rights acquisition, multi-cooperation project management, and the criterions for traditional techniques can not adapt the rapid commercial mineral exploration and evaluation. Under the new situation, the SOEC should be careful to make investment decisions, strengthen project management, introduce venture capital funds, and cooperate with the government and the state-owned exploration institution (SOEI). It's suggested to carry out small-scale assembled explorations to reduce the exploration risks and costs, and to increase the exploration success rate.

Managing Chronic Disease in Ontario Primary Care: The Impact of Organizational Factors

PubMed Central

Russell, Grant M.; Dahrouge, Simone; Hogg, William; Geneau, Robert; Muldoon, Laura; Tuna, Meltem

2009-01-01

PURPOSE New approaches to chronic disease management emphasize the need to improve the delivery of primary care services to meet the needs of chronically ill patients. This study (1) assessed whether chronic disease management differed among 4 models of primary health care delivery and (2) identified which practice organizational factors were independently associated with high-quality care. METHODS We undertook a cross-sectional survey with nested qualitative case studies (2 practices per model) in 137 randomly selected primary care practices from 4 delivery models in Ontario Canada: fee for service, capitation, blended payment, and community health centers (CHCs). Practice and clinician surveys were based on the Primary Care Assessment Tool. A chart audit assessed evidence-based care delivery for patients with diabetes, congestive heart failure, and coronary artery disease. Intermediate outcomes were calculated for patients with diabetes and hypertension. Multiple linear regression identified those organizational factors independently associated with chronic disease management. RESULTS Chronic disease management was superior in CHCs. Clinicians in CHCs found it easier than those in the other models to promote high-quality care through longer consultations and interprofessional collaboration. Across the whole sample and independent of model, high-quality chronic disease management was associated with the presence of a nurse-practitioner. It was also associated with lower patient-family physician ratios and when practices had 4 or fewer full-time-equivalent family physicians. CONCLUSIONS The study adds to the literature supporting the value of nurse-practitioners within primary care teams and validates the contributions of Ontario’s CHCs. Our observation that quality of care decreased in larger, busier practices suggests that moves toward larger practices and greater patient-physician ratios may have unanticipated negative effects on processes of care quality. PMID:19597168

12 CFR 932.1 - Risk management.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 12 Banks and Banking 8 2013-01-01 2013-01-01 false Risk management. 932.1 Section 932.1 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOME LOAN BANK RISK MANAGEMENT AND CAPITAL STANDARDS FEDERAL HOME LOAN BANK CAPITAL REQUIREMENTS § 932.1 Risk management. Before its new capital plan may take...

12 CFR 932.1 - Risk management.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 7 2011-01-01 2011-01-01 false Risk management. 932.1 Section 932.1 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOME LOAN BANK RISK MANAGEMENT AND CAPITAL STANDARDS FEDERAL HOME LOAN BANK CAPITAL REQUIREMENTS § 932.1 Risk management. Before its new capital plan may take...

12 CFR 932.1 - Risk management.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 12 Banks and Banking 8 2012-01-01 2012-01-01 false Risk management. 932.1 Section 932.1 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOME LOAN BANK RISK MANAGEMENT AND CAPITAL STANDARDS FEDERAL HOME LOAN BANK CAPITAL REQUIREMENTS § 932.1 Risk management. Before its new capital plan may take...

77 FR 45385 - Capital Research and Management Company, et al.; Notice of Application

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-31

...] Capital Research and Management Company, et al.; Notice of Application July 25, 2012. AGENCY: Securities... Management Company (``CRMC''). Filing Dates: The application was filed on December 19, 2008, and amended on... NE., Washington, DC 20549-1090. Applicants, Capital Research and Management Company, 333 South Hope...

12 CFR 932.1 - Risk management.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Risk management. 932.1 Section 932.1 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOME LOAN BANK RISK MANAGEMENT AND CAPITAL STANDARDS FEDERAL HOME LOAN BANK CAPITAL REQUIREMENTS § 932.1 Risk management. Before its new capital plan may take...

Controlling supply expenses through capitated supply contracting.

PubMed

Kowalski, J C

1997-07-01

Some providers dealing with the financial challenges of managed care are attempting to control supply expenses through capitated supply contracting and similar risk/reward sharing arrangements. Under such arrangements, a supplier sells products and services to a provider for a fixed, prospective price in exchange for the provider's exclusive business. If expenses exceed the prospectively established amount, the supplier and provider share the loss. Conversely, if expenses are less than the fixed amount, they share the savings. For a capitated supply arrangement to be successful, providers must be able to identify and track supply expense drivers, such as clinical pathways, technology utilization, and product selection and utilization. Sophisticated information systems are needed to capture data, such as total and per-transaction product usage/volume; unit price per item; average and cost per item; average and total cost per transaction; and total cost per outcome. Providers also will need to establish mutually cooperative relationships with the suppliers with whom they contract.

Developing human capital: what is the impact on nurse turnover?

PubMed

Rondeau, Kent V; Williams, Eric S; Wagar, Terry H

2009-09-01

To investigate the impact that increasing human capital through staff training makes on the voluntary turnover of registered nurses. Healthcare organizations in Canada, the United Kingdom, the United States, and Australia are experiencing turbulent nursing labour markets characterized by extreme staff shortages and high levels of turnover. Organizations that invest in the development of their nursing human resources may be able to mitigate high turnover through the creation of conditions that more effectively develop and utilize their existing human capital. A questionnaire was sent to the chief nursing officers of 2208 hospitals and long-term care facilities in every province and territory of Canada yielding a response rate of 32.3%. The analysis featured a three-step hierarchical regression with two sets of control variables. After controlling for establishment demographics and local labour market conditions, perceptions of nursing human capital and the level of staff training provided were modestly associated with lower levels of establishment turnover. and implications for Nursing Management The results suggest that healthcare organizations that have made greater investments in their nursing human capital are more likely to demonstrate lower levels of turnover of their registered nursing personnel.

Leveraging the principles of osteopathic medicine to improve diabetes outcomes within a new era of health care reform.

PubMed

Ciervo, Carman A; Shubrook, Jay H; Grundy, Paul

2015-04-01

First introduced conceptually decades before the passage of the Patient Protection and Affordable Care Act, the patient-centered medical home (PCMH) has evolved as a foundational element within the larger health care system or medical neighborhood, highlighting a coordinated and comprehensive disease management approach centered on intensive primary care interventions. More recently, in the wake of health care reform, accountable care organizations (ACOs) have been established to help health plans, physicians, hospitals, home health care practitioners, and other health care providers better coordinate care through an incentive-based payment arrangement. Osteopathic medicine is poised to proactively capitalize on these emerging health care models, with the anticipated end result of improved quality of care and reduced health care costs. As such, osteopathic physicians involved in the prevention and care of patients with type 2 diabetes mellitus need to identify models, best practices, and solutions to advance the medical neighborhood.

A multi-group path analysis of the relationship between perceived racial discrimination and self-rated stress: how does it vary across racial/ethnic groups?

PubMed

Yang, Tse-Chuan; Chen, Danhong

2018-04-01

The objective of this study was to answer three questions: (1) Is perceived discrimination adversely related to self-rated stress via the social capital and health care system distrust pathways? (2) Does the relationship between perceived discrimination and self-rated stress vary across race/ethnicity groups? and (3) Do the two pathways differ by one's race/ethnicity background? Using the Philadelphia Health Management Corporation's Southeastern Pennsylvania Household Survey, we classified 9831 respondents into 4 race/ethnicity groups: non-Hispanic White (n = 6621), non-Hispanic Black (n = 2359), Hispanic (n = 505), and non-Hispanic other races (n = 346). Structural equation modeling was employed to simultaneously estimate five sets of equations, including the confirmatory factor analysis for both social capital and health care distrust and both direct and indirect effects from perceived discrimination to self-rated stress. The key findings drawn from the analysis include the following: (1) in general, people who experienced racial discrimination have higher distrust and weaker social capital than those without perceived discrimination and both distrust and social capital are ultimately related to self-rated stress. (2) The direct relationship between perceived discrimination and self-rated stress is found for all race/ethnicity groups (except non-Hispanic other races) and it does not vary across groups. (3) The two pathways can be applied to non-Hispanic White and Black, but for Hispanic and non-Hispanic other races, we found little evidence for the social capital pathway. For non-Hispanic White, non-Hispanic Black, and Hispanic, perceived discrimination is negatively related to self-rated stress. This finding highlights the importance of reducing interpersonal discriminatory behavior even for non-Hispanic White. The health care system distrust pathway can be used to address the racial health disparity in stress as it holds true for all four race/ethnicity groups. On the other hand, the social capital pathway seems to better help non-Hispanic White and Black to mediate the adverse effect of perceived discrimination on stress.

Social capital, outpatient care utilization and choice between different levels of health facilities in rural and urban areas of Bhutan.

PubMed

Herberholz, Chantal; Phuntsho, Sonam

2018-06-18

This study examines the factors that explain outpatient care utilization and the choice between different levels of health facilities in Bhutan, focusing on individual social capital, given Bhutan's geography of remote and sparsely populated areas. The more isolated the living, the more important individual social capital may become. Standard factors proposed by the Andersen model of healthcare utilization serve as control variables. Data for 2526 households from the 2012 Bhutan Living Standards Survey, which contains a social capital module covering structural, cognitive and output dimensions of social capital, are used. The results from the logistic regression analysis show that individual social capital is positively related with the probability of seeking treatment when ill or injured. Informal social contacts and perceived help and support are most important in rural areas, whereas specific trust matters in urban areas. The explanatory power of the model using a subset of the data for urban areas only, however, is very low as most predisposing and enabling factors are insignificant, which is not surprising though in view of better access to health facilities in urban areas and the fact that healthcare is provided free of charge in Bhutan. Multinomial regression results further show that structural and output dimensions of social capital influence the likelihood of seeking care at secondary or tertiary care facilities relative to primary care facilities. Moreover, economic status and place of residence are significantly associated with healthcare utilization and choice of health facility. The findings with respect to social capital suggest that strategizing and organizing social capital may help improve healthcare utilization in Bhutan. Copyright © 2018 Elsevier Ltd. All rights reserved.

Making the business case for enhanced depression care: the National Institute of Mental Health-harvard Work Outcomes Research and Cost-effectiveness Study.

PubMed

Wang, Philip S; Simon, Gregory E; Kessler, Ronald C

2008-04-01

Explore the business case for enhanced depression care and establish a return on investment rationale for increased organizational involvement by employer-purchasers. Literature review, focused on the National Institute of Mental Health-sponsored Work Outcomes Research and Cost-effectiveness Study. This randomized controlled trial compared telephone outreach, care management, and optional psychotherapy to usual care among depressed workers in large national corporations. By 12 months, the intervention significantly improved depression outcomes, work retention, and hours worked among the employed. Results of the Work Outcomes Research and Cost-effectiveness Study trial and other studies suggest that enhanced depression care programs represent a human capital investment opportunity for employers.

Independent practice associations: Advantages and disadvantages of an alternative form of physician practice organization.

PubMed

Casalino, Lawrence P; Chenven, Norman

2017-03-01

Value-based purchasing (VBP) favors provider organizations large enough to accept financial risk and develop care management infrastructure. Independent Practice Associations (IPAs) are a potential alternative for physicians to becoming employed by a hospital or large medical group. But little is known about IPAs. We selected four IPAs that vary in location, structure, and strategy, and conducted interviews with their president and medical director, as well as with a hospital executive and health plan executive familiar with that IPA. The IPAs studied vary in size and sophistication, but overall are performing well and are highly regarded by hospital and health plan executives. IPAs can grow rapidly without the cost of purchasing and operating physician practices and make it possible for physicians to remain independent in their own practices while providing the scale and care management infrastructure to make it possible to succeed in VBP. However, it can be difficult for IPAs to gain cooperation from hundreds to thousands of independent physicians, and the need for capital for growth and care management infrastructure is increasing as VBP becomes more prevalent and more demanding. Some IPAs are succeeding at VBP. As VBP raises the performance bar, IPAs will have to demonstrate that they can achieve results equal to more highly capitalized and tightly structured large medical groups and hospital-owned practices. Physicians should be aware of IPAs as a potential option for participating in VBP. Payers are aware of IPAs; the Medicare ACO program and health insurer ACO programs include many IPAs. Copyright © 2016 Elsevier Inc. All rights reserved.

Health plan joins with physical therapy facility to manage back and neck pain.

PubMed

Tomlinson, Charles M; Gray, Chad; Kane, Tom

2008-06-01

Twenty-five billion dollars is spent each year on the medical care of back pain, and $50 billion is lost in productivity. Primary care physicians might have difficulty providing thorough counseling and treatment to their patients about the condition. In 2006, Capital Health Plan (CHP) partnered with Orthopedic and Sports Physical Therapy, which employed the mechanical diagnosis and therapy (MDT) technique. After undergoing this technique, members experienced a 79% improvement in pain scores and a 54% improvement in function scores, compared to when they started treatment.

Social barriers to Type 2 diabetes self-management: the role of capital.

PubMed

Henderson, Julie; Wilson, Christine; Roberts, Louise; Munt, Rebecca; Crotty, Mikaila

2014-12-01

Approaches to self-management traditionally focus upon individual capacity to make behavioural change. In this paper, we use Bourdieu's concepts of habitus and capital to demonstrate the impact of structural inequalities upon chronic illness self-management through exploring findings from 28 semi-structured interviews conducted with people from a lower socioeconomic region of Adelaide, South Australia who have type 2 diabetes. The data suggests that access to capital is a significant barrier to type 2 diabetes self-management. While many participants described having sufficient cultural capital to access and assess health information, they often lacked economic capital and social capital in the form of support networks who promote health. Participants were often involved in social networks in which activities which are contrary to self-management have symbolic value. As a consequence, they entered relationships with health professionals at a disadvantage. We conclude that structural barriers to self-management arising from habitus resulting in the performance of health behaviours rooted in cultural and class background and limited access to capital in the form of economic resources, social networks, health knowledge and prestige may have a negative impact on capacity for type 2 diabetes self-management. © 2014 John Wiley & Sons Ltd.

A comparison of the capital structures of nonprofit and proprietary health care organizations.

PubMed

Trussel, John

2012-01-01

The relative amount of debt used by an organization is an important determination of the organization's likelihood of financial problems and its cost of capital. This study addresses whether or not there are any differences between proprietary and nonprofit health care organizations in terms of capital structure. Controlling for profitability, risk, growth, and size, analysis of covariance is used to determine whether or not proprietary and nonprofit health care organizations use the same amount of leverage in their capital structures. The results indicate that there is no difference in the amount of leverage between the two institutional types. Although nonprofit and proprietary organizations have unique financing mechanisms, these differences do not impact the relative amount of debt and equity in their capital structures.

Independent practice association physician groups in California.

PubMed

Grumbach, K; Coffman, J; Vranizan, K; Blick, N; O'Neil, E H

1998-01-01

We surveyed independent practice association (IPA) physician groups in California about their approaches to staffing, physician payment, and governance. Most IPAs desired more primary care physicians but not more specialists. Capitation was the major mode of remuneration for primary care physicians in 77 percent of IPAs, and for specialists in 30 percent of IPAs. Most IPAs also used financial incentives related to use of referral or ancillary services. Boards of directors were dominated by physicians, but governance tended to be centralized rather than highly democratic. We found that IPAs mirror many of the broader trends in physician staffing and physician payment that exist in managed care organizations.

Medical and economic benefits of telehealth in low- and middle-income countries: results of a study in four district hospitals in Mali.

PubMed

Bagayoko, Cheick Oumar; Traoré, Diakaridia; Thevoz, Laurence; Diabaté, Soumahila; Pecoul, David; Niang, Mahamoudane; Bediang, Georges; Traoré, Seydou Tidiane; Anne, Abdrahamane; Geissbuhler, Antoine

2014-01-01

The aim of this study was to evaluate the impact of telehealth on 1) the diagnosis, and management in obstetrics and cardiology, 2) health care costs from patients' perspectives, 3) attendance at health centres located in remote areas of Mali. The impact of telehealth on health care utilization, quality, and costs was assessed using a five-point Likert-scale based questionnaire consisting of three dimensions. It was completed by health care professionals in four district hospitals. The role of telehealth on attendance at health centres was also assessed based on data collected from the consultations logs before and during the project, between project sites and control sites. Referrals specific to the activities of the research study were also evaluated using a questionnaire to measure the real share of telehealth tools in increasing attendance at project sites. Finally, the cost savings achieved was estimated using the transport and lodging costs incurred if patients were to travel to the capital city for the same tests or care. The telehealth activities contributed to improving medical diagnoses in cardiology and obstetrics (92.6%) and the patients' management system on site (96.2%). The attendance records at health centres increased from 8 to 35% at all project sites during the study period. Patients from project sites saved an average of 12380 XOF (CFA Francs) or 25 USD (American dollar) and a maximum of 35000 XOF or 70 USD compared to patients from neighbouring sites, who must go to the capital city to receive the same care. We conclude that in Mali, enhanced training in ultrasound / electrocardiography and the introduction of telehealth have improved the health system in remote areas and resulted in high levels of appropriate diagnosis and patient management in the areas of obstetrics and cardiology. Telehealth can also significantly reduce the cost to the patient.

[Social change in the physician's role and medical practice caused by managed care in Switzerland].

PubMed

Meyer, P C; Denz, M D

2000-03-01

Switzerland is the first European country where health maintenance organizations (HMOs) characterised by capitation (per capita lumpsum) and gatekeeping were implemented according to the HMO staff model known in the USA. The development of managed health care in Switzerland relies on the belief that adequate economic incentives and competition result in cost reduction and high quality health care. Whether this is true or not--in any case the deregulation of legally accepted forms of health insurance and managed care result in profound changes in the Swiss health care system. Observations are made by using expert interviews and analysis of documents. The implementation of managed care induces socio-cultural changes of the medical profession which are as profound as the induced economic changes. We discuss conflicts of interests among physicians using four main dimensions of conflict: (1) control, (2) monopolization, (3) valuation, and (4) specialization. In the HMOs we observe pronounced conflicts of the physicians' role. The changes of the physicians' role in HMOs is on the one hand the result of new duties. On the other hand it expresses strategies of coping with the role conflict between the main clinical duties and the new obligation to control cost and to monitor treatment via gatekeeping. In HMOs the teamwork of doctors and the quality control of care promotes the satisfaction of physicians with their work, however, it can also have dysfunctional effects.

Ethics and geographical equity in health care

PubMed Central

Rice, N.; Smith, P.

2001-01-01

Important variations in access to health care and health outcomes are associated with geography, giving rise to profound ethical concerns. This paper discusses the consequences of such concerns for the allocation of health care finance to geographical regions. Specifically, it examines the ethical drivers underlying capitation systems, which have become the principal method of allocating health care finance to regions in most countries. Although most capitation systems are based on empirical models of health care expenditure, there is much debate about which needs factors to include in (or exclude from) such models. This concern with legitimate and illegitimate drivers of health care expenditure reflects the ethical concerns underlying the geographical distribution of health care finance. Key Words: Health economics • resource allocation • ethics of regional health care finance • capitation systems PMID:11479357

A narrative synthesis of illustrative evidence on effects of capitation payment for primary care: lessons for Ghana and other low/middle-income countries.

PubMed

Andoh-Adjei, Francis-Xavier; Spaan, Ernst; Asante, Felix A; Mensah, Sylvester A; van der Velden, Koos

2016-12-01

To analyse and synthesize available international experiences and information on the motivation for, and effects of using capitation as provider payment method in country health systems and lessons and implications for low/middle-income countries. We did narrative review and synthesis of the literature on the effects of capitation payment on primary care. Eleven articles were reviewed. Capitation payment encourages efficiency: drives down cost, serves as critical source of income for providers, promotes adherence to guidelines and policies, encourages providers to work better and give health education to patients. It, however, induces reduction in the quantity and quality of care provided and encourages skimming on inputs, underserving of patients in bad state of health, "dumping" of high risk patients and negatively affect patient-provider relationship. The illustrative evidence adduced from the review demonstrates that capitation payment in primary care can create positive incentives but could also elicit un-intended effects. However, due to differences in country context, policy makers in Ghana and other low/middle-income countries may only be guided by the illustrative evidence in their design of a context-specific capitation payment for primary care. Netherlands Fellowship Programme (NFP), Fellowship number: NFP-PhD.12/352.

"Couch Surfing" of Latino Foster Care Alumni: Reliance on Peers as Social Capital

ERIC Educational Resources Information Center

Perez, Beatrix F.; Romo, Harriett D.

2011-01-01

Youth exiting foster care often experience difficulties transitioning into adulthood. This paper focuses on Latino foster care youth in a major southwestern U.S. city and addresses the importance of peer networks as a crucial form of social capital as youth leave foster care. Case studies illustrate experiences of foster care alumni ranging in age…

The impact of social context on self-management in women living with HIV.

PubMed

Webel, Allison R; Cuca, Yvette; Okonsky, Jennifer G; Asher, Alice K; Kaihura, Alphoncina; Salata, Robert A

2013-06-01

HIV self-management is central to the health of people living with HIV and is comprised of the daily tasks individuals employ to manage their illness. Women living with HIV are confronted with social context vulnerabilities that impede their ability to conduct HIV self-management behaviors, including demanding social roles, poverty, homelessness, decreased social capital, and limited access to health care. We examined the relationship between these vulnerabilities and HIV self-management in a cross-sectional secondary analysis of 260 women living with HIV from two U.S. sites. All social context variables were assessed using validated self-report scales. HIV Self-Management was assessed using the HIV Self-Management Scale that measures daily health practices, HIV social support, and the chronic nature of HIV. Data were analyzed using appropriate descriptive statistics and multivariable regression. Mean age was 46 years and 65% of participants were African-American. Results indicated that social context variables, particularly social capital, significantly predicted all domains of HIV self-management including daily health practices (F = 5.40, adjusted R(2) = 0.27, p < 0.01), HIV social support (F = 4.50, adjusted R(2) = 0.22, p < 0.01), and accepting the chronic nature of HIV (F = 5.57, adjusted R(2) = 0.27, p < 0.01). We found evidence to support the influence of the traditional social roles of mother and employee on the daily health practices and the chronic nature of HIV domains of HIV self-management. Our data support the idea that women's social context influences their HIV self-management behavior. While social context has been previously identified as important, our data provide new evidence on which aspects of social context might be important targets of self-management interventions for women living with HIV. Working to improve social capital and to incorporate social roles into the daily health practices of women living with HIV may improve the health of this population. Copyright © 2013 Elsevier Ltd. All rights reserved.

The Impact of Social Context on Self-Management in Women Living with HIV

PubMed Central

Webel, Allison R.; Cuca, Yvette; Okonsky, Jennifer G.; Asher, Alice K.; Kaihura, Alphoncina; Salata, Robert A.

2013-01-01

HIV self-management is central to the health of people living with HIV and is comprised of the daily tasks individuals employ to manage their illness. Women living with HIV are confronted with social context vulnerabilities that impede their ability to conduct HIV self-management behaviors, including demanding social roles, poverty, homelessness, decreased social capital, and limited access to health care. We examined the relationship between these vulnerabilities and HIV self-management in a cross-sectional secondary analysis of 260 women living with HIV from two U.S. sites. All social context variables were assessed using validated self-report scales. HIV Self-Management was assessed using the HIV Self-Management Scale that measures daily health practices, HIV social support, and the chronic nature of HIV. Data were analyzed using appropriate descriptive statistics and multivariable regression. Mean age was 46 years and 65% of participants were African-American. Results indicated that social context variables, particularly social capital, significantly predicated all domains of HIV self-management including daily health practices (F=5.40, adjusted R2=0.27, p<0.01), HIV social support (F=4.50, adjusted R2=0.22, p<0.01), and accepting the chronic nature of HIV (F=5.57, adjusted R2=0.27, p<0.01). We found evidence to support the influence of the traditional social roles of mother and employee on the daily health practices and the chronic nature of HIV domains of HIV self-management. Our data support the idea that women’s social context influences their HIV self-management behavior. While social context has been previously identified as important, our data provide new evidence on which aspects of social context might be important targets of self-management interventions for women living with HIV. Working to improve social capital and to incorporate social roles into the daily health practices of women living with HIV may improve the health of this population. PMID:23631790

76 FR 69030 - Delegation of Authority for the Office of the Chief Human Capital Officer

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-07

... security, and other like or related policies and programs related to Human Resources management and... all responsibility for human capital management within HUD, including, without limitation, the... human capital management and programs, administering leadership and employee development programs...

Physicians as Executives: Opportunities and Strategies for Health-System Pharmacy Leaders

PubMed Central

Harvin, Andre; Griffith, Niesha; Weber, Robert J.

2014-01-01

To deal with the pressures in health care that stress clinical excellence and profitability, health systems are increasingly recruiting physician executives or physicians in leadership and management positions. Physicians occupy less than 5% of all hospital leadership positions, but there is an apparent increase in the recruitment of physician executives. With the growth in the number of physician executives, pharmacy leaders must capitalize on their existing clinical relationship and apply it to health care leadership and management. By focusing on developing an executive presence, by clearly describing a patient-centered strategy and vision for pharmacy, and by nurturing the existing clinical relationships, the pharmacy director can work with physician executives to promote patient-centered pharmacy services. PMID:25477571

Building nursing intellectual capital for safe use of information technology: a systematic review.

PubMed

Poe, Stephanie S

2011-01-01

Information technology is integral to health care delivery. Nurse leaders recognize the need to build intellectual capital (knowledge, skills, and experience) in use and oversight of electronic health records despite financial constraints on indirect care time. A systematic literature review was conducted to answer the question, "What are the best practices to build nursing intellectual capital for use of IT for safe clinical care?" Evidence was translated to support a planned electronic health record rollout.

New Jersey 4-H Goat Extravaganza: Efficiently Meeting the Educational Needs of 4-H Goat Project Members, Volunteers, and Parents

ERIC Educational Resources Information Center

Ripberger, Chad

2014-01-01

The 4-H Goat Extravaganza maximizes limited resources to help youth and adults develop knowledge and skills in goat care and management. It capitalizes on the talents and interests of volunteers to efficiently combine a goat-themed art show, team presentation contest, quiz bowl, skillathon, and adult workshop into 1 day. This article outlines the…

The role of organizational context in moderating the effect of research use on pain outcomes in hospitalized children: a cross sectional study.

PubMed

Yamada, Janet; Squires, Janet E; Estabrooks, Carole A; Victor, Charles; Stevens, Bonnie

2017-01-23

Despite substantial research on pediatric pain assessment and management, health care professionals do not adequately incorporate this knowledge into clinical practice. Organizational context (work environment) is a significant factor in influencing outcomes; however, the nature of the mechanisms are relatively unknown. The objective of this study was to assess how organizational context moderates the effect of research use and pain outcomes in hospitalized children. A cross-sectional survey was undertaken with 779 nurses in 32 patient care units in 8 Canadian pediatric hospitals, following implementation of a multifaceted knowledge translation intervention, Evidence-based Practice for Improving Quality (EPIQ). The influence of organizational context was assessed in relation to pain process (assessment and management) and clinical (pain intensity) outcomes. Organizational context was measured using the Alberta Context Tool that includes: leadership, culture, evaluation, social capital, informal interactions, formal interactions, structural and electronic resources, and organizational slack (staff, space, and time). Marginal modeling estimated the effects of instrumental research use (direct use of research knowledge) and conceptual research use (indirect use of research knowledge) on pain outcomes while examining the effects of context. Six of the 10 organizational context factors (culture, social capital, informal interactions, resources, and organizational slack [space and time]) significantly moderated the effect of instrumental research use on pain assessment; four factors (culture, social capital, resources and organizational slack time) moderated the effect of conceptual research use and pain assessment. Only two factors (evaluation and formal interactions) moderated the effect of instrumental research use on pain management. All organizational factors except slack space significantly moderated the effect of instrumental research use on pain intensity; informal interactions and organizational slack space moderated the effect of conceptual research use and pain intensity. Many aspects of organizational context consistently moderated the effects of instrumental research use on pain assessment and pain intensity, while only a few influenced conceptual use of research on pain outcomes. Organizational context factors did not generally influence the effect of research use on pain management. Further research is required to further explore the relationships between organizational context and pain management outcomes.

77 FR 15145 - Ares Capital Corporation et al.;

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-14

...] Ares Capital Corporation et al.; Notice of Application March 9, 2012. AGENCY: Securities and Exchange... Company Act of 1940 (the ``Act'') for an exemption from section 12(d)(3) of the Act. Applicants: Ares Capital Corporation (the ``Company''), Ares Capital Management LLC (``ACM'') and Ivy Hill Asset Management...

"Fast" Capitalism and "Fast" Schools: New Realities and New Truths.

ERIC Educational Resources Information Center

Robertson, Susan L.

This paper locates the phenomenon of self-managing schools within the framework of "fast capitalism" and identifies themes of organization central to fast capitalism, which are argued to also underpin the self-managing schools. "Fast capitalism" refers to the rapidly intensified integration of regionalized productive activities into the global…

Financial risk management of pharmacy benefits.

PubMed

Saikami, D

1997-10-01

Financial risk management of pharmacy benefits in integrated health systems is explained. A managed care organization should assume financial risk for pharmacy benefits only if it can manage the risk. Horizontally integrated organizations often do not have much control over the management of drug utilization and costs. Vertically integrated organizations have the greatest ability to manage pharmacy financial risk; virtual integration may also be compatible. Contracts can be established in which the provider is incentivized or placed at partial or full risk. The main concerns that health plans have with respect to pharmacy capitation are formulary management and the question of who should receive rebates from manufacturers. The components needed to managed pharmacy financial risk depend on the type of contract negotiated. Health-system pharmacists are uniquely positioned to take advantage of opportunities opening up through pharmacy risk contracting. Functions most organizations must provide when assuming pharmacy financial risk can be divided into internal and external categories. Internally performed functions include formulary management, clinical pharmacy services and utilization management, and utilization reports for physicians. Functions that can be outsourced include claims processing and administration, provider- and customer support services, and rebates. Organizations that integrate the pharmacy benefit across the health care continuum will be more effective in controlling costs and improving outcomes than organizations that handle this benefit as separate from others. Patient care should not focus on payment mechanisms and unit costs but on developing superior processes and systems that improve health care.

Managing health and finance: challenges, outcome, and control in the Israel Defense Forces.

PubMed

Hosiosky, Ilan; Weiss, Yossi; Magnezi, Racheli

2007-11-01

The Ministry of Defense budget constitutes 16% of the state budget. The budget for the Ministry of Health and for civilian health care is derived from the state budget. The health care funds receive their budgets from several sources. The capitation formula, which is determined by law, is the main factor that affects the size of the budget each fund receives. The objective of this study is to describe the manner of planning, managing, monitoring, and controlling the budget allocated to medical services, which is a public budget for soldiers. Several parameters are suggested for comparison, including the interface with the civilian health system, the method for budgeting a health care system, possible results of managing a medically centered budget, and the possibilities for monitoring the provided services. We also examine the potential for decentralization of authority. Managing the budget and locating appropriate alternatives, as well as the availability and accessibility of medical services, are important for procurement and for forming contracts with both military and civilian systems. Turnover based on updated information might serve to improve future health services.

Oil and water? Lessons from Maryland's effort to protect safety net providers in moving to Medicaid managed care.

PubMed

Gold, M; Mittler, J; Lyons, B

2000-12-01

Studies have highlighted the tensions that can arise between Medicaid managed care organizations and safety net providers. This article seeks to identify what other states can learn from Maryland's effort to include protections for safety net providers in its Medicaid managed care program--HealthChoice. Under HealthChoice, traditional provider systems can sponsor managed care organizations, historical providers are assured of having a role, patients can self-refer and have open access to certain public health providers, and capitation rates are risk adjusted through the use of adjusted clinical groups and claims data. The article is based on a week-long site visit to Maryland in fall 1998 that was one part of a seven-state study. Maryland's experience suggests that states have much to gain in the way of "good" public policy by considering the impact of their Medicaid managed care programs on the safety net, but states should not underestimate the challenges involved in balancing the need to protect the safety net with the need to contain costs and minimize the administrative burden on providers. No amount of protection can compensate for a poorly designed or implemented program. As the health care environment continues to change, so may the need for and the types of protections change. It also may be most difficult to guarantee adequate protections to those who need it most--among relatively financially insecure providers that have a limited management infrastructure and that depend heavily on Medicaid and the state for funds to care for the uninsured.

A social capital approach to the prevention of elder mistreatment.

PubMed

Donohue, William A; Dibble, Jayson L; Schiamberg, Lawrence B

2008-01-01

The current demographic landscape features an increasing number of elderly individuals in the care of some trusted other. Being cared for by a trusted other raises the potential for mistreatment of the elder by that trusted other. The goal of this paper is to explore the possibility of preventing elder mistreatment by increasing the bridging and bonding social capital available to caretakers. Attending to social capital lets researchers expand their focus toward areas rarely examined through current stress-outcome models (e.g., interpersonal interactions). First, elder mistreatment and social capital are defined and discussed. Then, a model is forwarded that details how social capital might mitigate the effects of caretaker stress and decrease the probability that caretakers will engage in elder mistreatment in both home and long-term care institutional settings. Finally, implications for future research and practical intervention are discussed.

A method to manage and share anti-retroviral (ARV) therapy information of human immunodeficiency virus (HIV) patients in Vietnam.

PubMed

Nguyen, Phung Anh; Syed-Abdul, Shabbir; Minamareddy, Priti; Lee, Peisan; Ngo, Thuy Dieu; Iqbal, Usman; Nguyen, Phuong Hoang; Jian, Wen-Shan; Li, Yu-Chuan Jack

2013-08-01

Management of antiretroviral (ARV) drug and HIV patients data is an important component of Vietnam Administration of HIV/AIDS Control (VAAC) Department and hospitals/health care units when people often travel in other places of Vietnam; therefore, it would lead to a number of medical errors in treatment as well as patients do not adhere to ARV therapy. In this paper, we describe a system that manages and shares antiretroviral therapy information of 4438 HIV patients in three healthcare centers in Hanoi capital of Vietnam. The overall design considerations, architecture and the integration of centralized database and decentralized management for the system are also presented. The findings from this study can serve as a guide to consider in the implementation model of health care to manage and share information of patients not only in HIV infection, but also in the other chronic and non-communicable diseases. Copyright © 2013. Published by Elsevier Ireland Ltd.

Hospital heavies. Venture capital bulks up companies that outsource medicine's newest specialty: inpatient-only care.

PubMed

Huff, C

They're the designated drivers of inpatient care, cutting hospital stays by 19 percent on average. Yet as venture capital firms infuse hospitalist startup companies, some primary care doctors complain that their sickest patients are being taken away from them.

Social capital among healthcare professionals: A prospective study of its importance for job satisfaction, work engagement and engagement in clinical improvements.

PubMed

Strömgren, Marcus; Eriksson, Andrea; Bergman, David; Dellve, Lotta

2016-01-01

Social capital can be an important resource to facilitate the needed improvements in quality of care and efficiency in hospitals. To assess the importance of social capital (recognition, vertical trust, horizontal trust and reciprocity) for job satisfaction, work engagement and engagement in clinical improvements. A prospective cohort design was used. Intensive care units and emergency, surgical and medical units at five Swedish hospitals with ongoing development of their processes of care. Healthcare professionals (physicians, registered nurses, assistant nurses) at five Swedish midsize hospitals. The participants answered a questionnaire at two occasions, NN=1602 at baseline and NN=1548 at one-year follow-up. Mean hospital response rate was 53% at baseline and 59% at follow-up. Univariate, multivariate and logistic regression analyses were performed, and the prospective analysis was based on 477 respondents. Social capital was associated with healthcare professionals' general work engagement and job satisfaction. Analysis showed positive associations between all measured aspects of social capital and engagement in clinical improvements of patient safety and quality of care. The prospective analysis showed that increased social capital predicted increased job satisfaction, work engagement and engagement in clinical improvements of patient safety. Social capital is strongly related to job satisfaction and active engagement with clinical improvements. The findings contribute to a deeper knowledge of social capital as a predictive factor that influences patient safety and health among healthcare staff. Copyright © 2015 Elsevier Ltd. All rights reserved.

Cultural Health Capital on the margins: Cultural resources for navigating healthcare in communities with limited access.

PubMed

Madden, Erin Fanning

2015-05-01

Communities struggling with access to healthcare in the U.S. are often considered to be disadvantaged and lacking in resources. Yet, these communities develop and nurture valuable strategies for healthcare access that are underrecognized by health scholars. Combining medical sociology and critical race theory perspectives on cultural capital, this paper examines the health-relevant cultural resources, or Cultural Health Capital, in South Texas Mexican American border communities. Ethnographic data collected during 2011-2013 in Cameron and Hidalgo counties on the U.S.-Mexico border provide empirical evidence for expanding existing notions of health-relevant cultural capital. These Mexican American communities use a range of cultural resources to manage healthcare exclusion and negotiate care in alternative healthcare spaces like community clinics, flea markets and Mexican pharmacies. Navigational, social, familial, and linguistic skills and knowledge are used to access doctors and prescription drugs in these spaces despite social barriers to mainstream healthcare (e.g. cost, English language skills, etc.). Cultural capital used in marginalized communities to navigate limited healthcare options may not always fully counteract healthcare exclusion. Nevertheless, recognizing the cultural resources used in Mexican American communities to facilitate healthcare challenges deficit views and yields important findings for policymakers, healthcare providers, and advocates seeking to capitalize on community resources to improve healthcare access. Copyright © 2015 Elsevier Ltd. All rights reserved.

Mental health care for the elderly in low-income countries: a health systems approach

PubMed Central

PRINCE, MARTIN; LIVINGSTON, GILL; KATONA, CORNELIUS

2007-01-01

Future development of services for older people needs to be tailored to suit the health systems context. Low-income countries lack the economic and human capital to contemplate widespread introduction of specialist services. The most cost-effective way to manage people with dementia will be through supporting, educating and advising family caregivers. The next level of care to be prioritized would be respite care, both in day centres and in residential or nursing homes. An important prerequisite to improving care for older persons is to create a climate that fosters such advances. Better awareness is a necessary precondition for appropriate help-seeking, and lack of awareness is a public health problem for which population level interventions are needed. PMID:17342213

Medicare and Medicaid: Conflicting Incentives for Long-Term Care

PubMed Central

Grabowski, David C

2007-01-01

The structure of Medicare and Medicaid creates conflicting incentives regarding dually eligible beneficiaries without coordinating their care. Both Medicare and Medicaid have an interest in limiting their costs, and neither has an incentive to take responsibility for the management or quality of care. Examples of misaligned incentives are Medicare's cost-sharing rules, cost shifting within home health care and nursing homes, and cost shifting across chronic and acute care settings. Several policy initiatives—capitation, pay-for-performance, and the shift of the dually eligible population's Medicaid costs to the federal government—may address these conflicting incentives, but all have strengths and weaknesses. With the aging baby boom generation and projected federal and state budget shortfalls, this issue will be a continuing focus of policymakers in the coming decades. PMID:18070331

Does capitation payment under national health insurance affect subscribers' trust in their primary care provider? a cross-sectional survey of insurance subscribers in Ghana.

PubMed

Andoh-Adjei, Francis-Xavier; Cornelissen, Dennis; Asante, Felix Ankomah; Spaan, Ernst; van der Velden, Koos

2016-08-24

Ghana introduced capitation payment for primary care in 2012 with the view to containing escalating claims expenditure. This shift in provider payment method raised issues about its potential impact on patient-provider trust relationship and insured-patients' trust in the Ghana National Health Insurance Scheme. This paper presents findings of a study that explored insured-patients' perception about, and attitude towards capitation payment in Ghana; and determined whether capitation payment affect insured-patients' trust in their preferred primary care provider and the National Health Insurance Scheme in general. We adopted a survey design for the study. We administered closed-ended questionnaires to collect data from insurance card-bearing members aged 18 years and above. We performed both descriptive statistics to determine proportions of observations relating to the variables of interest and chi-square test statistics to determine differences within gender and setting. Sixty-nine per cent (69 %) out of 344 of respondents selected hospital level of care as their primary care provider. The two most important motivations for the choice of a provider were proximity in terms of geographical access (40 %) and perceived quality of care (38 %). Eighty-eight per cent (88 %) rated their trust in their provider as (very) high. Eighty-two per cent (82 %) actively selected their providers. Eighty-eight per cent (88 %) had no intention to switch provider. A majority (91 %) would renew their membership when it expires. Female respondents (91 %; n = 281) were more likely to renew their membership than males (87 %; n = 63). Notwithstanding capitation payment experience, 81 % of respondents would recommend to their peers to enrol with the NHIS with rural dwellers (87 %; n = 156) being more likely to do so than urban dwellers (76 %; n = 188). Almost all respondents (92 %) rated the NHIS as (very) good. Health Insurance subscribers in Ghana have high trust in their primary care provider giving them quality care under capitation payment despite their negative attitude towards capitation payment. They are guided by proximity and quality of care considerations in their choice of provider. The NHIA would, however, have to address itself to the negative perceptions about the capitation payment policy.

How women manage fatigue after childbirth.

PubMed

Taylor, Jan; Johnson, Maree

2010-06-01

to explore the strategies used by women to manage fatigue in the first six months following childbirth. a qualitative study using an exploratory descriptive design. Data were collected using open-ended questions contained in surveys posted to participants six, 12 and 24 weeks after birth. Canberra, Australian Capital Territory, Australia. 59 well women, 27 primipara and 32 multipara, aged 20-40 years, who gave birth in the Australian Capital Territory. three themes emerged from the analysis:'Looking after me' or self-care practices; 'Managing the load' or balancing the work to be done with the aim of managing the woman's fatigue; and 'How it worked', describing how useful the strategies had been in managing fatigue. From six weeks to six months, the women used self-care strategies (sleep/rest, relaxing, conserving energy) more often than strategies designed to manage the load (getting help, planning, lowering expectations). Most multiparas (24/32) conserved energy to manage fatigue, in contrast to primiparas (13/27). Women experiencing high fatigue conserved energy more often than women who were experiencing less fatigue. No differences in strategy choice were found between women who experienced a vaginal birth and those who had experienced a caesarean birth, or between those women who scored 13 on the Edinburgh Postnatal Depression Scale (EPDS) as opposed to those who scored <13. Overall, women rated their chosen strategies as very useful or useful. Womens' comments also indicated that getting help from partners and family was sometimes difficult, reducing the usefulness of this strategy. preparing women and their partners to manage postnatal fatigue more effectively is essential. Midwives should encourage women to identify sources of help and what particular help that individual could provide. Scenarios should be used in parenting classes to encourage women and their partners to negotiate issues surrounding the sharing of responsibilities after birth. After birth, ongoing assessment of fatigue and the strategies used to manage it is essential beyond the first six weeks. Copyright 2008 Elsevier Ltd. All rights reserved.

Costs associated with implementation of computer-assisted clinical decision support system for antenatal and delivery care: case study of Kassena-Nankana district of northern Ghana.

PubMed

Dalaba, Maxwell Ayindenaba; Akweongo, Patricia; Williams, John; Saronga, Happiness Pius; Tonchev, Pencho; Sauerborn, Rainer; Mensah, Nathan; Blank, Antje; Kaltschmidt, Jens; Loukanova, Svetla

2014-01-01

This study analyzed cost of implementing computer-assisted Clinical Decision Support System (CDSS) in selected health care centres in Ghana. A descriptive cross sectional study was conducted in the Kassena-Nankana district (KND). CDSS was deployed in selected health centres in KND as an intervention to manage patients attending antenatal clinics and the labour ward. The CDSS users were mainly nurses who were trained. Activities and associated costs involved in the implementation of CDSS (pre-intervention and intervention) were collected for the period between 2009-2013 from the provider perspective. The ingredients approach was used for the cost analysis. Costs were grouped into personnel, trainings, overheads (recurrent costs) and equipment costs (capital cost). We calculated cost without annualizing capital cost to represent financial cost and cost with annualizing capital costs to represent economic cost. Twenty-two trained CDSS users (at least 2 users per health centre) participated in the study. Between April 2012 and March 2013, users managed 5,595 antenatal clients and 872 labour clients using the CDSS. We observed a decrease in the proportion of complications during delivery (pre-intervention 10.74% versus post-intervention 9.64%) and a reduction in the number of maternal deaths (pre-intervention 4 deaths versus post-intervention 1 death). The overall financial cost of CDSS implementation was US$23,316, approximately US$1,060 per CDSS user trained. Of the total cost of implementation, 48% (US$11,272) was pre-intervention cost and intervention cost was 52% (US$12,044). Equipment costs accounted for the largest proportion of financial cost: 34% (US$7,917). When economic cost was considered, total cost of implementation was US$17,128-lower than the financial cost by 26.5%. The study provides useful information in the implementation of CDSS at health facilities to enhance health workers' adherence to practice guidelines and taking accurate decisions to improve maternal health care.

76 FR 76453 - Notice of Applications for Deregistration Under Section 8(f) of the Investment Company Act of 1940

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-07

... of Investment Management, Office of Investment Company Regulation, 100 F Street NE., Washington, DC... liquidation were paid by Hatteras Capital Investment Management, LLC, investment adviser to the master fund in... held by its investment adviser, Hatteras Capital Investment Management, LLC (``Hatteras Capital...

State Policies on Human Capital Resource Management: Illinois. Human Capital Resource Management Technical Brief

ERIC Educational Resources Information Center

Meyers, Coby; Bhatt, Monica; Wraight, Sara; Behrstock, Ellen; Cushing, Ellen

2010-01-01

Training, recruiting, developing, and supporting talented and effective educators throughout their careers is known as human capital resource management (HCRM) in education. HCRM has been identified in recent literature as one of the ways in which districts and states may increase school effectiveness and improve student learning (Heneman &…

State Policies on Human Capital Resource Management: Michigan. Human Capital Resource Management Technical Brief

ERIC Educational Resources Information Center

Meyer, Cassandra; Bhatt, Monica; Wraight, Sara; Behrstock, Ellen; Cushing, Ellen

2010-01-01

Training, recruiting, developing, and supporting talented and effective educators throughout their careers is known as human capital resource management (HCRM) in education. HCRM has been identified in recent literature as one of the ways in which districts and states may increase school effectiveness and improve student learning (Heneman &…

State Policies on Human Capital Resource Management: Wisconsin. Human Capital Resource Management Technical Brief

ERIC Educational Resources Information Center

Cushing, Ellen; Bhatt, Monica; Wraight, Sara; Behrstock, Ellen; Meyer, Cassandra

2010-01-01

Training, recruiting, developing, and supporting talented and effective educators throughout their careers is known as human capital resource management (HCRM) in education. HCRM has been identified in recent literature as one of the ways in which districts and states may increase school effectiveness and improve student learning (Heneman &…

State Policies on Human Capital Resource Management: Minnesota. Human Capital Resource Management Technical Brief

ERIC Educational Resources Information Center

Bhatt, Monica; Behrstock, Ellen; Cushing, Ellen; Wraight, Sara

2010-01-01

Training, recruiting, developing, and supporting talented and effective educators throughout their careers is known as human capital resource management (HCRM) in education. HCRM has been identified in recent literature as one of the ways in which districts and states may increase school effectiveness and improve student learning (Heneman &…

State Policies on Human Capital Resource Management: Iowa. Human Capital Resource Management Technical Brief

ERIC Educational Resources Information Center

Behrstock, Ellen; Bhatt, Monica; Cushing, Ellen; Wraight, Sara

2010-01-01

Training, recruiting, developing, and supporting talented and effective educators throughout their careers is known as human capital resource management (HCRM) in education. HCRM has been identified in recent literature as one of the ways in which districts and states may increase school effectiveness and improve student learning (Heneman &…

State Policies on Human Capital Resource Management: Indiana. Human Capital Resource Management Technical Brief

ERIC Educational Resources Information Center

Meyer, Cassandra; Bhatt, Monica; Wraight, Sara; Behrstock, Ellen; Cushing, Ellen

2010-01-01

Training, recruiting, developing, and supporting talented and effective educators throughout their careers is known as human capital resource management (HCRM) in education. HCRM has been identified in recent literature as one of the ways in which districts and states may increase school effectiveness and improve student learning (Heneman &…

State Policies on Human Capital Resource Management: Ohio. Human Capital Resource Management Technical Brief

ERIC Educational Resources Information Center

Bhatt, Monica; Wraight, Sara; Behrstock, Ellen; Cushing, Ellen

2010-01-01

Training, recruiting, developing, and supporting talented and effective educators throughout their careers is known as human capital resource management (HCRM) in education. HCRM has been identified in recent literature as one of the ways in which districts and states may increase school effectiveness and improve student learning (Heneman &…

Economic perspective on strategic human capital management and planning for the Centers for Disease Control and Prevention.

PubMed

Roy, Kakoli; Chen, Zhuo Adam; Crawford, Carol A Gotway

2009-11-01

An organization's workforce--or human capital--is its most valuable asset. The 2002 President's Management Agenda emphasizes the importance of strategic human capital management by requiring all federal agencies to improve performance by enhancing personnel and compensation systems. In response to these directives, the Centers for Disease Control and Prevention (CDC) drafted its strategic human capital management plan to ensure that it is aligned strategically to support the agency's mission and its health protection goals. In this article, we explore the personnel economics literature to draw lessons from research studies that can help CDC enhance its human capital management and planning. To do so, we focus on topics that are of practical importance and empirical relevance to CDC's internal workforce and personnel needs with an emphasis on identifying promising research issues or methodological approaches. The personnel economics literature is rich with theoretically sound and empirically rigorous approaches for shaping an evidence-based approach to human capital management that can enhance incentives to attract, retain, and motivate a talented federal public health workforce, thereby promoting the culture of high-performance government.

Case management in capitated long-term care

PubMed Central

Zawadski, Rick T.; Eng, Catherine

1988-01-01

For a very impaired population needing multiple interrelated services, the case management approach used by On Lok Senior Health Services in San Francisco, California, produces a responsive, flexible service system. Case management in On Lok's consolidated model has three key characteristics: (1) a true multidisciplinary team of medical as well as nonmedical personnel who separately assess, then, as a group, plan with the client and/or the family the services to be given; (2) use of the same team to assess needs and deliver services; and (3) team access to a potentially unlimited array of services, with freedom to adapt or create needed services. PMID:10312976

Capitated groups suffer under open access, consumer-driven care.

PubMed

2003-08-01

Complaints are starting to come in from capitated medical groups and medical associations about the movement to higher co-payments and deductibles in association with the rapidly expanding move toward consumer-driven health care.

Intellectual Capital.

ERIC Educational Resources Information Center

Snyder, Herbert W.; Pierce, Jennifer Burek

2002-01-01

This review focuses on intellectual capital and its relationship to information professionals. Discusses asset recognition; national practices and the acceptance of intellectual capital; definitions of intellectual capital; measuring intellectual capital, including multiple and single variable measures; managing intellectual capital; and knowledge…

A novel community-based model to enhance health promotion, risk factor management and chronic disease prevention.

PubMed

Carson, Shannon Ryan; Carr, Caroline; Kohler, Graeme; Edwards, Lynn; Gibson, Rick; Sampalli, Tara

2014-01-01

Chronic disease is a highly expensive but preventable problem to the healthcare system. Evidence suggests that impacting modifiable behaviours and risk management factors in the areas of physical inactivity, unhealthy diet, stress and obesity can alleviate the burden of chronic disease problem to a large extent. Despite this recognition, the challenge is embedding these recognized priorities into the community and in primary care in a sustainable and meaningful manner. Primary Health Care in Capital Health responded to this challenge by developing and implementing a free, interprofessional and community-based service, namely, the Community Health Teams (CHTs), that offers health and wellness, risk factor management, wellness navigation and behaviour-based programming. In this paper, the development and implementation of the CHTs are discussed. Preliminary outcomes for the model are significant and promising. Formal and large-scale studies are planned to validate these outcomes with additional research rigour. Copyright © 2014 Longwoods Publishing.

Army Support during the Hurricane Katrina Disaster

DTIC Science & Technology

2009-01-01

Human Capital Reform Act of 2004. 3. John D. Banusiewicz, “Bush Calls for Broader Military Disaster Response Role,” American Forces Press Service...Management (DHS/FEMA) ESF #6, Mass Care, Housing, and Human Services (DHS/FEMA) ESF #7, Resource Support (Government Services Administration) ESF #8...Public Health and Medical Services (Department of Health and Human Services) ESF #9, Urban Search and Rescue (DHS/FEMA) ESF #10, Oil and Hazardous

The Alignment and Blending of Payment Incentives within Physician Organizations

PubMed Central

Robinson, James C; Shortell, Stephen M; Li, Rui; Casalino, Lawrence P; Rundall, Thomas

2004-01-01

Objective To analyze the blend of retrospective (fee-for-service, productivity-based salary) and prospective (capitation, nonproductivity-based salary) methods for compensating individual physicians within medical groups and independent practice associations (IPAs) and the influence of managed care on the compensation blend used by these physician organizations. Data Sources Of the 1,587 medical groups and IPAs with 20 or more physicians in the United States, 1,104 responded to a one-hour telephone survey, with 627 providing detailed information on physician payment methods. Study Design We calculated the distribution of compensation methods for primary care and specialty physicians, separately, in both medical groups and IPAs. Multivariate regression methods were used to analyze the influence of market and organizational factors on the payment method developed by physician organizations for individual physicians. Principal Findings Within physician organizations, approximately one-quarter of physicians are paid on a purely retrospective (fee-for-service) basis, approximately one-quarter are paid on a purely prospective (capitation, nonproductivity-based salary) basis, and approximately one-half on blends of retrospective and prospective methods. Medical groups and IPAs in heavily penetrated managed care markets are significantly less likely to pay their individual physicians based on fee-for-service than are organizations in less heavily penetrated markets. Conclusions Physician organizations rely on a wide range of prospective, retrospective, and blended payment methods and seek to align the incentives faced by individual physicians with the market incentives faced by the physician organization. PMID:15333124

Measuring adverse selection in managed health care.

PubMed

Frank, R G; Glazer, J; McGuire, T G

2000-11-01

Health plans paid by capitation have an incentive to distort the quality of services they offer to attract profitable and to deter unprofitable enrollees. We characterize plans' rationing as a "shadow price" on access to various areas of care and show how the profit maximizing shadow price depends on the dispersion in health costs, individuals' forecasts of their health costs, the correlation between use in different illness categories, and the risk adjustment system used for payment. These factors are combined in an empirically implementable index that can be used to identify the services that will be most distorted by selection incentives.

42 CFR 413.130 - Introduction to capital-related costs.

Code of Federal Regulations, 2014 CFR

2014-10-01

... depreciable assets under § 413.134(f). (2) Taxes on land or depreciable assets used for patient care. (3... depreciable assets used for patient care or to refinance existing debt for which the original purpose was to acquire land or depreciable assets used for patient care. (11) The apportionment of the capital-related...

Health care entrepreneurship: financing innovation.

PubMed

Grazier, Kyle L; Metzler, Bridget

2006-01-01

Entrepreneurship is often described as the ability to create new ventures from new or existing concepts, ideas and visions. There has been significant entrepreneurial response to the changes in the scientific and social underpinnings of health care services delivery. However, a growing portion of the economic development driving health care industry expansion is threatened further by longstanding use of financing models that are suboptimal for health care ventures. The delayed pace of entrepreneurial activity in this industry is in part a response to the general economy and markets, but also due to the lack of capital for new health care ventures. The recent dearth of entrepreneurial activities in the health services sector may also due to failure to consider new approaches to partnerships and strategic ventures, despite their mutually beneficial organizational and financing potential. As capital becomes more scarce for innovators, it is imperative that those with new and creative ideas for health and health care improvement consider techniques for capital acquisition that have been successful in other industries and at similar stages of development. The capital and added expertise can allow entrepreneurs to leverage resources, dampen business fluctuations, and strengthen long term prospects.

12 CFR 225.83 - What are the consequences of failing to continue to meet applicable capital and management...

Code of Federal Regulations, 2012 CFR

2012-01-01

... 12 Banks and Banking 3 2012-01-01 2012-01-01 false What are the consequences of failing to continue to meet applicable capital and management requirements? 225.83 Section 225.83 Banks and Banking... the consequences of failing to continue to meet applicable capital and management requirements? (a...

12 CFR 225.83 - What are the consequences of failing to continue to meet applicable capital and management...

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 3 2010-01-01 2010-01-01 false What are the consequences of failing to continue to meet applicable capital and management requirements? 225.83 Section 225.83 Banks and Banking... the consequences of failing to continue to meet applicable capital and management requirements? (a...

Evaluating the Facilities Planning, Design, and Construction Department: The Capital Programs Management Audit.

ERIC Educational Resources Information Center

Kaiser, Harvey H.; Kirkwood, Dennis M.

2000-01-01

Presents a diagnostic model for assessing the state of an institution's capital programs management (CPM) by delineating "work processes" which comprise that function. What capital programs management is, its resources, and its phases and work processes are described, followed by case studies of the CPM Process Model as an assessment tool. (GR)

Planning factors for developing an enterprise-wide picture archiving and communication system maintenance program.

PubMed

Staley, S; Romlein, J; Chacko, A K; Wider, R

2000-05-01

Picture archiving and communication system (PACS) maintenance on an individual site basis has historically been a complex and costly challenge. With the advent of enterprise-wide PACS projects such as the Virtual Radiology Environment (VRE) project, the challenge of a maintenance program with even more complexities has presented itself. The approach of the project management team for the VRE project is not one of reactive maintenance, but one of highly proactive planning and negotiations, in hopes of capitalizing on the economies of scale of an enterprise-wide PACS maintenance program. A proactive maintenance program is one aspect of life-cycle management. As with any capital acquisition, life-cycle management may be used to manage the specific project aspects related to PACS. The purpose of an enterprise-wide warranty and maintenance life-cycle management approach is to maintain PACS at its maximum operational efficiency and utilization levels through a flexible, shared, yet symbiotic relationship between local, regional, and vendor resources. These goals include providing maximum operational performance levels on a local, regional, and enterprise basis, while maintaining acceptable costs and resource utilization levels. This goal must be achieved without negatively impacting point of care activities, regardless of changes to the clinical business environment.

Multimorbidity, clinical decision making and health care delivery in New Zealand Primary care: a qualitative study.

PubMed

Stokes, Tim; Tumilty, Emma; Doolan-Noble, Fiona; Gauld, Robin

2017-04-05

Multimorbidity is a major issue for primary care. We aimed to explore primary care professionals' accounts of managing multimorbidity and its impact on clinical decision making and regional health care delivery. Qualitative interviews with 12 General Practitioners and 4 Primary Care Nurses in New Zealand's Otago region. Thematic analysis was conducted using the constant comparative method. Primary care professionals encountered challenges in providing care to patients with multimorbidity with respect to both clinical decision making and health care delivery. Clinical decision making occurred in time-limited consultations where the challenges of complexity and inadequacy of single disease guidelines were managed through the use of "satisficing" (care deemed satisfactory and sufficient for a given patient) and sequential consultations utilising relational continuity of care. The New Zealand primary care co-payment funding model was seen as a barrier to the delivery of care as it discourages sequential consultations, a problem only partially addressed through the use of the additional capitation based funding stream of Care Plus. Fragmentation of care also occurred within general practice and across the primary/secondary care interface. These findings highlight specific New Zealand barriers to the delivery of primary care to patients living with multimorbidity. There is a need to develop, implement and nationally evaluate a revised version of Care Plus that takes account of these barriers.

Patient-reported access to primary care in Ontario: effect of organizational characteristics.

PubMed

Muggah, Elizabeth; Hogg, William; Dahrouge, Simone; Russell, Grant; Kristjansson, Elizabeth; Muldoon, Laura; Devlin, Rose Anne

2014-01-01

To describe patient-reported access to primary health care across 4 organizational models of primary care in Ontario, and to explore how access is associated with patient, provider, and practice characteristics. Cross-sectional survey. One hundred thirty-seven randomly selected primary care practices in Ontario using 1 of 4 delivery models (fee for service, established capitation, reformed capitation, and community health centres). Patients included were at least 18 years of age, were not severely ill or cognitively impaired, were not known to the survey administrator, had consenting providers at 1 of the participating primary care practices, and were able to communicate in English or French either directly or through a translator. Patient-reported access was measured by a 4-item scale derived from the previously validated adult version of the Primary Care Assessment Tool. Questions were asked about physician availability during and outside of regular office hours and access to health information via telephone. Responses to the scale were normalized, with higher scores reflecting greater patient-reported access. Linear regressions were used to identify characteristics independently associated with access to care. Established capitation model practices had the highest patient-reported access, although the difference in scores between models was small. Our multilevel regression model identified several patient factors that were significantly (P = .05) associated with higher patient-reported access, including older age, female sex, good-to-excellent self-reported health, less mental health disability, and not working. Provider experience (measured as years since graduation) was the only provider or practice characteristic independently associated with improved patient-reported access. This study adds to what is known about access to primary care. The study found that established capitation models outperformed all the other organizational models, including reformed capitation models, independent of provider and practice variables save provider experience. This suggests that the capitation models might provide better access to care and that it might take time to realize the benefits of organizational reforms.

The impact of health information technology on collaborative chronic care management.

PubMed

Marchibroda, Janet M

2008-03-01

Chronic disease is a growing problem in the United States. More than 125 million Americans had at least 1 chronic care condition in 2000, and this number is expected to grow to 157 million by the year 2020.1 Some of the challenges associated with current chronic care management approaches can be addressed through the use of health information technology (IT) and health information exchange. To review the current challenges of chronic care management and explore how health IT and health information exchange efforts at the national, state, and local levels can be leveraged to address some of these challenges. Efforts to effectively manage chronic care have been hampered by a number of factors, including a fragmented health care system and the need for more coordination across the health care setting; the lack of interoperable clinical information systems, which would help provide readily available, comprehensive information about the patient to those who deliver care, those who manage care, and those who receive care, and finally, the current predominantly fee-for-service reimbursement system that rewards volume and fragmentation, and does not effectively align incentives with the goals of chronic care management. The introduction of health IT, including electronic health records and health information exchange, holds great promise for addressing many of the barriers to effective chronic care management, by providing important clinical information about the patient when it is needed, and where it is needed, in a timely, secure fashion. Having information from the care delivery process readily available through health IT and health information exchange at the national, state, and local levels supports key components of the chronic care management process, including those related to measurement, clinical decision support, collaboration and coordination, and consumer activation. Those engaged in chronic care management should seek to leverage health IT and health information exchange initiatives particularly at the local levels. Community-based initiatives have built social capital and trust across multiple stakeholders; enabled access to clinical data derived from the care delivery process that only resides locally; and in many cases aligned incentives around the mobilization of clinical information across care settings. All of these elements are critical to the long-term success of chronic care management. While there is good research regarding interdisciplinary care models, more research is still needed to identify policies, practices, and strategies for facilitating and building cooperation among those engaged in chronic care management, and those engaged in multi-stakeholder efforts involved in the exchange of clinical health information electronically.

Reconsidering inequalities in preventive health care: an application of cultural health capital theory and the life-course perspective to the take-up of mammography screening.

PubMed

Missinne, Sarah; Neels, Karel; Bracke, Piet

2014-11-01

While there are abundant descriptions of socioeconomic inequalities in preventive health care, knowledge about the true mechanisms is still lacking. Recently, the role of cultural health capital in preventive health-care inequalities has been discussed theoretically. Given substantial analogies, we explore how our understanding of cultural health capital and preventive health-care inequalities can be advanced by applying the theoretical principles and methodology of the life-course perspective. By means of event history analysis and retrospective data from the Survey of Health Ageing and Retirement, we examine the role of cultural capital and cultural health capital during childhood on the timely initiation of mammography screening in Belgium (N = 1348). In line with cumulative disadvantage theory, the results show that childhood cultural conditions are independently associated with mammography screening, even after childhood and adulthood socioeconomic position and health are controlled for. Lingering effects from childhood are suggested by the accumulation of cultural health capital that starts early in life. Inequalities in the take-up of screening are manifested as a lower probability of ever having a mammogram, rather than in the late initiation of screening. © 2014 The Authors. Sociology of Health & Illness © 2014 Foundation for the Sociology of Health & Illness/John Wiley & Sons Ltd.

Rural physicians, rural networks, and free market health care in the 1990s.

PubMed

Rosenthal, T C; James, P; Fox, C; Wysong, J; FitzPatrick, P G

1997-01-01

The changes brought about by managed care in America's urban communities will have profound effects on rural physicians and hospitals. The rural health care market characterized by small, independent group practices working with community hospitals is being offered affiliations with large, often urban-based health care organizations. Health care is evolving into a free market system characterized by large networks of organizations capable of serving whole regions. Rural provider-initiated networks can assure local representation when participating in the new market and improve the rural health infrastructure. Although an extensive review of the literature from 1970 to 1996 reveals little definitive research about networks, many rural hospitals have embraced networking as one strategy to unify health care systems with minimal capitalization. These networks, now licensed in Minnesota and New York, offer rural physicians the opportunity to team up with their community hospital and enhance local health care accessibility.

Negotiating futility, managing emotions: nursing the transition to palliative care.

PubMed

Broom, Alex; Kirby, Emma; Good, Phillip; Wootton, Julia; Yates, Patsy; Hardy, Janet

2015-03-01

Nurses play a pivotal role in caring for patients during the transition from life-prolonging care to palliative care. This is an area of nursing prone to emotional difficulty, interpersonal complexity, and interprofessional conflict. It is situated within complex social dynamics, including those related to establishing and accepting futility and reconciling the desire to maintain hope. Here, drawing on interviews with 20 Australian nurses, we unpack their accounts of nursing the transition to palliative care, focusing on the purpose of nursing at the point of transition; accounts of communication and strategies for representing palliative care; emotional engagement and burden; and key interprofessional challenges. We argue that in caring for patients approaching the end of life, nurses occupy precarious interpersonal and interprofessional spaces that involve a negotiated order around sentimental work, providing them with both capital (privileged access) and burden (emotional suffering) within their day-to-day work. © The Author(s) 2014.

Scale and structure of capitated physician organizations in California.

PubMed

Rosenthal, M B; Frank, R G; Buchanan, J L; Epstein, A M

2001-01-01

Physician organizations in California broke new ground in the 1980s by accepting capitated contracts and taking on utilization management functions. In this paper we present new data that document the scale, structure, and vertical affiliations of physician organizations that accept capitation in California. We provide information on capitated enrollment, the share of revenue derived by physician organizations from capitation contracts, and the scope of risk sharing with health maintenance organizations (HMOs). Capitation contracts and risk sharing dominate payment arrangements with HMOs. Physician organizations appear to have responded to capitation by affiliating with hospitals and management companies, adopting hybrid organizational structures, and consolidating into larger entities.

Construction and Application of a Refined Hospital Management Chain.

PubMed

Yi, Lihua; Hao, Aimin; Hu, Minmin; Huang, Pei; Yuan, Huikang; Xing, Ming

2015-05-01

Gaining large scale success was quite common in the later period of industrialization for hospitals in China. Today, Chinese hospital management face such problems as service inefficiency, high human resources cost, and low rate of capital use. This study analyzes the refined management chain of the Wuxi No. 2 People's Hospital. This consists of six gears namely "organizational structure, clinical practice, outpatient service, medical technology, and nursing care and logistics" used to achieve maximum scale and benefits. The gears are based on "flat management system targets, chief of medical staff, centralized outpatient service, intensified medical examinations, vertical nursing management and socialized logistics". The hospital took innovative measures. The "one doctor-one patient-one clinic" was well accepted; "one dispensary" shorten the waiting time by 20 min. The 168 rear service hot line "made patients' lives easier; and a red wrist ribbon" for seriously ill patient was implemented to prioritize medical treatment. The core concepts of refined hospital management are optimizing flow process, reducing waste, improving efficiency, saving costs, and taking good care of patients as most important.

12 CFR 930.1 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-01-01

... or information systems. Permanent capital means the retained earnings of a Bank, determined in... Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOME LOAN BANK RISK MANAGEMENT AND CAPITAL STANDARDS DEFINITIONS APPLYING TO RISK MANAGEMENT AND CAPITAL REGULATIONS § 930.1 Definitions. As used in this...

12 CFR 930.1 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-01-01

... or information systems. Permanent capital means the retained earnings of a Bank, determined in... Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOME LOAN BANK RISK MANAGEMENT AND CAPITAL STANDARDS DEFINITIONS APPLYING TO RISK MANAGEMENT AND CAPITAL REGULATIONS § 930.1 Definitions. As used in this...

Evaluation of agreements between managed care organizations and providers of community-based mental illness and addiction disorder treatments.

PubMed

Rosenbaum, Sara; Mauery, D Richard; Teitelbaum, Joel; Vandivort-Warren, Rita

2002-02-01

To analyze the scope, content, and nature of contracts between managed care organizations (MCOs) and community-based mental illness and addiction disorder treatment and prevention service providers, focusing on implications for managed care policy. Qualitative and quantitative document content analysis. We reviewed and coded 107 provider contracts from 17 states. Data were aggregated on MCO and provider demographics, scope of services, contractual obligations, and financial reimbursement mechanisms. Results were compared with those from a similar study conducted in 1996 with a sample of 50 contracts to identify changes over time. The MCOs purchased relatively few services from providers, omitting many services integral to the proper management of mental illness and addiction disorders. Service duties were often ambiguously described, leading to potentially significant and unanticipated financial risk for providers. The MCOs exert strong control over treatment decision making. Capitation and other risk-based payment arrangements are increasingly common, although most continue to use fee-for-service reimbursement methods. Contracts are structured to remove provider bargaining power; they allow MCOs to unilaterally amend all provisions on notice and without negotiation and permit termination "at will." Managed care contracts favor the needs of the managed care industry and are constructed to (1) shift significant amounts of financial risk onto providers and (2) manage and restrain providers' choices over the use of benefits through close oversight, financial controls, and incentives. Because a signed contract is a precondition to access to patients and insurance revenues, health professionals must sign them and indicate a general inability to negotiate their terms.

Human Capital Analytics to Manage the Army Officer Population

DTIC Science & Technology

2017-06-09

employees from spending time and energy on a career path projected to be obsolete. Instead, managers are able to use data to show employees where they...HUMAN CAPITAL ANALYTICS TO MANAGE THE ARMY OFFICER POPULATION A thesis presented to the Faculty of the U.S. Army Command and...From - To) AUG 2016 – JUNE 2017 4. TITLE AND SUBTITLE Human Capital Analytics to Manage the Army Officer Population 5a. CONTRACT NUMBER 5b

12 CFR 225.83 - What are the consequences of failing to continue to meet applicable capital and management...

Code of Federal Regulations, 2014 CFR

2014-01-01

... 12 Banks and Banking 3 2014-01-01 2014-01-01 false What are the consequences of failing to continue to meet applicable capital and management requirements? 225.83 Section 225.83 Banks and Banking....83 What are the consequences of failing to continue to meet applicable capital and management...

Social capital and trust in providers.

PubMed

Ahern, Melissa M; Hendryx, Michael S

2003-10-01

Trust in providers has been in decline in recent decades. This study attempts to identify sources of trust in characteristics of health care systems and the wider community. The design is cross-sectional. Data are from (1) the 1996 Household Survey of the Community Tracking Study, drawn from 24 Metropolitan Statistical Areas; (2) a 1996 multi-city broadcast media marketing database including key social capital indicators; (3) Interstudy; (4) the American Hospital Association; and (5) the American Medical Association. Independent variables include individual socio-demographic variables, HMO enrollment, community-level health sector variables, and social capital. The dependent variable is self-reported trust in physicians. Data are merged from the various sources and analyzed using SUDAAN. Subjects include adults in the Household Survey who responded to the items on trust in physicians (N=17,653). Trust in physicians is independently predicted by community social capital (p<0.001). Trust is also negatively related to HMO enrollment and to many individual characteristics. The effect of HMOs is not uniform across all communities. Social capital plays a role in how health care is perceived by citizens, and how health care is delivered by providers. Efforts to build trust and collaboration in a community may improve trust in physicians, health care quality, access, and preserve local health care control.

The new organization of the health care delivery system.

PubMed

Shortell, S M; Hull, K E

1996-01-01

The U.S. health care system is restructuring at a dizzying pace. In many parts of the country, managed care has moved into third-generation models emphasizing capitated payment for enrolled lives and, in the process, turning most providers and institutions into cost centers to be managed rather than generators of revenue. While the full impact of the new managed care models remains to be seen, most evidence to date suggests that it tends to reduce inpatient use, may be associated with greater use of physician services and preventive care, and appears to result in no net differences either positive or negative with regard to quality or outcomes of care in comparison with fee-for-service plans. Some patients, however, tend to be somewhat less satisfied with scheduling of appointments and the amount of time spent with providers. There is no persuasive evidence that managed care lowers the rate of growth in overall health care costs within a given market. Further, managed care performance varies considerably across the country, and the factors influencing managed care performance are not well understood. Organized delivery systems are a somewhat more recent phenomenon representing various forms of ownership and strategic alliances among hospitals, physicians, and insurers designed to provide more cost-effective care to defined populations by achieving desired levels of functional, physician-system, and clinical integration. Early evidence suggests that organized delivery systems that are more integrated have the potential to provide more accessible coordinated care across the continuum, and appear to be associated with higher levels of inpatient productivity, greater total system revenue, greater total system cash flow, and greater total system operating margin than less integrated delivery forms. Some key success factors for developing organized delivery systems have been identified. Important roles are played by organizational culture, information systems, internal incentives, total quality management, physician leadership, and the growth of group practices. This chapter describes the growth and evolution of managed care and organized delivery systems, the research evidence regarding managed care and organized delivery systems, and the likely future organization of the health system in light of recent trends and evidence. It also highlights some of the more important public policy implications of the new health care infrastructure.

13 CFR 108.520 - Management Expenses of a NMVC Company.

Code of Federal Regulations, 2011 CFR

2011-01-01

... capital company. Cash Management by a NMVC Company ... 13 Business Credit and Assistance 1 2011-01-01 2011-01-01 false Management Expenses of a NMVC... VENTURE CAPITAL (âNMVCâ) PROGRAM Managing the Operations of a NMVC Company Management and Compensation...

New technology planning and approval: critical factors for success.

PubMed

Haselkorn, Ateret; Rosenstein, Alan H; Rao, Anil K; Van Zuiden, Michele; Coye, Molly J

2007-01-01

The steady evolution of technology, with the associated increased costs, is a major factor affecting health care delivery. In the face of limited capital resources, it is important for hospitals to integrate technology management with the strategic plan, mission, and resource availability of the organization. Experiences in technology management have shown that having a well-organized, consistent approach to technology planning, assessment, committee membership, approval, evaluation, implementation, and monitoring are key factors necessary to ensure a successful program. We examined the results of a survey that assessed the structure, processes, and cultural support behind hospital committees for new technology planning and approval.

Social representations of biosecurity in nursing: occupational health and preventive care.

PubMed

Sousa, Álvaro Francisco Lopes de; Queiroz, Artur Acelino Francisco Luz Nunes; Oliveira, Layze Braz de; Moura, Maria Eliete Batista; Batista, Odinéa Maria Amorim; Andrade, Denise de

2016-01-01

to understand the biosecurity social representations by primary care nursing professionals and analyze how they articulate with quality of care. exploratory and qualitative research based on social representation theory. The study participants were 36 nursing workers from primary health care in a state capital in the Northeast region of Brazil. The data were analyzed by descending hierarchical classification. five classes were obtained: occupational accidents suffered by professionals; occupational exposure to biological agents; biosecurity management in primary health care; the importance of personal protective equipment; and infection control and biosecurity. the different positions taken by the professionals seem to be based on a field of social representations related to the concept of biosecurity, namely exposure to accidents and risks to which they are exposed. However, occupational accidents are reported as inherent to the practice.

Markets and medical care: the United States, 1993-2005.

PubMed

White, Joseph

2007-09-01

Many studies arguing for or against markets to finance medical care investigate "market-oriented" measures such as cost sharing. This article looks at the experience in the American medical marketplace over more than a decade, showing how markets function as institutions in which participants who are self-seeking, but not perfectly rational, exercise power over other participants in the market. Cost experience here was driven more by market power over prices than by management of utilization. Instead of following any logic of efficiency or equity, system transformations were driven by beliefs about investment strategies. At least in the United States' labor and capital markets, competition has shown little ability to rationalize health care systems because its goals do not resemble those of the health care system most people want.

Markets and Medical Care: The United States, 1993–2005

PubMed Central

White, Joseph

2007-01-01

Many studies arguing for or against markets to finance medical care investigate “market-oriented” measures such as cost sharing. This article looks at the experience in the American medical marketplace over more than a decade, showing how markets function as institutions in which participants who are self-seeking, but not perfectly rational, exercise power over other participants in the market. Cost experience here was driven more by market power over prices than by management of utilization. Instead of following any logic of efficiency or equity, system transformations were driven by beliefs about investment strategies. At least in the United States' labor and capital markets, competition has shown little ability to rationalize health care systems because its goals do not resemble those of the health care system most people want. PMID:17718663

Association between physician compensation methods and delivery of guideline-concordant STD care: is there a link?

PubMed

Pourat, Nadereh; Rice, Thomas; Tai-Seale, Ming; Bolan, Gail; Nihalani, Jas

2005-07-01

To examine the association between primary care physician (PCP) reimbursement and delivery of sexually transmitted disease (STD) services. Cross-sectional sample of PCPs contracted with Medicaid managed care organizations in 2002 in 8 California counties with the highest rates of Medicaid enrollment and chlamydia cases. The association between physician reimbursement methods and physician practices in delivery of STD services was examined in multiple logistic regression models, controlling for a number of potential confounders. Evidence of an association between reimbursement based on management of utilization and the PCP practice of providing chlamydia drugs for the partner's treatment was most apparent. In adjusted analyses, physicians reimbursed with capitation and a financial incentive for management of utilization (odds ratio [OR] = 1.63) or salary and a financial incentive for management of utilization (OR = 2.63) were more likely than those reimbursed under other methods to prescribe chlamydia drugs for the partner. However, PCPs least often reported they annually screened females aged 15-19 years for chlamydia (OR = 0.63) if reimbursed under salary and a financial incentive for productivity, or screened females aged 20-25 years (OR = 0.43) if reimbursed under salary and a financial incentive for financial performance. Some physician reimbursement methods may influence care delivery, but reimbursement is not consistently associated with how physicians deliver STD care. Interventions to encourage physicians to consistently provide guideline-concordant care despite conflicting financial incentives can maintain quality of care. In addition, incentives that may improve guideline-concordant care should be strengthened.

Report: EPA Prepared to Implement Strategic Human Capital Management Activities But Challenges Remain

EPA Pesticide Factsheets

Report #2004-P-00024, September 20, 2004. EPA’s headquarters and regional offices are prepared to implement strategic human capital management activities, but an alignment of office-level activities to the Agency’s Strategy for Human Capital is lacking.

12 CFR 930.1 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOME LOAN BANK RISK MANAGEMENT AND CAPITAL STANDARDS DEFINITIONS APPLYING TO RISK MANAGEMENT AND CAPITAL REGULATIONS § 930.1 Definitions. As used in this.... Charges against the capital of the Bank means an other than temporary decline in the Bank's total equity...

Physician practice management companies: implications for hospital-based integrated delivery systems.

PubMed

Burns, L R; Robinson, J C

1997-01-01

Physician practice management companies (PPMCs) are one of the most visible entrants into the industry of managing physician practices, and anywhere from 100-150 are already in operation. Although PPMCs and hospital-based integrated delivery systems (IDSs) differ from each other in many ways, they share a number of common features, including the pursuit of capitation contracts from payors. As a result, PPMCs pose a growing, direct threat to hospital systems in competing for managed care contracts that cover physician service. PPMCs also provide an alternative to hospital-based IDSs at the local market level for physician group consolidation. This article looks at the structure, operation, and strategy of PPMCs and examines what implications their growth will have for hospital-based IDSs.

Market principles in health care and social security policy in Japan.

PubMed

Akiyama, Hiroshi

2004-01-01

Although health care in Japan is under the management of an obligatory insurance system, it is within the framework of a capitalist economy, and has helped achieve longevity during the post-war period. However, average lifetime has been improving in western European and Asian countries that have developed later. It has also been said that higher longevity is not necessarily due only to health care but also to the enhancement of environmental health achieved by economic improvements. On the other hand, the so-called 'development' led by capitalism and the market economy, and the luxuries that sometimes can be construed as uncultured, have caused unnecessary environmental destruction and disparities in wealth. Is it too cynical to think that the extended lifespan of the advanced countries has been achieved at the expense of the epidemics, refugee problems and wars which have resulted in a reduced lifespan in developing countries? It is said that capitalism is an economic ideology that includes many contradictions and is following a path of destruction. In addition, under the name of globalization, capitalism has continuously and rapidly caused vicious cycles of corruption, which are features commonly seen in today's world. It is still common that financial failures and threats are indirectly solved by initiating wars--a method completely inimical to health care. Along with environmental factors and the logic of this market doctrine, we have been trying to reform our financially-collapsed health care system. However, we cannot count on the 'durability' of any reform conducted without some awareness of our economic mistakes. It is often said that it is only because of the existence of the economy that we have health care. However, it is more realistic to say that stable health care and social security lead to a stable economy. Health care did not collapse. It was the market economy upon which health care depended that collapsed. Therefore, one must not consider that health care is subordinate to the economy. Without corrections in the failure of the market economy and in the 'trickle down' economic ideology, health care and social welfare cannot be established on a worldwide basis--the medical community should now take a leading position to emphasize this point.

Taking Human Capital Seriously: Talented Teachers in Every Classroom, Talented Principals in Every School. Principles and Recommendations for the Strategic Management of Human Capital in Public Education

ERIC Educational Resources Information Center

Consortium for Policy Research in Education, 2009

2009-01-01

The Strategic Management of Human Capital in Education Project was founded in 2008 with one goal: to improve student achievement dramatically in the 100 largest urban school districts. Unless teaching quality and principal leadership improve significantly, lasting education improvement is impossible. In policy terms, without "strategic management"…

Increasing the involvement of specialist physicians in chronic disease management.

PubMed

Taylor, Dylan; Lahey, Michele

2008-01-01

The Capital Health (CH) region in Alberta serves the population of the Edmonton area as well as a large referral population in western Canada. CH is responsible for the delivery of the spectrum of patient care, from inpatient to outpatient services. Growth in outpatient care, in particular, has led to the development of several ambulatory care facilities from which the delivery of care to several populations with a chronic disease will be coordinated. The traditional model of care delivery is unsuited to the management of chronic diseases. Physicians must be part of the planning and implementation of new models if they are to be successful and sustainable. The concept of integration into a delivery team is not well understood or practised. This is not conducive to the integration of specialist physicians into multidisciplinary teams in ambulatory care that serves the needs of patients from a large geographic area. Chronic disease management using the Chronic Care Model has proven to be an effective method of delivering care to this wide population. Specialist physicians have not always taken advantage of opportunities to be involved in the planning and development of such new health care projects. In CH, physician integration in the planning, development and implementation of this new model has proven vital to its success. We based our strategy for change on Wagner's Chronic Care Model. This involved eight steps, the first four of which have been completed and the fifth and sixth are underway. Five factors contributed to the successful integration of specialist physicians in chronic disease management: collaboration between disciplines and organizations; creating patient-centred services; organizational commitments; strong clinical leadership; and early involvement of clinicians.

Intellectual Capital and New Public Management: Reintroducing Enterprise

ERIC Educational Resources Information Center

Mouritsen, Jan; Thorbjornsen, Stefan; Bukh, Per N.; Johansen, Mette R.

2004-01-01

The paper reports on public sector organisations'/institutions' work to develop knowledge management and intellectual capital statements. Building on experiences collected during 2001-2002 where 26 public sector institutions in Denmark sought to develop intellectual capital statements, this paper discusses their experiences and in particular, it…

Primary care clinicians' recognition and management of depression: a model of depression care in real-world primary care practice.

PubMed

Baik, Seong-Yi; Crabtree, Benjamin F; Gonzales, Junius J

2013-11-01

Depression is prevalent in primary care (PC) practices and poses a considerable public health burden in the United States. Despite nearly four decades of efforts to improve depression care quality in PC practices, a gap remains between desired treatment outcomes and the reality of how depression care is delivered. This article presents a real-world PC practice model of depression care, elucidating the processes and their influencing conditions. Grounded theory methodology was used for the data collection and analysis to develop a depression care model. Data were collected from 70 individual interviews (60 to 70 min each), three focus group interviews (n = 24, 2 h each), two surveys per clinician, and investigators' field notes on practice environments. Interviews were audiotaped and transcribed for analysis. Surveys and field notes complemented interview data. Seventy primary care clinicians from 52 PC offices in the Midwest: 28 general internists, 28 family physicians, and 14 nurse practitioners. A depression care model was developed that illustrates how real-world conditions infuse complexity into each step of the depression care process. Depression care in PC settings is mediated through clinicians' interactions with patients, practice, and the local community. A clinician's interactional familiarity ("familiarity capital") was a powerful facilitator for depression care. For the recognition of depression, three previously reported processes and three conditions were confirmed. For the management of depression, 13 processes and 11 conditions were identified. Empowering the patient was a parallel process to the management of depression. The clinician's ability to develop and utilize interactional relationships and resources needed to recognize and treat a person with depression is key to depression care in primary care settings. The interactional context of depression care makes empowering the patient central to depression care delivery.

The manager and equipment decisions: the capital budget.

PubMed

McConnell, Charles R

2011-01-01

As part of his or her role in preparing a departmental budget, a manager must often become involved in budgeting for capital expenditures, those purchases that are of a type and sufficient dollar value to be capitalized and depreciated. Depending on the value of a proposed purchase, the department manager may have only a partial voice in the process; some significant purchases will require administrative approval, whereas some major acquisitions will require approval by the board of directors. Planning for possible capital purchases should begin well before the start of the annual budget exercise. Listing a capital item in the department's budget request does not imply approval; often, there are many more "needs" than there are capital funds available. Therefore, there must be a consistent process for identifying the proposed purchases that will be funded, such process necessarily including detailed specification of the need for a particular capital purchase, identification of all reasonable alternatives, consideration of any constraints, detailed financial comparison of alternatives, assessment of intangible factors, and a recommended choice.

‘More health for the money’: an analytical framework for access to health care through microfinance and savings groups

PubMed Central

Saha, Somen

2014-01-01

The main contributors to inequities in health relates to widespread poverty. Health cannot be achieved without addressing the social determinants of health, and the answer does not lie in the health sector alone. One of the potential pathways to address vulnerabilities linked to poverty, social exclusion, and empowerment of women is aligning health programmes with empowerment interventions linked to access to capital through microfinance and self-help groups. This paper presents a framework to analyse combined health and financial interventions through microfinance programmes in reducing barriers to access health care. If properly designed and ethically managed such integrated programmes can provide more health for the money spent on health care. PMID:25364028

'More health for the money': an analytical framework for access to health care through microfinance and savings groups.

PubMed

Saha, Somen

2014-10-01

The main contributors to inequities in health relates to widespread poverty. Health cannot be achieved without addressing the social determinants of health, and the answer does not lie in the health sector alone. One of the potential pathways to address vulnerabilities linked to poverty, social exclusion, and empowerment of women is aligning health programmes with empowerment interventions linked to access to capital through microfinance and self-help groups. This paper presents a framework to analyse combined health and financial interventions through microfinance programmes in reducing barriers to access health care. If properly designed and ethically managed such integrated programmes can provide more health for the money spent on health care.

Determinants of the process and outcomes of household participation in collaborative forest management in Ghana: a quantitative test of a community resilience model.

PubMed

Akamani, Kofi; Hall, Troy Elizabeth

2015-01-01

This study tested a proposed community resilience model by investigating the role of institutions, capital assets, community and socio-demographic variables as determinants of households' participation in Ghana's collaborative forest management (CFM) program and outcomes of the program. Quantitative survey data were gathered from 209 randomly selected households from two forest-dependent communities. Regression analysis shows that households' participation in the CFM program was predicted by community location, past connections with institutions, and past bonding social capital. Community location and past capitals were the strongest predictors of the outcomes of the CFM program as judged by current levels of capitals. Participation in the CFM program also had a positive effect on human capital but had minimal impact on the other capitals influencing household well-being and resilience, suggesting that the impact of co-management on household resilience may be modest. In all, the findings highlight the need for co-management policies to pay attention to the historical context of community interaction processes influencing access to capital assets and local institutions to successfully promote equitable resilience. Copyright © 2014 Elsevier Ltd. All rights reserved.

5 CFR 250.203 - Agency responsibilities.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 250.203 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PERSONNEL MANAGEMENT IN AGENCIES Strategic Human Capital Management § 250.203 Agency responsibilities. (a) To assist in the assessment of the management of human capital in the Federal Government, and to help meet the...

78 FR 16460 - Capital Project Management

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-15

...-0030] RIN 2132-AA92 Capital Project Management AGENCY: Federal Transit Administration (FTA), DOT... withdrawing its September 13, 2011, Notice of Proposed Rulemaking to revise the agency's project management... will reinitiate a rulemaking for project management oversight in the near future. Additionally, FTA may...

78 FR 3042 - J.P. Morgan Securities LLC, et al.; Notice of Application and Temporary Order

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-15

... Management Inc. (``BSAM''), Bear Stearns Health Innoventures Management, L.L.C. (``BSHIM''), BSCGP Inc. (``BSGCP''), Constellation Growth Capital LLC (``Constellation''), Constellation Ventures Management II, LLC (``Constellation II''), Highbridge Capital Management, LLC (``Highbridge''), JF International...

5 CFR 250.203 - Agency responsibilities.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 250.203 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PERSONNEL MANAGEMENT IN AGENCIES Strategic Human Capital Management § 250.203 Agency responsibilities. (a) To assist in the assessment of the management of human capital in the Federal Government, and to help meet the...

A Classification and Analysis of National Contract Management Journal Articles from 1990 to 1999 and Journal of Supply Chain Management Articles from 1987 to 2000

DTIC Science & Technology

2001-12-01

defense profits become excessive. Sorenson uses the Capital Asset Pricing Model ( CAPM ) to compare the risk-reward relationship for defense...firms. THEORETICAL, NORMATIVE, EMPIRICAL, INDUCTIVE [58] “A Comment on Using the Capital Asset Pricing ...combination asset revaluation, pensions, post-retirement health benefits, software capitalization , Material Management and Accounting System (MMAS), cost

49 CFR 639.33 - Management of leased assets.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., DEPARTMENT OF TRANSPORTATION CAPITAL LEASES Lease Management § 639.33 Management of leased assets. Each recipient must maintain an inventory of capital assets acquired by standard FTA project management... 49 Transportation 7 2010-10-01 2010-10-01 false Management of leased assets. 639.33 Section 639.33...

49 CFR 639.33 - Management of leased assets.

Code of Federal Regulations, 2014 CFR

2014-10-01

..., DEPARTMENT OF TRANSPORTATION CAPITAL LEASES Lease Management § 639.33 Management of leased assets. Each recipient must maintain an inventory of capital assets acquired by standard FTA project management... 49 Transportation 7 2014-10-01 2014-10-01 false Management of leased assets. 639.33 Section 639.33...

49 CFR 639.33 - Management of leased assets.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., DEPARTMENT OF TRANSPORTATION CAPITAL LEASES Lease Management § 639.33 Management of leased assets. Each recipient must maintain an inventory of capital assets acquired by standard FTA project management... 49 Transportation 7 2011-10-01 2011-10-01 false Management of leased assets. 639.33 Section 639.33...

49 CFR 639.33 - Management of leased assets.

Code of Federal Regulations, 2013 CFR

2013-10-01

..., DEPARTMENT OF TRANSPORTATION CAPITAL LEASES Lease Management § 639.33 Management of leased assets. Each recipient must maintain an inventory of capital assets acquired by standard FTA project management... 49 Transportation 7 2013-10-01 2013-10-01 false Management of leased assets. 639.33 Section 639.33...

49 CFR 639.33 - Management of leased assets.

Code of Federal Regulations, 2012 CFR

2012-10-01

..., DEPARTMENT OF TRANSPORTATION CAPITAL LEASES Lease Management § 639.33 Management of leased assets. Each recipient must maintain an inventory of capital assets acquired by standard FTA project management... 49 Transportation 7 2012-10-01 2012-10-01 false Management of leased assets. 639.33 Section 639.33...

Managerial perceptions of the incentives inherent in National Health Service capital charging.

PubMed

Heald, D; Scott, D A

1997-08-01

Capital charging was introduced into the National Health Service (NHS) in 1991 in order to stop capital being treated as a 'free' good and to encourage managers to use their assets more efficiently. This article seeks to examine the extent to which managerial thinking has been influenced. It uses as evidence interviews with NHS managers conducted in Scotland in 1994. The following uses of capital charges data are explored: capital programme; disposal programme; maintenance programme; contract pricing; and budgetary devolution. New capital programmes required more justification and capital charges were seen as relevant to estate rationalization. Less effect was found with regard to the maintenance programme, though this may have been due to a downgrading of the estates function in most Trusts. Although the capital charge costs included in contract prices affect the competitive position of providers, there was criticism of the lack of development of the purchasing function. Budgetary devolution was proceeding relatively slowly but, among those Trusts which had devolved capital charges, evidence was found that some clinicians were becoming aware of the full costs of equipment use. This article concludes, with cautious optimism, that capital charges are beginning to influence decisions and that, despite some incentives being dysfunctional, they will lead to a better managed NHS.

The PACE evaluation: initial findings.

PubMed

Branch, L G; Coulam, R F; Zimmerman, Y A

1995-06-01

As of mid-1994 there were nine replications of the On Lok model operating under dual capitation payments as sites in the Program of All-inclusive Care for the Elderly (PACE). A tenth site had begun operating under capitation, but was unable to remain viable. The present descriptive study documents the growth and development of the first seven of these sites, all that had been operating under capitation during 1992. Comparisons among these sites and with On Lok are presented in the areas of organizational structure, client characteristics, approaches to case management, service delivery options, and financing. There is considerable variability in the implementation of the PACE model. Combined Medicare and Medicaid capitation monthly payments range from $2,147 to $5,973. These seven PACE sites (excluding On Lok) served a total of 888 current clients at the end of 1992, after a cumulative 136 months of experience under capitation. The very slow enrollment rates may imply that the target clients are less enthusiastic about this model than are its architects. The client selection process may suggest niche-marketing or skimming, but not the full representation of the nursing home population in their states. Given both the slow enrollment and the niche-marketing (the benevolent term) or skimming (the pejorative term) that has occurred, caution about the long-term viability of the PACE model may be warranted.

Costs of health care across primary care models in Ontario.

PubMed

Laberge, Maude; Wodchis, Walter P; Barnsley, Jan; Laporte, Audrey

2017-08-01

The purpose of this study is to analyze the relationship between newly introduced primary care models in Ontario, Canada, and patients' primary care and total health care costs. A specific focus is on the payment mechanisms for primary care physicians, i.e. fee-for-service (FFS), enhanced-FFS, and blended capitation, and whether providers practiced as part of a multidisciplinary team. Utilization data for a one year period was measured using administrative databases for a 10% sample selected at random from the Ontario adult population. Primary care and total health care costs were calculated at the individual level and included costs from physician services, hospital visits and admissions, long term care, drugs, home care, lab tests, and visits to non-medical health care providers. Generalized linear model regressions were conducted to assess the differences in costs between primary care models. Patients not enrolled with a primary care physicians were younger, more likely to be males and of lower socio-economic status. Patients in blended capitation models were healthier and wealthier than FFS and enhanced-FFS patients. Primary care and total health care costs were significantly different across Ontario primary care models. Using the traditional FFS as the reference, we found that patients in the enhanced-FFS models had the lowest total health care costs, and also the lowest primary care costs. Patients in the blended capitation models had higher primary care costs but lower total health care costs. Patients that were in multidisciplinary teams (FHT), where physicians are also paid on a blended capitation basis, had higher total health care costs than non-FHT patients but still lower than the FFS reference group. Primary care and total health care costs increased with patients' age, morbidity, and lower income quintile across all primary care payment types. The new primary care models were associated with lower total health care costs for patients compared to the traditional FFS model, despite higher primary care costs in some models.

Strategies for navigating the healthcare credit market.

PubMed

Wareham, T L

2001-04-01

Not-for-profit healthcare organizations are experiencing a tightened credit market due to financial stresses on the healthcare industry such as declining payments, effects of the Balanced Budget Act of 1997, and the shift to outpatient care. In the future, healthcare organizations wanting to access the capital market will be expected to preserve cash as an "insurance policy," offer greater security and stricter covenants, and report financial information on a quarterly basis. To meet these requirements and navigate today's tighter credit market, healthcare financial managers will need to focus on the organization's most reliably profitable areas of business, link strategic and financial issues, and carefully monitor the balance sheet.

The Influence of Social Capital on Nurse-Perceived Evidence-Based Practice Implementation in South Korea.

PubMed

Shin, Ji In; Lee, Eunjoo

2017-05-01

To examine the relationship between evidence-based practice (EBP) adoption and social capital in nurses and to determine how social capital affected EBP adoption in South Korea. A cross-sectional, correlational design was used. In total, 432 registered nurses from two university-affiliated teaching hospitals in South Korea completed the questionnaire, which included demographic items, the Developing Evidence-Based Practice Questionnaire, and the Social Capital Outcomes for Nurses scale. Data were analyzed using hierarchical regression to identify the predictors of EBP adoption. Nurses with higher social capital scores reported fewer perceived barriers to finding and reviewing evidence, and changing practice. Higher social capital scores were associated with higher levels of perceived facilitators of EBP adoption and skills appraisal in finding and reviewing evidence. Social capital was a significant predictor of EBP adoption. Nurses with greater opportunities to exchange and communicate their ideas freely are more likely to accept new evidence through diverse channels and trust-based relationships between nurses, which allows healthcare organizations to promote innovations such as EBP adoption. Therefore, social capital in nurses could serve as a driving force for EBP adoption and should provide a healthy foundation for changes in patient care practices. Nurses with higher social capital are tending to adopt EBP willingly. High trust enables nurses to facilitate and support change in practice. Therefore, to improve EBP adoption in patient care, it needs to be monitored that relationships between nurses are carefully structured and that they foster mutual interaction. © 2017 Sigma Theta Tau International.

Curbing the urge to care: A Bourdieusian analysis of the effect of the caring disposition on nurse middle managers' clinical leadership in patient safety practices.

PubMed

Lalleman, P C B; Smid, G A C; Lagerwey, M D; Shortridge-Baggett, L M; Schuurmans, M J

2016-11-01

Nurse managers play an important role in implementing patient safety practices in hospitals. However, the influence of their professional background on their clinical leadership behaviour remains unclear. Research has demonstrated that concepts of Bourdieu (dispositions of habitus, capital and field) help to describe this influence. It revealed various configurations of dispositions of the habitus in which a caring disposition plays a crucial role. We explore how the caring disposition of nurse middle managers' habitus influences their clinical leadership behaviour in patient safety practices. Our paper reports the findings of a Bourdieusian, multi-site, ethnographic case study. Two Dutch and two American acute care, mid-sized, non-profit hospitals. A total of 16 nurse middle managers of adult care units. Observations were made over 560h of shadowing nurse middle managers, semi-structured interviews and member check meetings with the participants. We observed three distinct configurations of dispositions of the habitus which influenced the clinical leadership of nurse middle managers in patient safety practices; they all include a caring disposition: (1) a configuration with a dominant caring disposition that was helpful (via solving urgent matters) and hindering (via ad hoc and reactive actions, leading to quick fixes and 'compensatory modes'); (2) a configuration with an interaction of caring and collegial dispositions that led to an absence of clinical involvement and discouraged patient safety practices; and (3) a configuration with a dominant scientific disposition showing an investigative, non-judging, analytic stance, a focus on evidence-based practice that curbs the ad hoc repertoire of the caring disposition. The dispositions of the nurse middle managers' habitus influenced their clinical leadership in patient safety practices. A dominance of the caring disposition, which meant 'always' answering calls for help and reactive and ad hoc reactions, did not support the clinical leadership role of nurse middle managers. By perceiving the team of staff nurses as pseudo-patients, patient safety practice was jeopardized because of erosion of the clinical disposition. The nurse middle managers' clinical leadership was enhanced by leadership behaviour based on the clinical and scientific dispositions that was manifested through an investigative, non-judging, analytic stance, a focus on evidence-based practice and a curbed caring disposition. Copyright © 2016 Elsevier Ltd. All rights reserved.

12 CFR 931.1 - Classes of capital stock.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 7 2011-01-01 2011-01-01 false Classes of capital stock. 931.1 Section 931.1 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOME LOAN BANK RISK MANAGEMENT AND CAPITAL STANDARDS FEDERAL HOME LOAN BANK CAPITAL STOCK § 931.1 Classes of capital stock. The authorized capital...

12 CFR 931.1 - Classes of capital stock.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Classes of capital stock. 931.1 Section 931.1 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOME LOAN BANK RISK MANAGEMENT AND CAPITAL STANDARDS FEDERAL HOME LOAN BANK CAPITAL STOCK § 931.1 Classes of capital stock. The authorized capital...

Population-based contracting (population health): part II.

PubMed

Jacofsky, D J

2017-11-01

Modern healthcare contracting is shifting the responsibility for improving quality, enhancing community health and controlling the total cost of care for patient populations from payers to providers. Population-based contracting involves capitated risk taken across an entire population, such that any included services within the contract are paid for by the risk-bearing entity throughout the term of the agreement. Under such contracts, a risk-bearing entity, which may be a provider group, a hospital or another payer, administers the contract and assumes risk for contractually defined services. These contracts can be structured in various ways, from professional fee capitation to full global per member per month diagnosis-based risk. The entity contracting with the payer must have downstream network contracts to provide the care and facilities that it has agreed to provide. Population health is a very powerful model to reduce waste and costs. It requires a deep understanding of the nuances of such contracting and the appropriate infrastructure to manage both networks and risk. Cite this article: Bone Joint J 2017;99-B:1431-4. ©2017 The British Editorial Society of Bone & Joint Surgery.

Achieving Mental Health Care Parity Might Require Changes In Payments And Competition

PubMed Central

McGuire, Thomas G.

2016-01-01

One of the most prominent features of the Affordable Care Act has been the promotion of individual health plans chosen by consumers in the Marketplaces. These plans are subject to regulation and paid by risk-adjusted capitation, a set of policies known as managed competition. Individual health insurance markets, however, are vulnerable to what economists describe as efficiency problems stemming from adverse selection, and Marketplaces are no exception. Health plans have incentives to discriminate against services used by people with certain chronic illnesses, including mental health conditions. Parity regulations, which dictate coverage for mental health benefits on par with medical and surgical benefits, can eliminate discrimination in coverage but redirect discrimination toward hard-to-regulate tactics from managed care such as restrictive network design and provider payment. This article reviews policy options to contend with ongoing selection issues. “Better enforcement” of parity has less chance of success than more fundamental but feasible changes in the way plans are paid or in the way competition among plans is structured. PMID:27269019

Social capital and fisheries management: the case of Chilika Lake in India.

PubMed

Sekhar, Nagothu Udaya

2007-04-01

This article shows how social capital impacts fisheries management at the local level in Chilika Lake, located in the state of Orissa in India. In Chilika, the different fishing groups established norms and "rules of the game" including, but not limited to, spatial limits that determine who can fish and in what areas, temporal restrictions about when and for how long people may fish, gear constraints about what harvesting gear may be used by each group, and physical controls on size and other characteristics of fish that may be harvested. A survey of the members of fishing groups has shown that the bonding social capital is strong within the Chilika fishing groups. Bonding and bridging social capital keeps the fishers together in times of resource scarcity, checks violations of community rules and sanctions, and strengthens the community fisheries management. In contrast, linking social capital in Chilika appears to be weak, as is evident from the lack of trust in external agencies, seeking the help of formal institutions for legal support, and increasing conflicts. Trust and cooperation among fishers is crucial in helping to build the social capital. A social capital perspective on fisheries governance suggests that there should be a rethinking of priorities and funding mechanisms, from "top-down" fisheries management towards "co-management" with a focus on engendering rights and responsibilities for fishers and their communities.

Are the resources adoptive for conducting team-based diabetes management clinics? An explorative study at primary health care centers in Muscat, Oman.

PubMed

Al-Alawi, Kamila; Johansson, Helene; Al Mandhari, Ahmed; Norberg, Margareta

2018-05-08

AimThe aim of this study is to explore the perceptions among primary health center staff concerning competencies, values, skills and resources related to team-based diabetes management and to describe the availability of needed resources for team-based approaches. The diabetes epidemic challenges services available at primary health care centers in the Middle East. Therefore, there is a demand for evaluation of the available resources and team-based diabetes management in relation to the National Diabetes Management Guidelines. A cross-sectional study was conducted with 26 public primary health care centers in Muscat, the capital of Oman. Data were collected from manual and electronic resources as well as a questionnaire that was distributed to the physician-in-charge and diabetes management team members.FindingsThe study revealed significant differences between professional groups regarding how they perceived their own competencies, values and skills as well as available resources related to team-based diabetes management. The perceived competencies were high among all professions. The perceived team-related values and skills were also generally high but with overall lower recordings among the nurses. This pattern, along with the fact that very few nurses have specialized qualifications, is a barrier to providing team-based diabetes management. Participants indicated that there were sufficient laboratory resources; however, reported that pharmacological, technical and human resources were lacking. Further work should be done at public primary diabetes management clinics in order to fully implement team-based diabetes management.

Does capitated contracting improve efficiency? Evidence from California hospitals.

PubMed

Chu, Hsuan-Lien; Liu, Shuen-Zen; Romeis, James C

2004-01-01

This study examines the effect of capitated contracting on hospital efficiency to better understand strategies related to the recent financial crisis in the California health care market. Our findings indicate that less efficient hospitals are more likely to participate in capitated contracting. As a result, hospitals with capitated contracts are, on average, less efficient than hospitals without capitated contracts. Hospital efficiency generally increases with respect to the degree of capitation involvement. The efficiency improvement, however, becomes insignificant when capitation exposures are already high. Thus, hospital executives should not be overly optimistic about efficiency gains obtained in capitated contracting and should control the degree of capitation involvement.

Implementing a web-based home monitoring system within an academic health care network: barriers and facilitators to innovation diffusion.

PubMed

Pelletier, Alexandra C; Jethwani, Kamal; Bello, Heather; Kvedar, Joseph; Grant, Richard W

2011-01-01

The practice of outpatient type 2 diabetes management is gradually moving from the traditional visit-based, fee-for-service model to a new, health information communication technology (ICT)-supported model that can enable non-visit-based diabetes care. To date, adoption of innovative health ICT tools for diabetes management has been slowed by numerous barriers, such as capital investment costs, lack of reliable reimbursement mechanisms, design defects that have made some systems time-consuming and inefficient to use, and the need to integrate new ICT tools into a system not primarily designed for their use. Effective implementation of innovative diabetes health ICT interventions must address local practice heterogeneity and the interaction of this heterogeneity with clinical care delivery. The Center for Connected Health at Partners Healthcare has implemented a new ICT intervention, Diabetes Connect (DC), a Web-based glucose home monitoring and clinical messaging system. Using the framework of the diffusion of innovation theory, we review the implementation and examine lessons learned as we continue to deploy DC across the health care network. © 2010 Diabetes Technology Society.

Experimental Effects of Program Management Approach on Teachers' Professional Ties and Social Capital

ERIC Educational Resources Information Center

Quinn, David M.; Kim, James S.

2018-01-01

Theory and empirical work suggest that teachers' social capital influences school improvement efforts. Social ties are prerequisite for social capital, yet little causal evidence exists on how malleable factors, such as instructional management approaches, affect teachers' ties. In this cluster-randomized trial, we apply a decision-making…

An Analysis of Social Capital and Environmental Management of Higher Education Institutions

ERIC Educational Resources Information Center

Evangelinos, Konstantinos I.; Jones, Nikoleta

2009-01-01

Purpose: The purpose of this paper is to analyse the importance of the theory of social capital for the challenges presented during environmental management initiatives in higher education institutions (HEIs). In particular, the paper utilises the fundamental components of social capital theory and assesses a hypothesis that higher stocks of…

13 CFR 120.462 - What are SBA's additional requirements on capital maintenance for SBA Supervised Lenders?

Code of Federal Regulations, 2010 CFR

2010-01-01

.... The board of directors (or management, if the SBA Supervised Lender is a division of another company... adequacy goals; that is, the total amount of capital needed to assure the SBA Supervised Lender's continued... in developing the SBA Supervised Lender's capital adequacy plan: (i) Management capability; (ii...

Examining the structural challenges to communication as experienced by nurse managers in two US hospital settings.

PubMed

Marx, Marcia

2014-11-01

This study examined the structural barriers to communication for first-line nurse managers with their staff nurses. The delivery of quality care depends on effective communication in hospital units. First-line nurse managers are central figures in networks whose responsibility is to communicate information from the senior management to staff nurses. The data were collected using face-to-face interviews with first-line managers at two US hospitals The interviews were transcribed and coded with limited use of the qualitative software atlas Interview questions focused on work experiences of managers with special emphases on communication. Structural barriers that influenced managers' communication included the amount of face-to-face interaction with nurses, the amount of information to communicate, levels of formalization, outreach to all nurses, time constraints and nurses' subcultural networks These factors compromised managers' ability to communicate effectively with nurses. Managers should carefully examine how structure affects communication recognizing that some dynamics of structure cannot be changed but that they can influence others, such as formalization and communication networks. Managers should examine their own positioning within nurses' networks and demonstrate to nurses that their expertise contributes to the collaborative capital upon which nursing practice depends. © 2013 John Wiley & Sons Ltd.

76 FR 39447 - J.P. Morgan Securities LLC, et al.; Notice of Application and Temporary Order

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-06

... Capital Management, LLC (``Highbridge''); JF International Management Inc. (``JFIMI''); JPMorgan Asset... order. Applicants: J.P. Morgan Securities; Bear Stearns Asset Management Inc. (``BSAM''); Bear Stearns Health Innoventures Management, L.L.C. (``BSHIM''); BSCGP Inc. (``BSCGP''); Constellation Growth Capital...

Manage "Human Capital" Strategically

ERIC Educational Resources Information Center

Odden, Allan

2011-01-01

To strategically manage human capital in education means restructuring the entire human resource system so that schools not only recruit and retain smart and capable individuals, but also manage them in ways that support the strategic directions of the organization. These management practices must be aligned with a district's education improvement…

The Effects of Capitation on Outpatient Mental Health Episodes of Children

ERIC Educational Resources Information Center

Cohen, Edward; Snowden, Lonnie; Libby, Anne; Ma, Yifei

2006-01-01

We analyzed the effects of the Colorado Medicaid Capitation Program on the duration and services of over 21,000 outpatient mental health episodes for young children. The study spanned a three year period before and after capitation was implemented, and compared episodes of outpatient care for children from 14 capitated Community Mental Health…

Capitalism, the state and health care in the age of austerity: a Marxist analysis.

PubMed

Porter, Sam

2013-01-01

The capacity to provide satisfactory nursing care is being increasingly compromised by current trajectories of healthcare funding and governance. The purpose of this paper is to examine how well Marxist theories of the state and its relationship with capital can explain these trajectories in this period of ever-increasing austerity. Following a brief history of the current crisis, it examines empirically the effects of the crisis, and of the current trajectory of capitalism in general, upon the funding and organization of the UK and US healthcare systems. The deleterious effect of growing income inequalities to the health of the population is also addressed. Marx's writings on the state and its relation to the capitalist class were fragmentary and historically and geographically specific. From them, we can extract three theoretical variants: the instrumentalist theory of the state, where the state has no autonomy from capital; the abdication theory, whereby capital abstains from direct political power and relies on the state to serve its interests; and the class-balance theory, whereby the struggle between two opposed classes allows the state to assert itself. Discussion of modern Marxist interpretations includes Poulantzas's abdication theory and Miliband's instrumentalist theory. It is concluded that, despite the pluralism of electoral democracies, the bourgeoisie do have an overweening influence upon the state. The bourgeoisie's ownership of the means of production provides the foundation for its influence because the state is obliged to rely on it to manage the supply of goods and services and the creation of wealth. That power is further reinforced by the infiltration of the bourgeoisie into the organs of state. The level of influence has accelerated rapidly over recent decades. One of the consequences of this has been that healthcare systems have become rich pickings for the evermore confident bourgeoisie. © 2012 Blackwell Publishing Ltd.

Alternative financing sources. ECRI. Emergency Care Research Institute.

PubMed

1987-01-01

A number of new capital sources have been developed and used by health care institutions unable to finance high-tech projects with equity or conventional tax-exempt debt instruments; these include REITs, MLPs, per-use rentals, venture capital, and banks as brokers. However, there are no magic capital acquisition solutions. Institutions with good credit will continue to find a number of doors open to them; poorer credit risks will have fewer options, and those available will carry greater risk, allow for less provider control over projects, and limit potential return on investment to some extent. It is essential to examine carefully the drawbacks inherent in each type of alternative financing source. Venture capital in particular requires specific analysis because of the wide variety of possible arrangements that exist. If you cannot find either traditional or alternative sources of funding for a proposed project, you should reexamine the project and its underlying utilization projections and reimbursement assumptions.

Patient compliance with managed care emergency department referral: an orthopaedic view.

PubMed

Saroff, Don; Dell, Rick; Brown, E Richard

2002-04-01

Patient compliance with emergency department (ED)-generated referral is an important part of the delivery of quality health care. Although many studies from non-managed care health centers have reported on ED patient compliance, no studies have reported on this in a managed care setting. The objective of this study is to examine patient compliance with ED-generated referral and to produce a benchmark of follow-up rates possible in a capitated managed care system. That is to say, in a health care system whose members pay a uniform per capita payment or fee, one that has salaried physicians, owns its own hospitals, and has a mechanism of transition from ED to outpatient clinic that ensures referral accessibility. Retrospective review of consecutive ED patient compliance with ED-generated referral. All consecutive patients who presented to a managed care hospital's ED with an acute fracture and who were given an outpatient referral during the period from 23rd December 1998 to 23rd January, 1999. Of 8000 consecutive ED patients, 234 were included in the study. Compliance with ED-generated referral was determined from outpatient clinic records. Of the 234 patients treated in the ED and referred, 222 (94.9%) complied with follow-up appointments. We have demonstrated that an ED patient follow-up compliance rate of 94.9% can be obtained. It is probable that the high compliance rate is due to the features of the system studied. The high rate may also be related to the specific diagnosis studied, although previous literature reports poor ED patient compliance for the same diagnosis in a different ED setting. Additional research is needed to determine whether the high compliance rate reported in this study can be obtained in ED settings that are not part of a similar managed care system and to determine the role of referral accessibility (or inaccessibility) in current ED settings.

The relationships among social capital, organisational commitment and customer-oriented prosocial behaviour of hospital nurses.

PubMed

Hsu, Chiu-Ping; Chang, Chia-Wen; Huang, Heng-Chiang; Chiang, Chi-Yun

2011-05-01

This study examines the perceptions of registered nurses of social capital, organisational commitment and customer-oriented prosocial behaviour. Additionally, this study also addresses a conceptual model for testing how registered nurses' perceptions of three types of social capital influence their organisational commitment, in turn intensifying customer-oriented prosocial behaviour, including role-prescribed customer service and extra-role customer service. Customer-oriented prosocial behaviour explains differences in job satisfaction and job performance. However, the critical role of customer orientation in the hospital setting has yet to be explored. Survey. The survey was conducted to obtain data from registered nurses working for a large Taiwanese medical centre, yielding 797 usable responses and a satisfactory response rate of 86.7%. The partial least squares method was adopted to obtain parameter estimates and test proposed hypotheses. The study measurements display satisfactory reliability, as well as both convergent and discriminant validities. All hypotheses were supported. Empirical results indicate that registered nurses' perceptions of social capital were significantly impacted the extent of organisational commitment, which in turn significantly influenced customer-oriented prosocial behaviour. By stimulating nursing staff commitment, health care providers can urge them to pursue organisational goals and provide high quality customer service. To enhance organisational commitment, health care managers should endeavour to create interpersonal interaction platforms in addition to simply offering material rewards. Nurses act as contact employees for their patient customers in the hospital, and they are required to provide patient safety and service quality. This study shows that nurses with high organisational commitment are willing to provide customer-oriented prosocial activities, which in turn enhances patient satisfaction. © 2011 Blackwell Publishing Ltd.

12 CFR 931.6 - Transfer of capital stock.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 7 2011-01-01 2011-01-01 false Transfer of capital stock. 931.6 Section 931.6 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOME LOAN BANK RISK MANAGEMENT AND CAPITAL STANDARDS FEDERAL HOME LOAN BANK CAPITAL STOCK § 931.6 Transfer of capital stock. A Bank in its capital plan...

12 CFR 931.6 - Transfer of capital stock.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Transfer of capital stock. 931.6 Section 931.6 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOME LOAN BANK RISK MANAGEMENT AND CAPITAL STANDARDS FEDERAL HOME LOAN BANK CAPITAL STOCK § 931.6 Transfer of capital stock. A Bank in its capital plan...

Diabetes Care in India.

PubMed

Joshi, Shashank R

2015-01-01

Diabetes has become a major health care problem in India with an estimated 66.8 million people suffering from the condition, representing the largest number of any country in the world. The rising burden of diabetes has greatly affected the health care sector and economy in India. The goal of health care experts in India is to transform India into a diabetes care capital in the world. An expert detailed review of the medical literature with an Asian Indian context was performed. Recent epidemiologic studies from India point to a great burden from diabetes. Diabetes control in India is far from ideal with a mean hemoglobin A1c of 9.0%-at least 2.0% higher than suggested by international bodies. Nearly half of people with diabetes remain undetected, accounting for complications at the time of diagnosis. Screening can differentiate an asymptomatic individual at high risk from one at low risk for diabetes. Despite the large number of people with diabetes in India, awareness is low and needs to be addressed. Other challenges include balancing the need for glycemic control with risk reduction due to overly tight control, especially in high-risk groups and taking into account health care professional expertise, attitudes, and perceptions. Pharmacologic care should be individualized with early consideration of combination therapy. Regular exercise, yoga, mindful eating, and stress management form a cornerstone in the management of diabetes. Considering the high cost incurred at various steps of screening, diagnosis, monitoring, and management, it is important to realize the cost-effective measures of diabetes care that are necessary to implement. Result-oriented organized programs involving patient education, as well as updating the medical fraternity on various developments in the management of diabetes, are required to combat the current diabetes epidemic in India. Copyright © 2015. Published by Elsevier Inc.

Management of health system reform: a view of changes within New Zealand.

PubMed

Ritchie, D

1998-08-01

This paper reports on the context and process of health system reform in New Zealand. The study is based on interviews conducted with 31 managers from three Crown Health Enterprises (publicly funded hospital-based health care organizations). A number of countries with publicly funded health services (e.g., UK, Australia and New Zealand) have sought to shift from the traditional 'passive' health management style (using transactional management skills to balance historically-based expenditure budgets) to 'active' transformational leadership styles that reflect a stronger 'private sector' orientation (requiring active management of resources--including a return on 'capital' investment, identification of costs and returns on 'product lines', 'marketing' a 'product mix', reducing non-core activities and overhead costs, and a closer relationship with 'shareholders', suppliers and customers/clients). Evidence of activities and processes associated with transformational leadership are identified. Success of the New Zealand health reforms will be determined by the approach the new managers adopt to improve their organization's performance. Transformational leadership has been frequently linked to the successful implementation of significant organizational change in other settings (Kurz et al., 1988; Dunphy and Stace, 1990) but it is too early to assess whether this is applicable in a health care context.

Capital update factor: a new era approaches.

PubMed

Grimaldi, P L

1993-02-01

The Health Care Financing Administration (HCFA) has constructed a preliminary model of a new capital update method which is consistent with the framework being developed to refine the update method for PPS operating costs. HCFA's eventual goal is to develop a single update framework for operating and capital costs. Initial results suggest that adopting the new capital update method would reduce capital payments substantially, which might intensify creditor's concerns about extending loans to hospitals.

Comparison of three models of ownership of community health centres in China: a qualitative study.

PubMed

Wei, Xiaolin; Yang, Nan; Gao, Yang; Wong, Samuel Y S; Wong, Martin C S; Wang, Jiaji; Wang, Harry H X; Li, Donald K T; Tang, Jinling; Griffiths, Sian M

2015-07-01

Community health centres are the main form of provision of primary care in China. There are three models: government managed, hospital managed and private. Our aim was to describe and compare primary care under the three ownership models. Four aspects of primary care were studied: services, organization, financing and human resources. Interviews were undertaken with 60 managerial and professional staff in 13 community health centres in the Pearl River Delta region in 2010. Three community health centres were selected in the capital city and two were selected from each of the other five cities. Thematic framework analysis was conducted. Government-managed community health centres received the largest public funding, followed by hospital-managed community health centres, while private community health centres received the least. Private community health centres were the smallest in scale and provided lower quality public health services compared with the other two models. Patient out-of-pocket costs accounted for the majority of the revenue in all models of community health centres despite improved government funding for preventive services. General challenges such as the shortage of public funding, the exclusion of migrants in the funding for preventive services, low capacity in human resources and the separation of clinical and preventive care in community health centres were identified in all three models of community health centres. The ownership and management of a community health centre greatly influence the service it provides. Private community health centres are in a disadvantaged position to deliver high quality clinical and preventive care. © The Author(s) 2015.

Approaches of Russian oil companies to optimal capital structure

NASA Astrophysics Data System (ADS)

Ishuk, T.; Ulyanova, O.; Savchitz, V.

2015-11-01

Oil companies play a vital role in Russian economy. Demand for hydrocarbon products will be increasing for the nearest decades simultaneously with the population growth and social needs. Change of raw-material orientation of Russian economy and the transition to the innovative way of the development do not exclude the development of oil industry in future. Moreover, society believes that this sector must bring the Russian economy on to the road of innovative development due to neo-industrialization. To achieve this, the government power as well as capital management of companies are required. To make their optimal capital structure, it is necessary to minimize the capital cost, decrease definite risks under existing limits, and maximize profitability. The capital structure analysis of Russian and foreign oil companies shows different approaches, reasons, as well as conditions and, consequently, equity capital and debt capital relationship and their cost, which demands the effective capital management strategy.

Life course experiences and lay diagnosis explain low-income parents' child dental decisions: a qualitative study.

PubMed

Muirhead, Vanessa; Levine, Alissa; Nicolau, Belinda; Landry, Anne; Bedos, Christophe

2013-02-01

This study aimed to better understand low-income parents' child dental care decisions through a life course approach that captured parents' experiences within the social context of poverty. We conducted 43 qualitative life history interviews with 10 parents, who were long-term social assistance recipients living in Montreal, Canada. Thematic analysis involved interview debriefing, transcript coding, theme identification and data interpretation. Our interviews identified two emergent themes: lay diagnosis and parental oral health management. Parents described a process of 'lay diagnosis' that consisted of examining their children's teeth and interpreting their children's oral signs and symptoms based on their observations. These lay diagnoses were also shaped by their own dental crises, care experiences and oral health knowledge gained across a life course of poverty and dental disadvantage. Parents' management strategies included monitoring and managing their children's oral health themselves or by seeking professional recourse. Parents' management strategies were influenced both by their lay diagnoses and their perceived ability to manage their children's oral health. Parents felt responsible for their children's dental care, empowered to manage their oral health and sometimes forgo dental visits for their children because of their own self-management life history. This original approach revealed insights that help to understand why low-income parents may underutilize free dental services. Further research should consider how dental programs can nurture parental empowerment and capitalize on parents' perceived ability to diagnose and manage their children's oral health.

Long-term Morbidity of Testicular Cancer Treatment.

PubMed

Fung, Chunkit; Fossa, Sophie D; Williams, Annalynn; Travis, Lois B

2015-08-01

Second malignant neoplasms, cardiovascular disease, neurotoxicity and ototoxicity, pulmonary complications, hypogonadism, and nephrotoxicity are potentially life-threatening long-term complications of testicular cancer and its therapy. This article describes the pathogenesis, risks, and management of these late effects experienced by long-term testicular cancer survivors, who are defined as individuals who are disease free 5 years or more after primary treatment. Testicular cancer survivors should follow applicable national guidelines for cancer screening and management of cardiovascular disease risk factors. In addition, health care providers should capitalize on the time of cancer diagnosis as a teachable moment to introduce and promote lifestyle changes. Copyright © 2015 Elsevier Inc. All rights reserved.

Strategic Management of Human Capital in Education: Improving Instructional Practice and Student Learning in Schools

ERIC Educational Resources Information Center

Odden, Allan R.

2011-01-01

"Strategic Management of Human Capital in Education" offers a comprehensive and strategic approach to address what has become labeled as "talent and human capital." Grounded in extensive research and examples of leading edge districts, this book shows how the entire human resource system in schools--from recruitment, to selection/placement,…

Value Innovation in Hospital: Increase Organizational IQ by Managing Intellectual Capitals.

PubMed

Karami, Mahtab; Torabi, Mashallah

2015-02-01

Hospital is a complex organization rich in intellectual capitals. Effective management of these assets in line with innovating value to reach strategic goals and objectives can lead to increasing organizational IQ. In hospital with high organizational IQ, Increasing syntropy in intellectual capitals can convert it to an agile, learner, innovative, and smart organization.

Value Innovation in Hospital: Increase Organizational IQ by Managing Intellectual Capitals

PubMed Central

Karami, Mahtab; Torabi, Mashallah

2015-01-01

Hospital is a complex organization rich in intellectual capitals. Effective management of these assets in line with innovating value to reach strategic goals and objectives can lead to increasing organizational IQ. In hospital with high organizational IQ, Increasing syntropy in intellectual capitals can convert it to an agile, learner, innovative, and smart organization. PMID:25870494

12 CFR 932.4 - Credit risk capital requirement.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 7 2011-01-01 2011-01-01 false Credit risk capital requirement. 932.4 Section 932.4 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOME LOAN BANK RISK MANAGEMENT AND CAPITAL STANDARDS FEDERAL HOME LOAN BANK CAPITAL REQUIREMENTS § 932.4 Credit risk capital requirement. (a...

12 CFR 932.3 - Risk-based capital requirement.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 7 2011-01-01 2011-01-01 false Risk-based capital requirement. 932.3 Section 932.3 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOME LOAN BANK RISK MANAGEMENT AND CAPITAL STANDARDS FEDERAL HOME LOAN BANK CAPITAL REQUIREMENTS § 932.3 Risk-based capital requirement. (a...

12 CFR 932.2 - Total capital requirement.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 7 2011-01-01 2011-01-01 false Total capital requirement. 932.2 Section 932.2 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOME LOAN BANK RISK MANAGEMENT AND CAPITAL STANDARDS FEDERAL HOME LOAN BANK CAPITAL REQUIREMENTS § 932.2 Total capital requirement. (a) Each Bank shall...

12 CFR 932.6 - Operations risk capital requirement.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 7 2011-01-01 2011-01-01 false Operations risk capital requirement. 932.6 Section 932.6 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOME LOAN BANK RISK MANAGEMENT AND CAPITAL STANDARDS FEDERAL HOME LOAN BANK CAPITAL REQUIREMENTS § 932.6 Operations risk capital requirement...

13 CFR 108.585 - Voluntary decrease in NMVC Company's Regulatory Capital.

Code of Federal Regulations, 2010 CFR

2010-01-01

...'s Regulatory Capital. 108.585 Section 108.585 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION NEW MARKETS VENTURE CAPITAL (âNMVCâ) PROGRAM Managing the Operations of a NMVC Company Voluntary Decrease in Regulatory Capital § 108.585 Voluntary decrease in NMVC Company's Regulatory Capital. You must...

12 CFR 932.6 - Operations risk capital requirement.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Operations risk capital requirement. 932.6 Section 932.6 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOME LOAN BANK RISK MANAGEMENT AND CAPITAL STANDARDS FEDERAL HOME LOAN BANK CAPITAL REQUIREMENTS § 932.6 Operations risk capital requirement...

12 CFR 932.5 - Market risk capital requirement.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Market risk capital requirement. 932.5 Section 932.5 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOME LOAN BANK RISK MANAGEMENT AND CAPITAL STANDARDS FEDERAL HOME LOAN BANK CAPITAL REQUIREMENTS § 932.5 Market risk capital requirement. (a...

12 CFR 932.3 - Risk-based capital requirement.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Risk-based capital requirement. 932.3 Section 932.3 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOME LOAN BANK RISK MANAGEMENT AND CAPITAL STANDARDS FEDERAL HOME LOAN BANK CAPITAL REQUIREMENTS § 932.3 Risk-based capital requirement. (a...

12 CFR 932.2 - Total capital requirement.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Total capital requirement. 932.2 Section 932.2 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOME LOAN BANK RISK MANAGEMENT AND CAPITAL STANDARDS FEDERAL HOME LOAN BANK CAPITAL REQUIREMENTS § 932.2 Total capital requirement. (a) Each Bank shall...

Financial planning as a policy tool in the petroleum industry (the case study: ojsc ”SURGUTNEFTEGAS”)

NASA Astrophysics Data System (ADS)

Romanyuk, Vera; Karyakina, Anna; Vershkova, Elena; Grinkevish, Larisa; Pozdeeva, Galina

2016-09-01

The article deals with the financial planning of oil and gas company activities including capital structure optimization. One of the main tasks of up-to-date financial management is to optimize the capital structure of an organization and minimize the weighted average cost of capital. The applied method in capital structure optimization affects the research quality results, as well as management decisions. The study was conducted on the basis of OJSC "Surgutneftegas" financial statements.

Costs Associated with Implementation of Computer-Assisted Clinical Decision Support System for Antenatal and Delivery Care: Case Study of Kassena-Nankana District of Northern Ghana

PubMed Central

Dalaba, Maxwell Ayindenaba; Akweongo, Patricia; Williams, John; Saronga, Happiness Pius; Tonchev, Pencho; Sauerborn, Rainer; Mensah, Nathan; Blank, Antje; Kaltschmidt, Jens; Loukanova, Svetla

2014-01-01

Objective This study analyzed cost of implementing computer-assisted Clinical Decision Support System (CDSS) in selected health care centres in Ghana. Methods A descriptive cross sectional study was conducted in the Kassena-Nankana district (KND). CDSS was deployed in selected health centres in KND as an intervention to manage patients attending antenatal clinics and the labour ward. The CDSS users were mainly nurses who were trained. Activities and associated costs involved in the implementation of CDSS (pre-intervention and intervention) were collected for the period between 2009–2013 from the provider perspective. The ingredients approach was used for the cost analysis. Costs were grouped into personnel, trainings, overheads (recurrent costs) and equipment costs (capital cost). We calculated cost without annualizing capital cost to represent financial cost and cost with annualizing capital costs to represent economic cost. Results Twenty-two trained CDSS users (at least 2 users per health centre) participated in the study. Between April 2012 and March 2013, users managed 5,595 antenatal clients and 872 labour clients using the CDSS. We observed a decrease in the proportion of complications during delivery (pre-intervention 10.74% versus post-intervention 9.64%) and a reduction in the number of maternal deaths (pre-intervention 4 deaths versus post-intervention 1 death). The overall financial cost of CDSS implementation was US$23,316, approximately US$1,060 per CDSS user trained. Of the total cost of implementation, 48% (US$11,272) was pre-intervention cost and intervention cost was 52% (US$12,044). Equipment costs accounted for the largest proportion of financial cost: 34% (US$7,917). When economic cost was considered, total cost of implementation was US$17,128–lower than the financial cost by 26.5%. Conclusions The study provides useful information in the implementation of CDSS at health facilities to enhance health workers' adherence to practice guidelines and taking accurate decisions to improve maternal health care. PMID:25180831

Adaptive governance, ecosystem management, and natural capital.

PubMed

Schultz, Lisen; Folke, Carl; Österblom, Henrik; Olsson, Per

2015-06-16

To gain insights into the effects of adaptive governance on natural capital, we compare three well-studied initiatives; a landscape in Southern Sweden, the Great Barrier Reef in Australia, and fisheries in the Southern Ocean. We assess changes in natural capital and ecosystem services related to these social-ecological governance approaches to ecosystem management and investigate their capacity to respond to change and new challenges. The adaptive governance initiatives are compared with other efforts aimed at conservation and sustainable use of natural capital: Natura 2000 in Europe, lobster fisheries in the Gulf of Maine, North America, and fisheries in Europe. In contrast to these efforts, we found that the adaptive governance cases developed capacity to perform ecosystem management, manage multiple ecosystem services, and monitor, communicate, and respond to ecosystem-wide changes at landscape and seascape levels with visible effects on natural capital. They enabled actors to collaborate across diverse interests, sectors, and institutional arrangements and detect opportunities and problems as they developed while nurturing adaptive capacity to deal with them. They all spanned local to international levels of decision making, thus representing multilevel governance systems for managing natural capital. As with any governance system, internal changes and external drivers of global impacts and demands will continue to challenge the long-term success of such initiatives.

Adaptive governance, ecosystem management, and natural capital

PubMed Central

Schultz, Lisen; Folke, Carl; Österblom, Henrik; Olsson, Per

2015-01-01

To gain insights into the effects of adaptive governance on natural capital, we compare three well-studied initiatives; a landscape in Southern Sweden, the Great Barrier Reef in Australia, and fisheries in the Southern Ocean. We assess changes in natural capital and ecosystem services related to these social–ecological governance approaches to ecosystem management and investigate their capacity to respond to change and new challenges. The adaptive governance initiatives are compared with other efforts aimed at conservation and sustainable use of natural capital: Natura 2000 in Europe, lobster fisheries in the Gulf of Maine, North America, and fisheries in Europe. In contrast to these efforts, we found that the adaptive governance cases developed capacity to perform ecosystem management, manage multiple ecosystem services, and monitor, communicate, and respond to ecosystem-wide changes at landscape and seascape levels with visible effects on natural capital. They enabled actors to collaborate across diverse interests, sectors, and institutional arrangements and detect opportunities and problems as they developed while nurturing adaptive capacity to deal with them. They all spanned local to international levels of decision making, thus representing multilevel governance systems for managing natural capital. As with any governance system, internal changes and external drivers of global impacts and demands will continue to challenge the long-term success of such initiatives. PMID:26082542

Non-acute care facility ownership: if not you, who?

PubMed

Davis, J Michael

2007-01-01

Physician groups now face a dynamic medical real estate market that can provide an attractive alternative to self-owned and self-financed outpatient facilities and medical office buildings. The ownership and financing options available to physicians and physician groups considering the development of new medical projects have expanded greatly over the past few years and are likely to continue to evolve in the foreseeable future. This changing environment, driven by new sources of institutional capital and the emergence of qualified developers, has led to a more competitive market for physicians and groups seeking real estate capital partners, and physicians are starting to take advantage of it. Physicians and groups have embraced third-party ownership and management of real estate, because it can preserve capital resources and minimizes risk. These groups are using third parties to develop and own new medical real estate projects. This article describes medical real estate project development alternatives, the attributes and concerns of developers, typical transaction terms, and a recommended process for physicians and groups to select the best real estate development partner.

49 CFR 633.5 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... TRANSPORTATION PROJECT MANAGEMENT OVERSIGHT General Provisions § 633.5 Definitions. As used in this part... construction and management of a project. Major capital project means a project that: (1) Involves the...; or (3) The Administrator determines is a major capital project because the project management...

49 CFR 633.5 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... TRANSPORTATION PROJECT MANAGEMENT OVERSIGHT General Provisions § 633.5 Definitions. As used in this part... construction and management of a project. Major capital project means a project that: (1) Involves the...; or (3) The Administrator determines is a major capital project because the project management...

49 CFR 633.5 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... TRANSPORTATION PROJECT MANAGEMENT OVERSIGHT General Provisions § 633.5 Definitions. As used in this part... construction and management of a project. Major capital project means a project that: (1) Involves the...; or (3) The Administrator determines is a major capital project because the project management...

49 CFR 633.5 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... TRANSPORTATION PROJECT MANAGEMENT OVERSIGHT General Provisions § 633.5 Definitions. As used in this part... construction and management of a project. Major capital project means a project that: (1) Involves the...; or (3) The Administrator determines is a major capital project because the project management...

49 CFR 633.5 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... TRANSPORTATION PROJECT MANAGEMENT OVERSIGHT General Provisions § 633.5 Definitions. As used in this part... construction and management of a project. Major capital project means a project that: (1) Involves the...; or (3) The Administrator determines is a major capital project because the project management...

Caregiver financial distress, depressive symptoms and limited social capital as barriers to children's dental care in a mid-western county in the United States.

PubMed

Kruger, J S; Kodjebacheva, G D; Kunkel, L; Smith, K D; Kruger, D J

2015-12-01

To identify barriers to children's access to dental care. A cross-sectional health survey. All residential census tracts in Genesee County, Michigan, USA. 498 adults who reported having children in their households, extracted from 2,932 randomly selected adult participants in the 2009 and 2011 surveys. Stepwise logistic regression was used to predict two dependent variables: children's lack of any visits to dentists' offices and unmet dental care needs (defined as needing dental care but not receiving it due to cost) in the previous year as reported by the adults. Independent variables included gender, age, education, race/ethnicity, financial planning, financial distress, fear of crime, stress, depressive symptoms, experiences of discrimination, and neighbourhood social capital. Of the 498 adults, 29.9% reported that they had children who had not visited a dentist in the past 12 months and 13% reported that they had household children with unmet dental care needs in the past year. Adults who reported higher depressive symptoms, lower neighbourhood social capital, greater financial distress, and who were younger were more likely to have household children who did not visit a dentist in the past year. Financial distress was the only significant predictor when controlling for other variables to predict unmet dental care needs. Factors beyond financial distress affect children's dental care; these include parental depressive symptoms and lower neighbourhood social capital. Interventions promoting parental mental health and social integration may increase dental care among children.

Characteristics of Medical Practices in Three Developed Managed Care Markets

PubMed Central

Landon, Bruce E; Normand, Sharon-Lise T; Frank, Richard; McNeil, Barbara J

2005-01-01

Objective To describe physician practices, ranging from solo and two-physician practices to large medical groups, in three geographically diverse parts of the country with strong managed care presences. Data Sources/Study Design Surveys of medical practices in three managed care markets conducted in 2000–2001. Study Design We administered questionnaires to all medical practices affiliated with two large health plans in Boston, MA, and Portland, OR, and to all practices providing primary care for cardiovascular disease patients admitted to five large hospitals in Minneapolis, MN. We offer data on how physician practices are structured under managed care in these geographically diverse regions of the country with a focus on the structural characteristics, financial arrangements, and care management strategies adopted by practices. Data Collection A two-staged survey consisting of an initial telephone survey that was undertaken using CATI (computerized assisted telephone interviewing) techniques followed by written modules triggered by specific responses to the telephone survey. Principal Findings We interviewed 468 practices encompassing 668 distinct sites of care (overall response rate 72 percent). Practices had an average of 13.9 member physicians (range: 1–125). Most (80.1 percent) medium- (four to nine physicians) and large-size (10 or more physicians) groups regularly scheduled meetings to discuss resource utilization and referrals. Almost 90 percent of the practices reported that these meetings occurred at least once per month. The predominant method for paying practices was via fee-for-service payments. Most other payments were in the form of capitation. Overall, 75 percent of physician practices compensated physicians based on productivity, but there was substantial variation related to practice size. Nonetheless, of the practices that did not use straight productivity methods (45 percent of medium-sized practices and 54 percent of large practices), most used arrangements consisting of combinations of salary and productivity formulas. Conclusions We found diversity in the characteristics and capabilities of medical practices in these three markets with high managed care involvement. Financial practices of most practices are geared towards rewarding productivity, and care management practices and capabilities such as electronic medical records remain underdeveloped. PMID:15960686

Characteristics of medical practices in three developed managed care markets.

PubMed

Landon, Bruce E; Normand, Sharon-Lise T; Frank, Richard; McNeil, Barbara J

2005-06-01

To describe physician practices, ranging from solo and two-physician practices to large medical groups, in three geographically diverse parts of the country with strong managed care presences. Surveys of medical practices in three managed care markets conducted in 2000-2001. We administered questionnaires to all medical practices affiliated with two large health plans in Boston, MA, and Portland, OR, and to all practices providing primary care for cardiovascular disease patients admitted to five large hospitals in Minneapolis, MN. We offer data on how physician practices are structured under managed care in these geographically diverse regions of the country with a focus on the structural characteristics, financial arrangements, and care management strategies adopted by practices. A two-staged survey consisting of an initial telephone survey that was undertaken using CATI (computerized assisted telephone interviewing) techniques followed by written modules triggered by specific responses to the telephone survey. We interviewed 468 practices encompassing 668 distinct sites of care (overall response rate 72 percent). Practices had an average of 13.9 member physicians (range: 1-125). Most (80.1 percent) medium- (four to nine physicians) and large-size (10 or more physicians) groups regularly scheduled meetings to discuss resource utilization and referrals. Almost 90 percent of the practices reported that these meetings occurred at least once per month. The predominant method for paying practices was via fee-for-service payments. Most other payments were in the form of capitation. Overall, 75 percent of physician practices compensated physicians based on productivity, but there was substantial variation related to practice size. Nonetheless, of the practices that did not use straight productivity methods (45 percent of medium-sized practices and 54 percent of large practices), most used arrangements consisting of combinations of salary and productivity formulas. We found diversity in the characteristics and capabilities of medical practices in these three markets with high managed care involvement. Financial practices of most practices are geared towards rewarding productivity, and care management practices and capabilities such as electronic medical records remain underdeveloped.

77 FR 65234 - Notice of Intention To Cancel Registrations of Certain Investment Advisers Pursuant to the...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-25

... Investment Management, Office of Investment Adviser Regulation). Notice is also given that any interested... 801-63858 ALPINE CAPITAL MANAGEMENT, LLC 801-63029 AM INVESTMENT PARTNERS LLC 801-67985 AMERICAN... INVESTMENT MANAGEMENT, LP 801-72622 ARCHETYPE ADVISORS, LLC 801-70395 ARTIENCE CAPITAL MANAGEMENT, LLC 801...

Topics in Finance Part IX--Working Capital Management

ERIC Educational Resources Information Center

Laux, Judy

2012-01-01

The final topic in a series looking at financial management from a theoretical perspective, working capital management provides the focus of the current article. We investigate how three key axioms--the risk-return tradeoff, agency conflicts, and stockholder wealth maximization--relate to this activity that occupies much of the financial manager's…

Meta-manager: a requirements analysis.

PubMed

Cook, J F; Rozenblit, J W; Chacko, A K; Martinez, R; Timboe, H L

1999-05-01

The digital imaging network-picture-archiving and communications system (DIN-PACS) will be implemented in ten sites within the Great Plains Regional Medical Command (GPRMC). This network of PACS and teleradiology technology over a shared T1 network has opened the door for round the clock radiology coverage of all sites. However, the concept of a virtual radiology environment poses new issues for military medicine. A new workflow management system must be developed. This workflow management system will allow us to efficiently resolve these issues including quality of care, availability, severe capitation, and quality of the workforce. The design process of this management system must employ existing technology, operate over various telecommunication networks and protocols, be independent of platform operating systems, be flexible and scaleable, and involve the end user at the outset in the design process for which it is developed. Using the unified modeling language (UML), the specifications for this new business management system were created in concert between the University of Arizona and the GPRMC. These specifications detail a management system operating through a common object request brokered architecture (CORBA) environment. In this presentation, we characterize the Meta-Manager management system including aspects of intelligence, interfacility routing, fail-safe operations, and expected improvements in patient care and efficiency.

Practice options.

PubMed

BeSaw, L

1996-04-01

If Laredo pediatric allergist Gladys Keene, MD, and her husband, otolaryngologist Roger Keene, MD, had their druthers, they would maintain the solo practices they have had for the past 20 years. But they know changes in the form of managed care are coming to the border city, and medicine as they know it will never be the same again. Preferred provider organizations have already captured about 20% of the Laredo market in the past 2 to 3 years, and health maintenance organizations (HMOs) and capitation are not far behind.

Make sure your imaging equipment goes the distance.

PubMed

Halverson, K A

1997-11-01

Today's hospitals have invested a substantial portion of their capital budgets on the purchase of high-tech equipment--diagnostic imaging machinery, clinical laboratory apparatus, biomedical devices--and yet only half have developed strategies for taking care of that equipment as it ages. When do you replace it? When is it obsolete? How do you determine whether it is cost effective? Kenneth Halverson examines the steps to take to develop and implement a successful asset management program that will enable you to keep your high-tech equipment going.

Power and new economic relationships.

PubMed

Brown, M

1995-12-01

We are going through a transformation of our health services from a community and patient focus fueled by fee-for-service and cost-plus reimbursement. This transformation, called managed care, is shifting power away from professionals and communities into both new and old organizations financed by Wall Street. Even traditional community organizations are driven by Wall Street-dictated financial ratios that represent scoreboards to determine who gets capital for growth and development. Times are changing, organizations are changing, and still more change is ahead.

Hospitals adopt intensive programs for diabetic patients to avoid high inpatient costs.

PubMed

Conklin, M S

1994-06-01

Just over a year ago, a 24-year-old man walked into a free health screening at Palmyra Medical Centers in Albany, Ga., complaining of weight loss, unending thirst and frequent urination. A quick blood test revealed the man was diabetic, with an alarming hemoglobin A1c level of 20.1. After six months of intervention, the man's hemoglobin dropped to an excellent rating of 7.1 and his physician is now ready to take him off insulin, said Layne Cox, program manager of the Diabetes Treatment Center at Palmyra, a Columbia/HCA hospital. While health fairs of yesterday were used to attract patients into the hospital, today's outreach programs are measured by success stories such as this. The goal now is to keep patients healthy and out of the hospital to reduce costs to managed care plans and health-care providers at risk through capitation contracts.

Spirituality and the physician executive.

PubMed

Kaiser, L R

2000-01-01

The "s" word can now be spoken without flinching in health care organizations. Spirituality is becoming a common topic in management conferences around the world. Many U.S. corporations are recognizing the role of spirituality in creating a new humanistic capitalism that manages beyond the bottom line. Spirituality refers to a broad set of principles that transcend all religions. It is the relationship between yourself and something larger, such as the good of your patient or the welfare of the community. Spirituality means being in right relationship to all that is and understanding the mutual interdependence of all living beings. Physician executives should be primary proponents of spirituality in their organizations by: Modeling the power of spirituality in their own lives; integrating spiritual methodologies into clinical practice; fostering an integrative approach to patient care; encouraging the organization to tithe its profits for unmet community health needs; supporting collaborative efforts to improve the health of the community; and creating healing environments.

Improving wait times to care for individuals with multimorbidities and complex conditions using value stream mapping.

PubMed

Sampalli, Tara; Desy, Michel; Dhir, Minakshi; Edwards, Lynn; Dickson, Robert; Blackmore, Gail

2015-04-05

Recognizing the significant impact of wait times for care for individuals with complex chronic conditions, we applied a LEAN methodology, namely - an adaptation of Value Stream Mapping (VSM) to meet the needs of people with multiple chronic conditions and to improve wait times without additional resources or funding. Over an 18-month time period, staff applied a patient-centric approach that included LEAN methodology of VSM to improve wait times to care. Our framework of evaluation was grounded in the needs and perspectives of patients and individuals waiting to receive care. Patient centric views were obtained through surveys such as Patient Assessment of Chronic Illness Care (PACIC) and process engineering based questions. In addition, LEAN methodology, VSM was added to identify non-value added processes contributing to wait times. The care team successfully reduced wait times to 2 months in 2014 with no wait times for care anticipated in 2015. Increased patient engagement and satisfaction are also outcomes of this innovative initiative. In addition, successful transformations and implementation have resulted in resource efficiencies without increase in costs. Patients have shown significant improvements in functional health following Integrated Chronic Care Service (ICCS) intervention. The methodology will be applied to other chronic disease management areas in Capital Health and the province. Wait times to care in the management of multimoribidities and other complex conditions can add a significant burden not only on the affected individuals but also on the healthcare system. In this study, a novel and modified LEAN methodology has been applied to embed the voice of the patient in care delivery processes and to reduce wait times to care in the management of complex chronic conditions. © 2015 by Kerman University of Medical Sciences.

A contemporary perspective on capitated reimbursement for imaging services.

PubMed

Schwartz, H W

1995-01-01

Capitation ensures predictability of healthcare costs, requires acceptance of a premium in return for providing all required medical services and defines the actual dollar amount paid to a physician or hospital on a per member per month basis for a service or group of services. Capitation is expected to dramatically affect the marketplace in the near future, as private enterprise demands lower, more stable healthcare costs. Capitation requires detailed quantitative and financial data, including: eligibility and benefits determination, encounter processing, referral management, claims processing, case management, physician compensation, insurance management functions, outcomes reporting, performance management and cost accounting. It is important to understand actuarial risk and capitation marketing when considering a capitation contract. Also, capitated payment methodologies may vary to include modified fee-for-service, incentive pay, risk pool redistributions, merit, or a combination. Risk is directly related to the ability to predict utilization and unit cost of imaging services provided to a specific insured population. In capitated environments, radiologists will have even less control over referrals than they have today and will serve many more "covered lives"; long-term relationships with referring physicians will continue to evaporate; and services will be provided under exclusive, multi-year contracts. In addition to intensified use of technology for image transfer, telecommunications and sophisticated data processing and tracking systems, imaging departments must continue to provide the greatest amount of appropriate diagnostic information in a timely fashion at the lowest feasible cost and risk to the patient.

Impact of managed MediCal on California family practice programs.

PubMed

Zweifler, J A

2001-05-01

An important source of patients for California's family practice program is MediCal. During the past 5 years, MediCal has established a variety of capitated managed care plans. To assess the impact of California's managed MediCal program on the state's 38 family practice training programs. A cross-sectional, retrospective descriptive survey. A 3-page, 11-question survey was developed by family practice residency directors and staff from the California Academy of Family Physicians, San Francisco. The 38 family practice programs in existence in California in September 1997 were stratified by type of managed MediCal in their county and by type of sponsoring institution--university, county, community based, staff-model health maintenance organization, or managed care system. Of the 38 family practice programs, 27 responded; 19 of 27 programs participated in managed MediCal. The total number of family health center patients, and the percentage of MediCal patients (48%-60%) at family practice programs was similar when stratified by programs with and without managed MediCal and by type of sponsorship. Most programs reported that they were able to compete effectively, although most also reported increased administrative, nursing, and front office costs. Managed MediCal patients were directly assigned to residents in only 3 of 19 programs. The introduction of managed MediCal has not adversely affected the number of patients cared for in California's family practice programs. Continued vigilance regarding California family practice programs' involvement in managed MediCal, including collection of accurate data on the number of MediCal patients and the financial and educational implications for California's family practice programs, is warranted.

12 CFR 931.3 - Minimum investment in capital stock.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 7 2011-01-01 2011-01-01 false Minimum investment in capital stock. 931.3 Section 931.3 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOME LOAN BANK RISK MANAGEMENT AND CAPITAL STANDARDS FEDERAL HOME LOAN BANK CAPITAL STOCK § 931.3 Minimum investment in capital stock. (a) A...

12 CFR 933.3 - Independent review of capital plan.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 7 2011-01-01 2011-01-01 false Independent review of capital plan. 933.3 Section 933.3 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOME LOAN BANK RISK MANAGEMENT AND CAPITAL STANDARDS BANK CAPITAL STRUCTURE PLANS § 933.3 Independent review of capital plan. Prior to...

12 CFR 933.5 - Disclosure to members concerning capital plan and capital stock conversion.

Code of Federal Regulations, 2011 CFR

2011-01-01

... FEDERAL HOME LOAN BANK RISK MANAGEMENT AND CAPITAL STANDARDS BANK CAPITAL STRUCTURE PLANS § 933.5... its risk-based capital requirement, calculated in accordance with § 932.3 of this chapter, and of its... dividends, product volumes, investment volumes, new business lines and risk profile. (3) A description of...

12 CFR 931.3 - Minimum investment in capital stock.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Minimum investment in capital stock. 931.3 Section 931.3 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOME LOAN BANK RISK MANAGEMENT AND CAPITAL STANDARDS FEDERAL HOME LOAN BANK CAPITAL STOCK § 931.3 Minimum investment in capital stock. (a) A...

12 CFR 933.5 - Disclosure to members concerning capital plan and capital stock conversion.

Code of Federal Regulations, 2010 CFR

2010-01-01

... FEDERAL HOME LOAN BANK RISK MANAGEMENT AND CAPITAL STANDARDS BANK CAPITAL STRUCTURE PLANS § 933.5... its risk-based capital requirement, calculated in accordance with § 932.3 of this chapter, and of its... dividends, product volumes, investment volumes, new business lines and risk profile. (3) A description of...

Collaboration between primary care and psychiatric services: does it help family physicians?

PubMed

Kisely, Stephen; Duerden, Debbie; Shaddick, Susan; Jayabarathan, Ajantha

2006-07-01

To compare family physicians' reports of their experiences managing patients with psychiatric disorders in settings with and without access to collaborative mental health services. Survey using a questionnaire adapted from a similar study in Australia. Family physicians were asked about their knowledge, skills, and degree of comfort in managing the following psychiatric disorders derived from the primary care version of the 10th edition of the International Classification of Diseases: psychosis, depression, anxiety, childhood disorders, and stress-related disorders. We also compared the 2 groups of physicians regarding their satisfaction with mental health services in general. The Capital District Health Authority (CDHA) in Nova Scotia. All family physicians practising in the CDHA. Self-reported knowledge, skills, and degree of comfort in managing psychiatric problems; satisfaction with mental health services, adjusted for family physicians' demographics; and stated interest in mental health. We received 101 responses (37 from physicians with access to collaborative care and 64 from physicians without access) from 7 communities in the CDHA. Family physicians who had access to collaborative care reported significantly greater knowledge in the areas of psychosis, alcohol or substance use, and childhood behavioural problems; and better skills in managing psychosis, alcohol or substance use, childhood depression or anxiety, childhood behavioural disorders, and relationship problems. Their comfort levels in managing relationship problems and childhood behavioural disorders were also significantly higher. Family physicians with access to collaborative care were significantly more satisfied with mental health services, over and above shared care. All these differences remained significant after controlling for sex, level of interest in mental health, and years in practice. Family physicians with access to collaborative care reported greater knowledge, better skills, and more comfort in managing psychiatric disorders and greater satisfaction with mental health services. Further work is needed to establish why this is so and to determine any effect on patient outcomes, such as symptoms, quality of life, and psychosocial functioning.

Implementing a balanced scorecard as a strategic management tool in a long-term care organization.

PubMed

Schalm, Corinne

2008-01-01

The Capital Care Group, the largest public sector continuing care organization in Canada, had no ready access to information on its own performance and therefore was limited in its pursuit of evidence-informed decision-making. To remedy this, it was decided to introduce a balanced scorecard. A literature review was conducted together with interviews with 10 other health care organizations which had implemented balanced scorecards. With this information, a workshop was held that resulted in a framework and about 120 potential indicators. Subsequently the number of indicators was reduced to 29, using pre-determined criteria. Development of a corporate balanced scorecard facilitated executive strategic thinking and clarified the organization's strategic direction. In parallel, scorecards were developed at the level of care centres. These had a common core of indicators, plus some site-specific ones. Development of the corporate scorecard took three years and an additional six months for the care centre scorecards. A formal implementation plan has been accepted by the executive team. Key to this is communicating to staff the role of scorecards for strategic management and not just performance measurement. Traditional thinking needs to change from a short-term operational focus to long-term strategy. In addition, champions need to be identified in each care centre and they need to be networked together. Finally, the scorecard is being integrated into existing operational management as a routine component together with resources to support its use. The balanced scorecard has focused on its role as a strategic management tool. The indicators and dimensions need to be customized to the organization. Senior management must be seen to be driving its introduction. It is worth spending sufficient time developing and implementing a scorecard rather than trying to rush its introduction. The scorecard needs to be integrated with existing management processes and sufficient resources must be assigned. However, success will ultimately depend on the culture of the organization being appropriate and receptive.

Measuring the ROI on Knowledge Management Systems.

ERIC Educational Resources Information Center

Wickhorst, Vickie

2002-01-01

Defines knowledge management and corporate portals and provides a model that can be applied to assessing return on investment (ROI) for a knowledge management solution. Highlights include leveraging knowledge in an organization; assessing the value of human capital; and the Intellectual Capital Performance Measurement Model. (LRW)

Social capital among migrating doctors: the "bridge" over troubled water.

PubMed

Terry, Daniel R; Quynh, Lê

2014-01-01

The purpose of this paper is to examine the concept of social capital among International Medical Graduates (IMGs). It will specifically examine bridging social capital and greater intercultural communication which provides IMGs access to the wider community and plays a key role in cross-cultural adaptation and acculturation. A review of the literature. An Australian wide shortage of doctors has led to an increased reliance on the recruitment of IMGs. As IMGs migrate, they may encounter different meanings of illness, models of care and a number of social challenges. Nevertheless, greater cross-cultural adaptation and acculturation occurs through bridging social capital, where intercultural communication, new social networks and identity aids integration. This process produces more opportunities for economic capital growth and upward mobility than bonding social capital. Concerns regarding immigration, appropriate support and on-going examination processes have been expressed by IMGs in a number of studies and policy papers. However, there is very little insight into what contributes cross-cultural adaptation of IMGs. As IMGs migrate to not only a new country, but also a new health system and workplace they arrive with different cultural meanings of illness and models of care. These differences may be in contrast to the dominant western medical model, but often bring positive contributions to patient care in the new environment. In addition, improving bridging social capital provides IMGs access to the wider community and has been demonstrated to play a key role in cross-cultural adaptation and ultimately acculturation.

Delivery of primary health care to persons who are socio-economically disadvantaged: does the organizational delivery model matter?

PubMed Central

2013-01-01

Background As health systems evolve, it is essential to evaluate their impact on the delivery of health services to socially disadvantaged populations. We evaluated the delivery of primary health services for different socio-economic groups and assessed the performance of different organizational models in terms of equality of health care delivery in Ontario, Canada. Methods Cross sectional study of 5,361 patients receiving care from primary care practices using Capitation, Salaried or Fee-For-Service remuneration models. We assessed self-reported health status of patients, visit duration, number of visits per year, quality of health service delivery, and quality of health promotion. We used multi-level regressions to study service delivery across socio-economic groups and within each delivery model. Identified disparities were further analysed using a t-test to determine the impact of service delivery model on equity. Results Low income individuals were more likely to be women, unemployed, recent immigrants, and in poorer health. These individuals were overrepresented in the Salaried model, reported more visits/year across all models, and tended to report longer visits in the Salaried model. Measures of primary care services generally did not differ significantly between low and higher income/education individuals; when they did, the difference favoured better service delivery for at-risk groups. At-risk patients in the Salaried model were somewhat more likely to report health promotion activities than patients from Capitation and Fee-For-Service models. At-risk patients from Capitation models reported a smaller increase in the number of additional clinic visits/year than Fee-For-Service and Salaried models. At-risk patients reported better first contact accessibility than their non-at-risk counterparts in the Fee-For-Service model only. Conclusions Primary care service measures did not differ significantly across socio-economic status or primary care delivery models. In Ontario, capitation-based remuneration is age and sex adjusted only. Patients of low socio-economic status had fewer additional visits compared to those with high socio-economic status under the Capitation model. This raises the concern that Capitation may not support the provision of additional care for more vulnerable groups. Regions undertaking primary care model reforms need to consider the potential impact of the changes on the more vulnerable populations. PMID:24341530

Delivery of primary health care to persons who are socio-economically disadvantaged: does the organizational delivery model matter?

PubMed

Dahrouge, Simone; Hogg, William; Ward, Natalie; Tuna, Meltem; Devlin, Rose Anne; Kristjansson, Elizabeth; Tugwell, Peter; Pottie, Kevin

2013-12-17

As health systems evolve, it is essential to evaluate their impact on the delivery of health services to socially disadvantaged populations. We evaluated the delivery of primary health services for different socio-economic groups and assessed the performance of different organizational models in terms of equality of health care delivery in Ontario, Canada. Cross sectional study of 5,361 patients receiving care from primary care practices using Capitation, Salaried or Fee-For-Service remuneration models. We assessed self-reported health status of patients, visit duration, number of visits per year, quality of health service delivery, and quality of health promotion. We used multi-level regressions to study service delivery across socio-economic groups and within each delivery model. Identified disparities were further analysed using a t-test to determine the impact of service delivery model on equity. Low income individuals were more likely to be women, unemployed, recent immigrants, and in poorer health. These individuals were overrepresented in the Salaried model, reported more visits/year across all models, and tended to report longer visits in the Salaried model. Measures of primary care services generally did not differ significantly between low and higher income/education individuals; when they did, the difference favoured better service delivery for at-risk groups. At-risk patients in the Salaried model were somewhat more likely to report health promotion activities than patients from Capitation and Fee-For-Service models. At-risk patients from Capitation models reported a smaller increase in the number of additional clinic visits/year than Fee-For-Service and Salaried models. At-risk patients reported better first contact accessibility than their non-at-risk counterparts in the Fee-For-Service model only. Primary care service measures did not differ significantly across socio-economic status or primary care delivery models. In Ontario, capitation-based remuneration is age and sex adjusted only. Patients of low socio-economic status had fewer additional visits compared to those with high socio-economic status under the Capitation model. This raises the concern that Capitation may not support the provision of additional care for more vulnerable groups. Regions undertaking primary care model reforms need to consider the potential impact of the changes on the more vulnerable populations.

Overview of employer capitation activities

PubMed Central

Moley, Kevin E.

1986-01-01

This article addresses a new initiative of the Health Care Financing Administration (HCFA) to contract on a group basis with: employer self-insurance plans, unions, group health insurance companies, and Taft-Hartley Health and Welfare Funds for groups of Medicare beneficiaries. Under this new concept, Medicare beneficiaries may elect in the future to obtain Medicare coverage through their group insurance plan rather than through traditional Medicare, with HCFA paying the premiums. This Medicare demonstration will bridge the gap between employer plans, which coordinate with traditional Medicare coverage, and employer-sponsored health benefit plans. This will make available to Medicare-eligible retirees similar, if not the same, managed-care alternatives as are currently available to active employees. PMID:10311924

Intellectual Capital: Comparison and Contrast.

ERIC Educational Resources Information Center

Madsen, Susan R.

2001-01-01

Suggests that one of the most important keys for improving individual and organizational performance is in developing and strengthening intellectual capital (IC) and explores the similarities and differences between the concepts of intellectual capital, human capital, and knowledge management. Presents four IC characteristics and addresses the…

A study on factors that drive variation in the levels of social capital among people living with HIV/AIDS in Iran.

PubMed

Rimaz, Shahnaz; Nikooseresht, Zahra; Vesali, Samera; Nedjat, Saharnaz; Asadi-Lari, Mohsen

2015-03-30

Social capital is increasingly used in relation to health issues, particularly in sexually transmitted diseases/infections and health behaviors. Experiences indicated that social capital can contribute in changing HIV related risk behaviors and a decline of HIV infection through social groups and networking and make more effective use of HIV/AIDS prevention, care, and treatment services. We aimed to assess social capital in these persons through a quantitative study. This cross-sectional study was performed with a convenience sample of 300 people living HIV/AIDS referred to a counseling center of behavioral diseases, in Imam Khomeini Hospital, in Tehran, the capital of Iran, during September 2011 to May 2012. Data collection tools were a demographic questionnaire and World Bank Social Capital Questionnaire (SC-IQ). The analysis of data was performed by the SPSS statistic software version 18. To identify factors influencing social capital in participations, Pearson correlation coefficient, ANOVA, t-test, and a multiple regression were applied. The significant level was considered 0.05 in this study. 165 (55%) were male and the rest female. The mean age of participants was 34.3 ± 7.5. The mean score of total social capital was 2.34 ± 0.5 in all participants. The domain of individual trust had the highest mean score (2.53 ± 0.66). The lowest mean score was related to the domain of social trust and associative relations (2.23 ± 0.62). Variables such as ethnicity, age, and middle economic status had a significant impact on the domain of individual trust so that the mean score of this component of social capital was lower among women (0.396) than men. Factors affecting total social capital were ethnicity and middle economic status. Finding emphasized on the role of economic status, ethnicity and gender in persons living with HIV/AIDS. Thus recommended that policy makers and program managers consider social groups and networks, especially in women in the design and delivery of intervention strategies to reduce HIV transmission.

Caring for the Unseen: Using Linking Social Capital to Improve Healthcare Access to Irregular Migrants in Spain

PubMed Central

2016-01-01

Abstract Purpose To describe a novel strategy using linking social capital to provide healthcare access to irregular migrants with low literacy, low numeracy, and limited cultural assimilation in a European metropolitan area. Organizing Construct Public data show numerous shortcomings in meeting the healthcare needs of refugees and irregular migrants surging into Europe. Many irregular migrants living in European communities are unable to access information, care, or services due to lack of social capital. An overview of the problem and traditional charity strategies, including their barriers, are briefly described. A novel strategy using linking social capital to improve healthcare access of irregular migrants is explored and described. Information regarding the impact of this approach on the target population is provided. The discussion of nursing's role in employing linking social capital to care for the vulnerable is presented. Conclusions Immigration and refugee data show that issues related to migration will continue. The novel strategy presented can be implemented by nurses with limited financial and physical resources in small community settings frequented by irregular migrants to improve health care. Clinical Relevance The health and well‐being of irregular migrants has an impact on community health. Nurses must be aware of and consider implementing novel strategies to ensure that all community members’ healthcare needs, which are a basic human right, are addressed. PMID:27355488

The Continuum of Neurosurgical Care: Increasing the Neurosurgeon's Role and Responsibility.

PubMed

Zusman, Edie E; Benzil, Deborah L

2017-04-01

The Health Care Reform Act has fostered a shift toward capitation and shared risk among providers to improve quality and reduce the escalating costs of healthcare. Like all physicians, neurosurgeons are increasingly being incentivized to participate in efforts to streamline care through the use of surgical pathways to reduce hospital length of stay and prevent readmissions. These changes have expanded the role of the neurosurgeon along the continuum of care for the neurosurgery patient. This paper predicts and advocates for a further broadening of neurosurgery participation from programs that reward physicians for helping to prevent a high-risk patient's need for surgery to management of postacute rehabilitation. It also introduces the concept of risk reduction more generally at the community level through collaborative interventions that improve health through changes to the built environment, innovations in transportation, and improved access to healthy food and recreation opportunities. Copyright © 2017 by the Congress of Neurological Surgeons.

75 FR 82317 - Risk-Based Capital Standards: Advanced Capital Adequacy Framework-Basel II; Establishment of a...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-30

... collection unless it displays a currently valid Office of Management and Budget (OMB) control number. Each of... CORPORATION 12 CFR Part 325 RIN 3064-AD58 Risk-Based Capital Standards: Advanced Capital Adequacy Framework--Basel II; Establishment of a Risk-Based Capital Floor AGENCY: Office of the Comptroller of the Currency...

12 CFR 6.4 - Capital measures and capital category definitions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... categories of asset quality, management, earnings, or liquidity. [57 FR 44891, Sept. 29, 1992, as amended at... measures. For purposes of section 38 and this part, the relevant capital measures shall be: (1) The total...) Well capitalized if the bank: (i) Has a total risk-based capital ratio of 10.0 percent or greater; and...

12 CFR 931.2 - Issuance of capital stock.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 7 2011-01-01 2011-01-01 false Issuance of capital stock. 931.2 Section 931.2 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOME LOAN BANK RISK MANAGEMENT AND CAPITAL STANDARDS FEDERAL HOME LOAN BANK CAPITAL STOCK § 931.2 Issuance of capital stock. (a) In general. A Bank may...

12 CFR 6.4 - Capital measures and capital category definitions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... categories of asset quality, management, earnings, or liquidity. [57 FR 44891, Sept. 29, 1992, as amended at... measures. For purposes of section 38 and this part, the relevant capital measures shall be: (1) The total...) Well capitalized if the bank: (i) Has a total risk-based capital ratio of 10.0 percent or greater; and...

12 CFR 931.2 - Issuance of capital stock.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Issuance of capital stock. 931.2 Section 931.2 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOME LOAN BANK RISK MANAGEMENT AND CAPITAL STANDARDS FEDERAL HOME LOAN BANK CAPITAL STOCK § 931.2 Issuance of capital stock. (a) In general. A Bank may...

The relationship between transformational leadership and social capital in hospitals--a survey of medical directors of all German hospitals.

PubMed

Hammer, Antje; Ommen, Oliver; Röttger, Julia; Pfaff, Holger

2012-01-01

The German hospital market has been undergoing major changes in recent years. Success in this new market is determined by a multitude of factors. One is the quality of the social relationships between staff and the presence of shared values and rules. This factor can be considered an organization's "social capital." This study investigates the relationship between social capital and leadership style in German hospitals using a written survey of medical directors. In 2008, a cross-sectional representative study was conducted with 1224 medical directors from every hospital in Germany with at least 1 internal medicine unit and 1 surgery unit. Among the scales included in the standardized questionnaire were scales used to assess the medical directors' evaluation of social capital and transformational leadership in the hospital. We used a multiple linear regression model to examine the relationship between social capital and internal coordination. We controlled for hospital ownership, teaching status, and number of beds. In total, we received questionnaires from 551 medical directors, resulting in a response rate of 45.2%. The participating hospitals had an average of 345 beds. The sample included public (41.3%), not-for-profit (46.9%), and for-profit (11.7%) hospitals. The data, which exclusively represent the perceptions of the medical directors, indicate a significant correlation between a transformational leadership style of the executive management and the social capital as perceived by medical directors. A transformational leadership style of the executive management accounted for 36% of variance of the perceived social capital. The perceived social capital in German hospitals is closely related to the leadership style of the executive management. A transformational leadership style of the executive management appears to successfully strengthen the hospital's social capital.

Risk-adjusted capitation payments for catastrophic risks based on multi-year prior costs.

PubMed

van Barneveld, E M; van Vliet, R C; van de Ven, W P

1997-02-01

In many countries regulated competition among health insurance companies has recently been proposed or implemented. A crucial issue is whether or not the benefits package offered by competing insurers should also cover catastrophic risks (like several forms of expensive long-term care) in addition to non-catastrophic risks (like hospital care and physician services). In 1988 the Dutch government proposed compulsory national health insurance based on regulated competition among insurer as well as among providers of care. The competing insurers should offer a benefits package covering both non-catastrophic risks and catastrophic risks. The insurers would be largely financed via risk-adjusted capitation payments. The government intended to use a capitation formula that is, besides some demographic variables, based on multi-year prior costs. This paper presents the results of an explorative empirical analysis of the possible consequences of such a capitation formula for catastrophic risks. The main conclusion is that this formula would be inadequate because it would leave ample room for cream skimming.

Harnessing the Power of Intellectual Capital.

ERIC Educational Resources Information Center

Bassi, Laurie J.

1997-01-01

Describes intellectual capital--employees' brainpower, know-how, knowledge, and processes--and knowledge management--the processes by which a company creates and leverages intellectual capital--as the primary sources of competitive advantage in many industries. Offers ways to measure intellectual capital, a glossary, and additional resources. (JOW)

The Strategic Management of Human Capital: Issues and Ideas

ERIC Educational Resources Information Center

Berry, Barnett

2008-01-01

Most recently a number of school districts, with support from growing numbers of philanthropic foundations, have been honing in on the strategic management of human capital(SMHC)--which has been defined as "the acquisition, development, performance management and retention of top talent." Granted, over the last two decades policymakers and…

75 FR 65528 - Membership of National Science Foundation's Senior Executive Service Performance Review Board

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-25

..., Office of Budget, Finance and Award Management, and Chief Financial Officer; Brian W. Stone, Deputy... Director, Division of Human Resource Management and Chief Human Capital Officer, National Science..., Division of Human Resource Management and Chief Human Capital Officer; Mark L. Weiss, Director, Division of...

The Importance of Teaching Management's Role in Capital Equipment Purchases.

ERIC Educational Resources Information Center

Silbergleid, Michael Ian

This essay discusses broadcasting and telecommunication management curricula and makes an argument for including instruction in capital equipment purchases. The argument is based on recent changes in the role of the television station department managers who in economically competitive times are involved in decisions about equipment purchasing. In…

44 CFR 208.2 - Definitions of terms used in this part.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Definitions of terms used in this part. 208.2 Section 208.2 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY... defined term unless such capitalization results from the application of standard capitalization or style...

Voluntary Medication Error Reporting by ED Nurses: Examining the Association With Work Environment and Social Capital.

PubMed

Farag, Amany; Blegen, Mary; Gedney-Lose, Amalia; Lose, Daniel; Perkhounkova, Yelena

2017-05-01

Medication errors are one of the most frequently occurring errors in health care settings. The complexity of the ED work environment places patients at risk for medication errors. Most hospitals rely on nurses' voluntary medication error reporting, but these errors are under-reported. The purpose of this study was to examine the relationship among work environment (nurse manager leadership style and safety climate), social capital (warmth and belonging relationships and organizational trust), and nurses' willingness to report medication errors. A cross-sectional descriptive design using a questionnaire with a convenience sample of emergency nurses was used. Data were analyzed using descriptive, correlation, Mann-Whitney U, and Kruskal-Wallis statistics. A total of 71 emergency nurses were included in the study. Emergency nurses' willingness to report errors decreased as the nurses' years of experience increased (r = -0.25, P = .03). Their willingness to report errors increased when they received more feedback about errors (r = 0.25, P = .03) and when their managers used a transactional leadership style (r = 0.28, P = .01). ED nurse managers can modify their leadership style to encourage error reporting. Timely feedback after an error report is particularly important. Engaging experienced nurses to understand error root causes could increase voluntary error reporting. Published by Elsevier Inc.

12 CFR 933.4 - Transition provisions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 7 2011-01-01 2011-01-01 false Transition provisions. 933.4 Section 933.4 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOME LOAN BANK RISK MANAGEMENT AND CAPITAL... its minimum leverage capital requirement and its minimum risk-based capital requirement. The capital...

12 CFR 933.4 - Transition provisions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Transition provisions. 933.4 Section 933.4 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOME LOAN BANK RISK MANAGEMENT AND CAPITAL... its minimum leverage capital requirement and its minimum risk-based capital requirement. The capital...

Patient Protection and Risk Selection

PubMed Central

Wynia, Matthew K; Zucker, Deborah; Supran, Stacey; Selker, Harry P

2002-01-01

BACKGROUND Individual physicians who are paid prospectively, as in capitated health plans, might tend to encourage patients to avoid or to join these plans according to the patient's health status. Though insurance risk selection has been well documented among organizations paid on a prospective basis, such physician-level risk selection has not been studied. OBJECTIVE To assess physician reports of risk selection in capitated health plans and explore potentially related factors. DESIGN AND PARTICIPANTS National mailed survey of primary care physicians in 1997–1998, oversampling physicians in areas with more capitated health plans. RESULTS The response rate was 63% (787 of 1,252 eligible recipients). Overall, 44% of physicians reported encouraging patients either to join or to avoid capitated health plans according to the patients' health status: 40% encouraged more complex and ill patients to avoid capitated plans and 23% encouraged healthier patients to join capitated plans. In multivariable models, physicians with negative perceptions of capitated plan quality, with more negative experiences in capitated plans, and those who knew at each patient encounter how they were being compensated had higher odds of encouraging sicker patients to avoid capitated plans (odds ratios, 2.0, 2.2, and 2.0; all confidence intervals >1). CONCLUSIONS Many primary care physicians report encouraging patients to join or avoid capitated plans according to the patient's health status. Although these physicians' recommendations might be associated primarily with concerns about quality, they can have the effect of insulating certain health plans from covering sicker and more expensive patients. PMID:11903774

Family support in the transition to adulthood in Portugal--its effects on identity capital development, uncertainty management and psychological well-being.

PubMed

Oliveira, José Egídio; Mendonça, Marina; Coimbra, Susana; Fontaine, Anne Marie

2014-12-01

In a familistic southern European society such as the Portuguese, the family has historically played a prominent role in supporting the negotiation of transition pathways into adulthood. The present study aimed at capturing (1) the relative weight of parental financial support and autonomy support in contributing to the youngsters' psychological well-being (PWB), and (2) the mediating role of identity capital and uncertainty management in this relationship. A total of 620 participants completed measures of parental support, identity capital, uncertainty management and PWB. Autonomy support was found to be the strongest predictor of PWB, both directly and indirectly through its effects on identity capital and the use of target focused uncertainty management strategies. Conversely, financial support evidenced only a minor indirect impact through the mediation of tangible identity capital. Autonomy stimulation may constitute one of the most developmentally determinant family challenges in assisting the process of coming of age in Portugal. Copyright © 2014 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

An Application of Instructional System Development to Determine Financial Management Education Needs for Logistics Management Positions.

DTIC Science & Technology

1976-09-01

The purpose of this research effort was to determine the financial management educational needs of USAF graduate logistics positions. Goal analysis...was used to identify financial management techniques and task analysis was used to develop a method to identify the use of financial management techniques...positions. The survey identified financial management techniques in five areas: cost accounting, capital budgeting, working capital, financial forecasting, and programming. (Author)

Interventions to improve outpatient referrals from primary care to secondary care.

PubMed

Akbari, Ayub; Mayhew, Alain; Al-Alawi, Manal Alawi; Grimshaw, Jeremy; Winkens, Ron; Glidewell, Elizabeth; Pritchard, Chanie; Thomas, Ruth; Fraser, Cynthia

2008-10-08

The primary care specialist interface is a key organisational feature of many health care systems. Patients are referred to specialist care when investigation or therapeutic options are exhausted in primary care and more specialised care is needed. Referral has considerable implications for patients, the health care system and health care costs. There is considerable evidence that the referral processes can be improved. To estimate the effectiveness and efficiency of interventions to change outpatient referral rates or improve outpatient referral appropriateness. We conducted electronic searches of the Cochrane Effective Practice and Organisation of Care (EPOC) group specialised register (developed through extensive searches of MEDLINE, EMBASE, Healthstar and the Cochrane Library) (February 2002) and the National Research Register. Updated searches were conducted in MEDLINE and the EPOC specialised register up to October 2007. Randomised controlled trials, controlled clinical trials, controlled before and after studies and interrupted time series of interventions to change or improve outpatient referrals. Participants were primary care physicians. The outcomes were objectively measured provider performance or health outcomes. A minimum of two reviewers independently extracted data and assessed study quality. Seventeen studies involving 23 separate comparisons were included. Nine studies (14 comparisons) evaluated professional educational interventions. Ineffective strategies included: passive dissemination of local referral guidelines (two studies), feedback of referral rates (one study) and discussion with an independent medical adviser (one study). Generally effective strategies included dissemination of guidelines with structured referral sheets (four out of five studies) and involvement of consultants in educational activities (two out of three studies). Four studies evaluated organisational interventions (patient management by family physicians compared to general internists, attachment of a physiotherapist to general practices, a new slot system for referrals and requiring a second 'in-house' opinion prior to referral), all of which were effective. Four studies (five comparisons) evaluated financial interventions. One study evaluating change from a capitation based to mixed capitation and fee-for-service system and from a fee-for-service to a capitation based system (with an element of risk sharing for secondary care services) observed a reduction in referral rates. Modest reductions in referral rates of uncertain significance were observed following the introduction of the general practice fundholding scheme in the United Kingdom (UK). One study evaluating the effect of providing access to private specialists demonstrated an increase in the proportion of patients referred to specialist services but no overall effect on referral rates. There are a limited number of rigorous evaluations to base policy on. Active local educational interventions involving secondary care specialists and structured referral sheets are the only interventions shown to impact on referral rates based on current evidence. The effects of 'in-house' second opinion and other intermediate primary care based alternatives to outpatient referral appear promising.

Managing for Results: Using Strategic Human Capital Management To Drive Transformational Change. Testimony before the National Commission on the Public Service.

ERIC Educational Resources Information Center

Walker, David M.

The General Accounting Office (GAO) examined the effectiveness of using strategic human capital (HC) management to drive transformational change in federal agencies and reported on its own implementation of a new competency-based performance management system. First, the potential impacts of the following three broad HC reform opportunities to…

Business ethics and health care: a stakeholder perspective.

PubMed

Gilmartin, Mattia J; Freeman, R Edward

2002-01-01

This article examines the recent controversy in health care delivery about whether it should be conceptualized as a business. The current debate implicitly appeals to a common understanding of business and business practices that is no longer very useful. This common notion, which the authors call "cowboy capitalism," conceptualizes business as a competitive jungle resting on self-interest and an urge for competition in order to survive. The authors suggest that stakeholder capitalism offers a more useful framework for the dialogue about health care reform.

The Case for Case-Mix: A New Construct for Hospital Management

PubMed Central

Plomann, Marilyn Peacock; Garzino, Fred R.

1981-01-01

Case-mix is a useful methodology for health care management, planning and control. It provides managers with a powerful tool by providing a framework for relating resource consumption profiles with specific treatment patterns. In the long run, it will assist hospital planners in analyzing the demands which different classes of patients bring to the hospital. Decisions concerning capital financing, facilities planning, new services, and the medical and financial implications of physician activities are more efficiently analyzed within a case-mix framework. In the near term, inventory management, staffing policies and the on-going need for the astute management of cash flow will be postively and decisively affected by the use of case-mix measures. The benefits derived from a case-mix system are not limited to hospitals possessing sophisticated management information systems. The case-mix methodology also provides a useful tool for hospitals with less advanced data processing systems and management practices in applying a variety of management science techniques to their planning and control activities.

Promoting and Disseminating Good Practice in the Planning and Management of Educational Facilities: Capital Investment Strategic Planning - A Case Study, Gold Coast Institute of TAFE, Queensland, Australia.

ERIC Educational Resources Information Center

Crump, Kelvin

This paper presents a case study of the process of capital investment strategic planning at the Gold Coast Institute of Technical and Further Education (TAFE), Queensland, Australia. Capital investment strategic planning is a means of contributing to success by providing strategies to ensure that assets are managed efficiently, effectively, and…

A disciplined approach to capital: today's healthcare imperative.

PubMed

Dupuis, Patrick J; Kaufman, Kenneth

2007-07-01

BJC HealthCare's experience exemplifies several basic principles of a finance-based approach to capital. Organizations that adopt this approach look to improve processes first, remove costs second, and spend capital last. Multiyear planning is required to quantitatively identify the profitability and liquidity requirements of strategic initiatives and address essential funding and financing issues.

Quantitative assessment of medical waste generation in the capital city of Bangladesh

DOE Office of Scientific and Technical Information (OSTI.GOV)

Patwary, Masum A.; O'Hare, William Thomas; Street, Graham

2009-08-15

There is a concern that mismanagement of medical waste in developing countries may be a significant risk factor for disease transmission. Quantitative estimation of medical waste generation is needed to estimate the potential risk and as a basis for any waste management plan. Dhaka City, the capital of Bangladesh, is an example of a major city in a developing country where there has been no rigorous estimation of medical waste generation based upon a thorough scientific study. These estimates were obtained by stringent weighing of waste in a carefully chosen, representative, sample of HCEs, including non-residential diagnostic centres. This studymore » used a statistically designed sampling of waste generation in a broad range of Health Care Establishments (HCEs) to indicate that the amount of waste produced in Dhaka can be estimated to be 37 {+-} 5 ton per day. The proportion of this waste that would be classified as hazardous waste by World Health Organisation (WHO) guidelines was found to be approximately 21%. The amount of waste, and the proportion of hazardous waste, was found to vary significantly with the size and type of HCE.« less

75 FR 65528 - Membership of the National Science Board's Senior Executive Service Performance Review Board

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-25

...: Comments should be addressed to Interim Director, Division of Human Resource Management and Chief Human.... Judith S. Sunley, Interim Director, Division of Human Resource Management and Chief Human Capital Officer..., Interim Director, Division of Human Resource Management and Chief Human Capital Officer. [FR Doc. 2010...

Achieving Mental Health Care Parity Might Require Changes In Payments And Competition.

PubMed

McGuire, Thomas G

2016-06-01

One of the most prominent features of the Affordable Care Act has been the promotion of individual health plans chosen by consumers in the Marketplaces. These plans are subject to regulation and paid by risk-adjusted capitation, a set of policies known as managed competition. Individual health insurance markets, however, are vulnerable to what economists describe as efficiency problems stemming from adverse selection, and Marketplaces are no exception. Health plans have incentives to discriminate against services used by people with certain chronic illnesses, including mental health conditions. Parity regulations, which dictate coverage for mental health benefits on par with medical and surgical benefits, can eliminate discrimination in coverage but redirect discrimination toward hard-to-regulate tactics from managed care such as restrictive network design and provider payment. This article reviews policy options to contend with ongoing selection issues. "Better enforcement" of parity has less chance of success than more fundamental but feasible changes in the way plans are paid or in the way competition among plans is structured. Project HOPE—The People-to-People Health Foundation, Inc.

Joint Task Force National Capital Region Medical: Integration of Education, Training, and Research

DTIC Science & Technology

2009-05-01

Defense established the Joint Task Force National Capital Region Medical (JTF CapMed ) on the National Naval Medical Center campus in Bethesda, Maryland in...transfor- mation of military health services in the National Capital Area including education, training, and research activities. JTF CAPMED ...BACKGROUND JTF CapMed was established to lead the integration of mili- tary health care in the National Capital Region. The Command is charged with overseeing

The macroeconomics of vitreoretinal diseases.

PubMed

Ko, George J; Brown, Melissa M; Brown, Gary C

2005-06-01

The purpose of this review is to examine the macroeconomics of vitreoretinal diseases. Approximately 6% of the Medicare Part B expenditure was spent on ocular diseases and 0.3% on vitreoretinal interventions. Among the 17,674 practicing ophthalmologists, 1849 (10.5%) designated themselves as specializing in the treatment of vitreoretinal diseases. Ophthalmologists receive 38% of their payments from Medicare; 13% of their total income were capitated. Age-related macular degeneration and diabetic retinopathy, two conditions commonly treated by vitreoretinal specialists, are projected to affect more than 10 million people in 2020. Vitreoretinal interventions account for only a small portion of the total health care expenditure. The rising demand from the aging population and health care costs will continue to put pressure on all physicians and society. The changes in the sources of payment and managed care will directly affect the economics of a physician's practice.

Quality of asthma care under different primary care models in Canada: a population-based study.

PubMed

To, Teresa; Guan, Jun; Zhu, Jingqin; Lougheed, M Diane; Kaplan, Alan; Tamari, Itamar; Stanbrook, Matthew B; Simatovic, Jacqueline; Feldman, Laura; Gershon, Andrea S

2015-02-14

Previous research has shown variations in quality of care and patient outcomes under different primary care models. The objective of this study was to use previously validated, evidence-based performance indicators to measure quality of asthma care over time and to compare quality of care between different primary care models. Data were obtained for years 2006 to 2010 from the Ontario Asthma Surveillance Information System, which uses health administrative databases to track individuals with asthma living in the province of Ontario, Canada. Individuals with asthma (n=1,813,922) were divided into groups based on the practice model of their primary care provider (i.e., fee-for-service, blended fee-for-service, blended capitation). Quality of asthma care was measured using six validated, evidence-based asthma care performance indicators. All of the asthma performance indicators improved over time within each of the primary care models. Compared to the traditional fee-for-service model, the blended fee-for-service and blended capitation models had higher use of spirometry for asthma diagnosis and monitoring, higher rates of inhaled corticosteroid prescription, and lower outpatient claims. Emergency department visits were lowest in the blended fee-for-service group. Quality of asthma care improved over time within each of the primary care models. However, the amount by which they improved differed between the models. The newer primary care models (i.e., blended fee-for-service, blended capitation) appear to provide better quality of asthma care compared to the traditional fee-for-service model.

Administrative and policy issues in reimbursement for nursing home capital investment.

PubMed

Boerstler, H; Carlough, T; Schlenker, R E

1991-01-01

The way in which states reimburse for nursing home capital costs can create incentives for nursing home owners to use the home primarily as a vehicle for real estate speculation, with potentially adverse consequences for patient care. In order to help promote and control the stability, adequacy, and quality of capital investment in long-term care, an increasing number of states are using a fair-rental approach for calculating capital reimbursement. In this article we compare the fair-rental approach with traditional cost-based capital reimbursement in terms of administration and policy. We discuss issues of concern to the state (cost and reimbursement design options) and the investor (after-tax cash flows, rate of return, etc.). Our analysis suggests that fair-rental systems may be superior to traditional cost-based reimbursement in promoting and controlling industry stability, while at the same time providing an adequate return to investors, without incurring long-term increases in the costs of administering programs.

Recycling pool provides innovative financing for an integrated system.

PubMed

Ciolek, R J; Fahy, P A

1997-12-01

Not-for-profit integrated delivery systems require innovative financing mechanisms to compete effectively with expanding for-profit systems. The Massachusetts Health and Educational Facilities Authority (Mass HEFA), in collaboration with Partners HealthCare Systems, Inc., Boston, Massachusetts, developed such a mechanism--a capital asset recycling pool funded through a $150 million bond issue. The recycling pool gives Partners flexible access to tax-exempt capital to fund routine capital expenses across the system and has enabled the system to centralize control of capital resources. Over the pool's 30-year life-span, Partners will be able to issue tax-exempt loans from the pool to any of its affiliates or, with Mass HEFA and insurer approval, transfer the funds to outside organizations. When the loans are repaid, the funds remain available and can be recycled at no additional cost to fund further capital projects. Creation of the pool was made possible by Partners' outstanding credit, strong market position, expanding primary care network, and substantial unrestricted net assets.

\\t Capital Planning and Investment Control (CPIC) for the Management of Information Technology Investments

EPA Pesticide Factsheets

Capital Planning and Investment Control (CPIC) is the Information Technology (IT) governance and management methodology in use at EPA for selecting, controlling and evaluating the performance of EPA IT investments throughout the full lifecycle.

12 CFR 208.43 - Capital measures and capital category definitions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... categories of asset quality, management, earnings, liquidity, or sensitivity to market risk. .... For purposes of section 38 and this subpart, the relevant capital measures are: (1) The total risk...” if the bank: (i) Has a total risk-based capital ratio of 10.0 percent or greater; and (ii) Has a Tier...

12 CFR 931.7 - Redemption and repurchase of capital stock.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 7 2011-01-01 2011-01-01 false Redemption and repurchase of capital stock. 931.7 Section 931.7 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOME LOAN BANK RISK MANAGEMENT AND CAPITAL STANDARDS FEDERAL HOME LOAN BANK CAPITAL STOCK § 931.7 Redemption and repurchase of...

12 CFR 208.43 - Capital measures and capital category definitions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... categories of asset quality, management, earnings, liquidity, or sensitivity to market risk. .... For purposes of section 38 and this subpart, the relevant capital measures are: (1) The total risk...” if the bank: (i) Has a total risk-based capital ratio of 10.0 percent or greater; and (ii) Has a Tier...

12 CFR 931.7 - Redemption and repurchase of capital stock.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Redemption and repurchase of capital stock. 931.7 Section 931.7 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOME LOAN BANK RISK MANAGEMENT AND CAPITAL STANDARDS FEDERAL HOME LOAN BANK CAPITAL STOCK § 931.7 Redemption and repurchase of...

Testing the Human Capital Development Model: The Case of Apprenticeships in Turkey

ERIC Educational Resources Information Center

Akpinar, Taner; Gün, Servet

2016-01-01

Human capital theory was developed to study how individual agents make rational choices or how they invest in human capital to maximize their welfare. One of the leading founders of this perspective, Becker, argues that schooling, on-the-job training, medical care, migration and searching for information about prices and incomes are different…

Accountable care organizations and radiology: threat or opportunity?

PubMed

Abramson, Richard G; Berger, Paul E; Brant-Zawadzki, Michael N

2012-12-01

Although the anticipated rise of accountable care organizations brings certain potential threats to radiologists, including direct threats to revenue and indirect systemic changes jeopardizing the bargaining leverage of radiology groups, accountable care organizations, and other integrated health care delivery models may provide radiology with an important opportunity to reassert its leadership and assume a more central role within health care systems. Capitalizing on this potential opportunity, however, will require radiology groups to abandon the traditional "film reader" mentality and engage actively in the design and implementation of nontraditional systems service lines aimed at adding differentiated value to larger health care organizations. Important interlinked and mutually reinforcing components of systems service lines, derived from radiology's core competencies, may include utilization management and decision support, IT leadership, quality and safety assurance, and operational enhancements to meet organizational goals. Such systems-oriented service products, tailored to the needs of individual integrated care entities and supported by objective performance metrics, may provide market differentiation to shield radiology from commoditization and could become an important source of new nonclinical revenue. Copyright © 2012 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Women's status and experiences of mistreatment during childbirth in Uttar Pradesh: a mixed methods study using cultural health capital theory.

PubMed

Sudhinaraset, May; Treleaven, Emily; Melo, Jason; Singh, Kanksha; Diamond-Smith, Nadia

2016-10-28

Mistreatment of women in healthcare settings during childbirth has been gaining attention globally. Mistreatment during childbirth directly and indirectly affects health outcomes, patient satisfaction, and the likelihood of delivering in a facility currently or in the future. It is important that we study patients' reports of mistreatment and abuse to develop a deeper understanding of how it is perpetrated, its consequences, and to identify potential points of intervention. Patients' perception of the quality of care is dependent, not only on the content of care, but importantly, on women's expectations of care. This study uses rich, mixed-methods data to explore women's characteristics and experiences of mistreatment during childbirth among slum-resident women in Uttar Pradesh, India. To understand the ways in which women's social and cultural factors influence their expectations of care and consequently their perceptions of respectful care, we adopt a Cultural Health Capital (CHC) framework. The quantitative sample includes 392 women, and the qualitative sample includes 26 women. Quantitative results suggest high levels of mistreatment (over 57 % of women reported any form of mistreatment). Qualitative findings suggest that lack of cultural health capital disadvantages patients in their patient-provider relationships, and that women use resources to improve care they receive. Participants articulated how providers set expectations and norms regarding behaviors in facilities; patients with lower social standing may not always understand standard practices and are likely to suffer poor health outcomes as a result. Of importance, however, patients also blame themselves for their own lack of knowledge. Lack of cultural health capital disadvantages women during delivery care in India. Providers set expectations and norms around behaviors during delivery, while women are often misinformed and may have low expectations of care.

Human Capital Accumulation: The Role of Human Resource Development.

ERIC Educational Resources Information Center

Garavan, Thomas N.; Morley, Michael; Gunnigle, Patrick; Collins, Eammon

2001-01-01

Presents definitions of intellectual and human capital. Examines human capital from the individual perspective (employability, performance, career development) and organization perspective (investment, ownership, knowledge management). Reviews papers in the theme issue. (Contains 117 references.) (SK)

The Strategic Management of Human Capital: Brief Reflections and a Few Propositions

ERIC Educational Resources Information Center

Berry, Barnett

2008-01-01

The author shares how he was fascinated by the recent interest in and focus on the strategic management of human capital (SMHC)--which has been defined as "the acquisition, development, performance management and retention of top talent in the nation's schools." It is one thing to identify talented educators; it is another to utilize them…

77 FR 73065 - Notice of Applications for Deregistration Under Section 8(f) of the Investment Company Act of 1940

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-07

... INFORMATION CONTACT: Diane L. Titus at (202) 551-6810, SEC, Division of Investment Management, Office of Investment Company Regulation, 100 F Street NE., Washington, DC 20549-8010. EM Capital Management, LLC [File... operate as, an investment company. EM Capital Management, LLC will continue to operate as an investment...

Tracking the demise of state hospital rate setting.

PubMed

McDonough, J E

1997-01-01

From its once preeminent position in state health policy, prospective hospital rate setting has declined in use from more than thirty states in 1980 to two today. This essay tracks the trend toward deregulation in various states--especially Massachusetts, New Jersey, and New York-- and examines the continuation of rate setting in Maryland. Principally, the decline reflects the development of managed care and capitation as alternative means to control health spending growth. This trend represents both an evolution in prospective payment methodology and a renewed preference for private over public-sector price controls.

Using Executive Information Systems to Manage Capital Projects and Facilities.

ERIC Educational Resources Information Center

Kaynor, Robert

1993-01-01

In higher education, facilities data are essential for long-term capital and financial planning and for testing assumptions underlying anticipated policy change. Executive information systems should incorporate life-cycle considerations (planning, construction, renovation, and management) and resource linkages (describing interrelationships of…

Self-management support interventions that are clinically linked and technology enabled: can they successfully prevent and treat diabetes?

PubMed

Kaufman, Neal D; Woodley, Paula D Patnoe

2011-05-01

Patients with diabetes need a complex set of services and supports. The challenge of integrating these services into the diabetes regimen can be successfully overcome through self-management support interventions that are clinically linked and technology enabled: self-management support because patients need help mastering the knowledge, attitudes, skills, and behaviors so necessary for good outcomes; interventions because comprehensive theory-based, evidence-proven, long-term, longitudinal interventions work better than direct-to-consumer or nonplanned health promotion approaches; clinically linked because patients are more likely to adopt new behaviors when the approach is in the context of a trusted therapeutic relationship and within an effective medical care system; and technology enabled because capitalizing on the amazing power of information technology leads to the delivery of cost-effective, scalable, engaging solutions that prevent and manage diabetes. © 2011 Diabetes Technology Society.

Iranian senior nursing managers’ experiences and understanding of social capital in the nursing profession

PubMed Central

Manoochehri, Houman; Lolaty, Hamideh Azimi; Hassani, Parkhideh; Arbon, Paul; Shorofi, Seyed Afshin

2014-01-01

Background: This study aimed to explore the role of social capital within the context of the nursing profession in Iran, based on the experience and perspectives of senior nursing managers. Materials and Methods: The study was conducted using the Graneheim and Lundman content analysis method. Using purposive sampling, 26 senior nursing managers from the Ministry of Health and Medical Education, the College of Nursing and Midwifery, the Iranian Nursing Organization, nursing associations and hospitals were selected, who participated in semi-structured in-depth interviews. Results: Content analysis revealed three main themes (social capital deficit, applying multiple strategies, and cultivating social capital) as well as eight categories which included professional remoteness, deficiency in professional potency, deficiency in professional exchanges, accumulation of personal social capital, accumulation of professional social capital, socio-political strategies, psychological–cognitive strategies, and ethical/spiritual strategies. The results show the perceived level of social capital in nursing in Iran, the application of some key strategies, and the principal rewards accrued from active participation in improving the social capital in nursing environment and profession. Conclusions: Efforts should be made to strengthen the social capital and apply key strategies with the aim of achieving personal and professional benefits for nurses, their patients, and co-workers, and for the delivery of healthcare in general. In this respect, the role of senior managers is vital in stimulating collective action within the profession, planning for the development of a culture of participation in healthcare services, helping to develop all fields of the profession, and developing and strengthening intra- and inter-professional exchanges and networking. PMID:25400673

Integrating payer and provider risk through capitation.

PubMed

Barth, S M

1997-01-01

Capitation payment mechanisms promote conservative use of medical resources by transferring risk to the decision maker, the physician. However, there is another view of capitation: defining common risk between provider-driven organizations (i.e., physician/hospital organizations (PHOs) or integrated delivery systems (IDS), and risk-managing entities such as HMOs or insurance companies. This article discusses a strategy to align provider and risk manager incentives to share the risks and rewards for a total book of business or population.

The importance of working capital management for hospital profitability: evidence from bond-issuing, not-for-profit U.S. hospitals.

PubMed

Rauscher, Simone; Wheeler, John R C

2012-01-01

Increased financial pressures on hospitals have elevated the importance of working capital management, that is, the management of current assets and current liabilities, for hospitals' profitability. Efficient working capital management allows hospitals to reduce their holdings of current assets, such as inventory and accounts receivable, which earn no interest income and require financing with short-term debt. The resulting cash inflows can be reinvested in interest-bearing financial instruments or used to reduce short-term borrowing, thus improving the profitability of the organization. This study examines the relationship between hospitals' profitability and their performance at managing two components of working capital: accounts receivable, measured in terms of hospitals' average collection periods, and accounts payable, measured in terms of hospitals' average payment periods. Panel data derived from audited financial statements for 1,397 bond-issuing, not-for-profit U.S. hospitals for 2000-2007 were analyzed using hospital-level fixed-effects regression analysis. The results show a negative relationship between hospitals' average collection period and profitability. That is, hospitals that collected on their patient revenue faster reported higher profit margins than did hospitals that have larger balances of accounts receivable outstanding. We also found a negative relationship between hospitals' average payment period and their profitability. Hospital managers did not appear to delay paying their vendors. Rather, the findings indicated that more profitable hospitals paid their suppliers faster, possibly to avoid high effective interest rates on outstanding accounts payable, whereas less profitable hospitals waited longer to pay their bills. The findings of this study suggest that working capital management indeed matters for hospitals' profitability. Efforts aimed at reducing large balances in both accounts receivable and accounts payable may frequently be worthwhile investments that have the potential to reduce the costs associated with working capital management and thus improve the profitability of an organization.

Life cycle assessment of capital goods in waste management systems.

PubMed

Brogaard, Line K; Christensen, Thomas H

2016-10-01

The environmental importance of capital goods (trucks, buildings, equipment, etc.) was quantified by LCA modelling 1 tonne of waste treated in five different waste management scenarios. The scenarios involved a 240L collection bin, a 16m(3) collection truck, a composting plant, an anaerobic digestion plant, an incinerator and a landfill site. The contribution of capital goods to the overall environmental aspects of managing the waste was significant but varied greatly depending on the technology and the impact category: Global Warming: 1-17%, Stratospheric Ozone Depletion: 2-90%, Ionising Radiation, Human Health: 2-91%, Photochemical Ozone Formation: 2-56%, Freshwater Eutrophication: 0.05-99%, Marine Eutrophication: 0.03-8%, Terrestrial Acidification: 2-13%, Terrestrial Eutrophication: 1-8%, Particulate Matter: 11-26%, Human Toxicity, Cancer Effect: 10-92%, Human Toxicity, non-Cancer Effect: 1-71%, Freshwater Ecotoxicity: 3-58%. Depletion of Abiotic Resources - Fossil: 1-31% and Depletion of Abiotic Resources - Elements (Reserve base): 74-99%. The single most important contribution by capital goods was made by the high use of steel. Environmental impacts from capital goods are more significant for treatment facilities than for the collection and transportation of waste and for the landfilling of waste. It is concluded that the environmental impacts of capital goods should always be included in the LCA modelling of waste management, unless the only impact category considered is Global Warming. Copyright © 2016 Elsevier Ltd. All rights reserved.

Are leaders portable?

PubMed

Groysberg, Boris; McLean, Andrew N; Nohria, Nitin

2006-05-01

Does management talent transfer from one company to another? The market certainly seems to think so. Stock prices spike when companies announce new CEOs from a talent generator like General Electric. But how do these executives perform over the long term? The authors studied the careers of 20 former GE executives who went on to lead other major organizations, with strikingly uneven results. Even the best management talent, the authors found, is transferable only if it maps to the challenges of the new environment. More specifically, the authors identified five types of skills that may or may not transfer to a new job: general management human capital, or the skills to gather, cultivate, and deploy financial, technical, and human resources; strategic human capital, or individuals' expertise in cost cutting, growth, or cyclical markets; industry human capital, meaning the technical and regulatory knowledge unique to an industry; relationship human capital, or the extent to which a manager's effectiveness can be attributed to his or her experience working with colleagues or as part of a team; and company-specific human capital, or the knowledge about routines and procedures, corporate culture and informal structures, and systems and processes that are unique to a company. The GE executives' performance as CEOs depended on whether their new organizations were able to leverage each type of skill. The authors'findings challenge the conventional wisdom on human capital, which holds that there are two types of skill: general management, which is readily transferable, and company specific, which is not. In fact, they argue, other types of management capabilities can make a significant contribution to performance, and company-specific skills can be an asset in a new job.

12 CFR 931.8 - Other restrictions on the repurchase or redemption of Bank stock.

Code of Federal Regulations, 2011 CFR

2011-01-01

... LOAN BANK RISK MANAGEMENT AND CAPITAL STANDARDS FEDERAL HOME LOAN BANK CAPITAL STOCK § 931.8 Other... the Bank from maintaining adequate capital against a potential risk that may not be adequately...

Integrating Capital Studies within Physical Plant Operations.

ERIC Educational Resources Information Center

Christensen, Douglas K.

1986-01-01

Brigham Young University's program integrating ongoing campus capital replacement and renewal into overall physical plant administration is described, including the initial capital needs study, planning for replacement cycles and one-time expenditures, and management of the information gathered. (MSE)

12 CFR 931.8 - Other restrictions on the repurchase or redemption of Bank stock.

Code of Federal Regulations, 2010 CFR

2010-01-01

... LOAN BANK RISK MANAGEMENT AND CAPITAL STANDARDS FEDERAL HOME LOAN BANK CAPITAL STOCK § 931.8 Other... the Bank from maintaining adequate capital against a potential risk that may not be adequately...

Natural Capital Management: An Evolutionary Paradigm for Sustainable Restoration Investment - 13455

DOE Office of Scientific and Technical Information (OSTI.GOV)

Koetz, Maureen T.

2013-07-01

Unlike other forms of capital assets (built infrastructure, labor, financial capital), the supply of usable or accessible air, land, and water elements (termed Natural Capital Assets or NCA) available to enterprise processes is structurally shrinking due to increased demand and regulatory restriction. This supply/demand imbalance is affecting all forms of public and private enterprise (including Federal Facilities) in the form of encroachment, production limits, cost increases, and reduced competitiveness. Department of Energy (DOE) sites are comprised of significant stocks of NCA that function as both conserved capital (providing ecosystem services and other reserve capacity), and as natural infrastructure (supporting majormore » Federal enterprise programs). The current rubric of 'Environmental Stewardship' provides an unduly constrained management paradigm that is focused largely on compliance process metrics, and lacks a value platform for quantifying, documenting, and sustainably re-deploying re-capitalized natural asset capacity and capability. By adopting value-based system concepts similar to built infrastructure accounting and information management, 'stewarded' natural assets relegated to liability- or compliance-focused outcomes become 're-capitalized' operational assets able to support new or expanded mission. This growing need for new accounting and management paradigms to capture natural capital value is achieving global recognition, most recently by the United Nations, world leaders, and international corporations at the Rio+20 Summit in June of 2012. Natural Capital Asset Management (NCAM){sup TM} is such an accounting framework tool. Using a quantification-based design, NCAM{sup TM} provides inventory, capacity and value data to owners or managers of natural assets such as the DOE that parallel comparable information systems currently used for facility assets. Applied to Environmental Management (EM) and other DOE program activities, the natural asset capacity and value generated by EM projects and other investment and operational programming can be recorded and then allocated to mission and/or ecosystem needs as part of overall site, complex, and Federal decision-making. NCAM{sup TM} can also document post-restoration asset capability and value for use in weighing loss mitigation and ecosystem damage claims arising from past operational activities. A prototype NCAM{sup TM} evaluation developed at the Savannah River Site (SRS) demonstrates use of this framework as an advanced paradigm for NCA accounting and decision-making for the larger DOE complex and other enterprise using natural capital in operations. Applying a quantified value paradigm, the framework catalogues the results of activities that sustain, restore, and modernize natural assets for enterprise-wide value beyond that of compliance milestones. Capturing and assigning recapitalization value using NCAM{sup TM} concepts and tools improves effective reuse of taxpayer-sustained assets, records ecosystem service value, enables mission and enterprise optimization, and assures the sustainability of shared natural capital assets in regional pools vital to both complex sites and local and regional economies. (authors)« less

Phases of capitalism, welfare states, medical dominance, and health care in Ontario.

PubMed

Coburn, D

1999-01-01

There has been a lacuna in previous studies of medicine and health care of concepts or structures relating changes in health care with their contextualizing social structures. That is, there is a need to more adequately account for health care and social structure in terms of dynamic rather than static concepts. This article reports the application of a general schema outlining the transformation of capitalism through the phases of entrepreneurial, monopoly, and global capitalism, first presented by Ross and Trachte, to help understand both the changing role of medicine in Canada and the historical trajectory of the development of health insurance. These related events are shown to be partly reflective of the transformed class dynamic involved in a changing capitalist mode of production. The recent history of challenges to medicare in Canada as well as evidence of the declining power of medicine are both related directly and indirectly to the increased power of business and the decline in the relative autonomy of the state accompanying globalization. The application of the phases of capitalism sequence does roughly fit the Canadian instance although some modifications will be required to account for the specifics of the Canadian case. The schema also helps resolve two previously competing class arguments about the rise of health insurance in Canada.

13 CFR 120.462 - What are SBA's additional requirements on capital maintenance for SBA Supervised Lenders?

Code of Federal Regulations, 2011 CFR

2011-01-01

... financial viability and provide for any necessary growth. The minimum standards set in § 120.471 for SBLCs... in developing the SBA Supervised Lender's capital adequacy plan: (i) Management capability; (ii... capital (e.g., portfolio growth rate). (2) An SBA Supervised Lender must keep its capital plan current...

Using and improving social capital to increase community preparedness for wildfire

Treesearch

Shruti Agrawal; Martha C. Monroe

2006-01-01

Communities with more social capital are better able to work together to cope with problems such as a wildfire threat. This study found a positive relationship between perceiving greater social capital and participating in wildfire preparedness educational programs. Results suggest that managers can take advantage of existing social capital in communities to improve...

Banking on Families: How Families Generate and Distribute Social Capital

ERIC Educational Resources Information Center

Furstenberg, Frank F.

2005-01-01

Before we can determine the relevance of social capital to the sociology of family and kinship, we must fill the gaps in our theoretical knowledge. For example, we still do not know how couples, parents, children, and groups generate, accumulate, manage, and deploy social capital. Neither do we know the consequences of social capital for the…

Measuring Social Capital among First-Generation and Non-First-Generation, Working-Class, White Males

ERIC Educational Resources Information Center

Moschetti, Roxanne; Hudley, Cynthia

2008-01-01

Social capital is a useful theory for understanding the experiences of working class, first-generation college students. Social capital is the value of a relationship that provides support and assistance in a given social situation. According to social capital theory, networks of relationships can aid students in managing an otherwise unfamiliar…

Cutting costs without drawing blood.

PubMed

Copeland, T

2000-01-01

When looking for ways to cut costs, most managers reach for the head-count hatchet, and the markets usually roar with approval. But a company can almost always create far more sustainable value by rigorously evaluating the small-ticket capital items that often get rubber-stamped. Drawing on his experience as a consultant and providing numerous anecdotes, the author contends that those "little" requests often prove to be gold plated or unnecessary. A disciplined evaluation involves asking only eight questions and conducting postmortems--regular audits of units' capital spending. But the payoff is enormous. Because cutting the capital budget increases cash flow, the author argues that a permanent cut of just 15% in the planned level of capital spending could boost some companies' market capitalization by as much as 30%. The first three questions--Is this your investment to make? Does it really have to be new? How are our competitors meeting compliance needs?--are asked of operating managers as they assemble capital project requests. The next three are asked by senior managers of themselves and their colleagues as they examine proposals: Is the left hand duplicating investments made by the right? Are trade-offs between profit and capital spending well understood? Are there signs of budget massage? At the end of the review process, senior managers ask: Are we fully using shared assets? How fine-grained are our capacity measures? The author's suggestions for the postmortem include searching for systematic problems with whole classes of expenditures and making sure audit teams come up with specific recommendations for change.

12 CFR 930.1 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOME LOAN BANK RISK MANAGEMENT AND CAPITAL STANDARDS DEFINITIONS APPLYING TO RISK MANAGEMENT AND CAPITAL REGULATIONS § 930.1 Definitions. As used in this... contract means a derivative contract that transfers credit risk. Credit risk means the risk that the market...

Associations between Social Capital and HIV Stigma in Chennai, India: Considerations for Prevention Intervention Design

ERIC Educational Resources Information Center

Sivaram, Sudha; Zelaya, Carla; Srikrishnan, A. K.; Latkin, Carl; Go, V. F.; Solomon, Suniti; Celentano, David

2009-01-01

Stigma against persons living with HIV/AIDS (PLHA) is a barrier to seeking prevention education, HIV testing, and care. Social capital has been reported as an important factor influencing HIV prevention and social support upon infection. In the study, we explored the associations between social capital and stigma among men and women who are…

Healthy Youth/Healthy Regions: Informing Action for the Nine County Capital Region and Its Youth

ERIC Educational Resources Information Center

London, Jonathan; Erbstein, Nancy

2011-01-01

Will the Sacramento Capital Region prosper, thrive and ultimately grow into its full potential in coming years? To answer this question, the authors have to look carefully at the well-being of young people who now inhabit the Capital Region's nine counties. As go today's young people--tomorrow's workers, parents, neighbors and leaders--so goes the…

Hospital Capital Investment During the Great Recession.

PubMed

Choi, Sung

2017-01-01

Hospital capital investment is important for acquiring and maintaining technology and equipment needed to provide health care. Reduction in capital investment by a hospital has negative implications for patient outcomes. Most hospitals rely on debt and internal cash flow to fund capital investment. The great recession may have made it difficult for hospitals to borrow, thus reducing their capital investment. I investigated the impact of the great recession on capital investment made by California hospitals. Modeling how hospital capital investment may have been liquidity constrained during the recession is a novel contribution to the literature. I estimated the model with California Office of Statewide Health Planning and Development data and system generalized method of moments. Findings suggest that not-for-profit and public hospitals were liquidity constrained during the recession. Comparing the changes in hospital capital investment between 2006 and 2009 showed that hospitals used cash flow to increase capital investment by $2.45 million, other things equal.

Hospital Capital Investment During the Great Recession

PubMed Central

Choi, Sung

2017-01-01

Hospital capital investment is important for acquiring and maintaining technology and equipment needed to provide health care. Reduction in capital investment by a hospital has negative implications for patient outcomes. Most hospitals rely on debt and internal cash flow to fund capital investment. The great recession may have made it difficult for hospitals to borrow, thus reducing their capital investment. I investigated the impact of the great recession on capital investment made by California hospitals. Modeling how hospital capital investment may have been liquidity constrained during the recession is a novel contribution to the literature. I estimated the model with California Office of Statewide Health Planning and Development data and system generalized method of moments. Findings suggest that not-for-profit and public hospitals were liquidity constrained during the recession. Comparing the changes in hospital capital investment between 2006 and 2009 showed that hospitals used cash flow to increase capital investment by $2.45 million, other things equal. PMID:28617202

77 FR 64568 - Medley Capital Corporation, et al.

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-22

... Capital Corporation, et al.; Notice of Application October 16, 2012. AGENCY: Securities and Exchange.... Applicants: Medley Capital Corporation (the ``Company''), MCC Advisors LLC (the ``Investment Adviser.... Applicants' Representations 1. The Company, a Delaware corporation, is an externally managed, non-diversified...

13 CFR 108.550 - Prior approval of secured third-party debt of NMVC companies.

Code of Federal Regulations, 2010 CFR

2010-01-01

... ADMINISTRATION NEW MARKETS VENTURE CAPITAL (âNMVCâ) PROGRAM Managing the Operations of a NMVC Company Borrowing... total outstanding borrowings (not including Leverage) to exceed 50 percent of your Leverageable Capital. Voluntary Decrease in Regulatory Capital ...

77 FR 34126 - Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-08

... soliciting comments concerning reporting and record retention requirements for the Capital Magnet Fund (CMF.... ADDRESSES: Direct all comments to Capital Magnet Fund Manager, Community Development Financial Institutions...-7024. This is not a toll free number. SUPPLEMENTARY INFORMATION: Title: Capital Magnet Fund Reporting...

Academic health systems management: the rationale behind capitated contracts.

PubMed

Taheri, P A; Butz, D A; Greenfield, L J

2000-06-01

To determine why hospitals enter into "capitated" contracts, which often generate accounting losses. The authors' hypothesis is that hospitals coordinate contracts to keep beds full and that in principal, capitated contracts reflect sound capacity management. In high-overhead industries, different consumers pay different prices for similar services (e.g., full-fare vs. advanced-purchase plane tickets, full tuition vs. financial aid). Some consumers gain access by paying less than total cost. Hospitals, like other high-overhead business enterprises, must optimize the use of their capacity, amortizing overhead over as many patients as possible. This necessity for enhanced throughput forces hospitals and health systems to discount empty beds, sometimes to the point where they incur accounting losses serving some payors. The authors analyzed the cost accounting system at their university teaching hospital to compare hospital and intensive care unit (ICU) lengths of stay (LOS), variable direct costs (VDC), overhead of capitated patients, and reimbursement versus other payors for all hospital discharges (n = 29,036) in fiscal year 1998. The data were analyzed by diagnosis-related groups (DRGs), length of stay (LOS), insurance carrier, proximity to hospital, and discharge disposition. Patients were then distinguished across payor categories based on their resource utilization, proximity to the hospital, DRG, LOS, and discharge status. The mean cost for capitated patients was $4,887, less than half of the mean cost of $10,394 for the entire hospitalized population. The mean capitated reimbursement was $928/day, exceeding the mean daily VDC of $616 but not the total cost of $1,445/day. Moreover, the mean total cost per patient day of treating a capitated patient was $400 less than the mean total cost per day for noncapitated patients. The hospital's capitated health maintenance organization (HMO) patients made up 16. 0% of the total admissions but only 9.4% of the total patient days. Both the mean LOS of 3.4 days and the mean ICU LOS of 0.3 days were significantly different from the overall values of 5.8 days and 1 day, respectively, for the noncapitated population. For patients classified with a DRG with complication who traveled from more than 60 miles away, the mean LOS was 10.7 days and the mean total cost was $21,658. This is in contrast to all patients who traveled greater than 60 miles, who had an LOS of 7.2 days and a mean total cost of $12,569. The capitated payor directed the bulk of its subscribers to one hospital (other payors transferred their sicker patients). This was reflected in the capitated group's lower costs and LOS. This stable stream of relatively low-acuity patients enhanced capacity utilization. For capitated patients, the hospital still benefits by recovering the incremental cost (VDC) of treating these patients, and only a portion of the assigned overhead. Thus, in the short run, capitated patients provide a positive economic benefit. Other payors' higher-acuity patients arrive more randomly, place greater strains on capacity, and generate higher overhead costs. This results in differential reimbursement to cover this incremental overhead. Having a portfolio of contracts allows the hospital to optimize capacity both in terms of patient flows and acuity. One risk of operating near capacity is that capitated patients could displace other higher-paying patients.

Dimensions of social capital of families with thalassemia in an indigenous population in Tamil Nadu, India - a qualitative study.

PubMed

Palanisamy, Bharathi; Kosalram, Kalpana; Gopichandran, Vijayaprasad

2017-06-24

Studies have shown that social capital is positively associated with health, and the association is context-based. Indigenous populations with poor access to health care largely depend on social capital for their health care needs. This study was conducted to explore the dimensions and types of social capital and its utilization by families with thalassemia for their health and well-being in an indigenous population in Tamil Nadu, India. The participants in the study were parents who had children with thalassemia, belonged to an indigenous community in Tamil Nadu, were poor and marginalized, and had poor access to health care. Different dimensions and types of social capital were examined with the help of qualitative in-depth interviews using a phenomenological approach. A total of 8 in-depth interviews were conducted and transcribed. Thematic analysis of the data was performed. The social capital identified through the in-depth interviews consisted of various levels of family support, financial support from relatives and neighbors, the provision of information from formal and informal networks, and trust in the physician. Indigenous communities are close-knit due to their geographical remoteness and limited accessibility. Family ties were a form of social capital that encouraged bonding, and provided support and care to the children affected by thalassemia. The bonding also helped to meet the regular requirement of blood donation for the children. Relatives and neighbors were an asset that served as a bridge for the families affected, helping them in times of immediate and urgent financial need, making it easier to sustain long-term treatment and providing emotional support. There were informal networks that bridged parents belonging to indigenous and non-indigenous communities, with the latter providing the former with information to help them choose better health care at an affordable cost. The other formal links were the ties between the parents and nongovernmental organizations, such as the local thalassemia association, which connected members belonging to different areas. It was these ties that were of the greatest assistance to the families affected in coping with the disease, enabling them to sustain the treatment, and assisting them to choose and carry out the complicated bone marrow transplantation, which is the definitive treatment for this condition. The bonding, bridging, and linking dimensions of social capital help communities cope with thalassemia, the more so in indigenous and marginalized communities.

Hospitals, nursing homes turn to 3rd-party financing

DOE Office of Scientific and Technical Information (OSTI.GOV)

Slaff, J.

Experience is teaching the administrators of hospitals and nursing homes how to make better arrangements for third-party financing of energy-management systems. Accustomed to health-insurance reimbursement for health-care costs, hospitals have lacked incentives for conservation. Plans now used most by hospitals and health-care facilities involve third-party arrangements where: (1) an equipment vendor installs equipment and takes a share of the energy-cost savings; or (2) energy-services firms both install capital-intensive equipment and implement a variety of low-cost conservation measures, again for a percentage of the savings. Although most users think these arrangements are satisfactory, they advise a preliminary low-cost audit and participationmore » in a basic energy-management seminar before employing an energy-services firm. Accurate baseline energy-consumption data should be developed in order to evaluate results, and assurance is needed that staff members understand the accounting formulas. Also recommended are independent audits after installation and attention to the legal clauses in contracts. (DCK)« less

The Association between Quality Improvement Initiatives in Dementia Care and Supportive Psychosocial Work Environments in Nursing Homes.

PubMed

Nakanishi, Miharu; Tei-Tominaga, Maki

2018-05-08

Background : Quality improvement initiatives can help nursing homes strengthen psychosocial work environments. The aim of the present study was to examine the association between supportive psychosocial work environment, and professional and organizational characteristics regarding quality improvement initiatives in dementia care. Methods : A paper questionnaire survey was administered to a convenience sample of 365 professional caregivers in 12 special nursing homes in Japan. Psychosocial work environment was assessed using the Social Capital and Ethical Climate at the Workplace Scale to calculate a score of social capital in the workplace, ethical leadership, and exclusive workplace climate. Variables for quality improvement initiatives included type of home (unit-type or traditional), presence of additional benefit for dementia care, and professionalism in dementia care among caregivers evaluated using the Japanese version of the Sense of Competence in Dementia Care Staff Scale. Results : Elevated professionalism and unit-type home were significantly associated with high social capital, strong ethical leadership, and low exclusive workplace climate. The presence of dementia care benefit was not associated with any subscale of psychosocial work environment. Conclusions : Quality improvement initiatives to foster supportive psychosocial work environment should enhance professionalism in dementia care with unit-based team building of professional caregivers in special nursing homes.

77 FR 48137 - Combined Notice of Filings #1

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-13

... Applicants: Capital Research and Management Company. Description: Request for Amended Order Under Section 203 of the Federal Power Act of Capital Research and Management Company. Filed Date: 8/2/12 Accession... Service Company of Colorado, BIV Generation Company, L.L.C., Colorado Power Partners, Centennial Power...

30 CFR 220.010 - NPSL capital account.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 2 2010-07-01 2010-07-01 false NPSL capital account. 220.010 Section 220.010 Mineral Resources MINERALS MANAGEMENT SERVICE, DEPARTMENT OF THE INTERIOR MINERALS REVENUE MANAGEMENT ACCOUNTING PROCEDURES FOR DETERMINING NET PROFIT SHARE PAYMENT FOR OUTER CONTINENTAL SHELF OIL AND GAS LEASES...

Adaptive exchange of capitals in urban water resources management : an approach to sustainability?

EPA Science Inventory

With water availability increasingly restricted by deficiencies in quality and quantity, water resources management is a central issue in planning for sustainability in the Anthropocene. We first offer a definition of sustainability based on the ease with which capitals (e.g., na...

Priority directions of the improvement of energy management at the enterprise

NASA Astrophysics Data System (ADS)

Dyakova, Galina; Izmaylova, Svetlana; Mottaeva, Angela; Karanina, Elena

2017-10-01

The relevance of article is caused by the fact that at the industrial enterprises pay little attention to the matters of energy saving or to the management of energy efficiency. The authors of the article defined that the potential of the increase in energy efficiency as well as the improvement of quality of strategic management at the enterprise, is connected with investment into the human capital. For the improvement of system of energy management, the key indicators of energy efficiency at the individual level are defined, the algorithm of the development of key indicators by means of which the energy efficiency of the human capital will be measured is developed, actions for support to the developed transitional strategy of power management are offered, positive results of formation of the human capital directed to increase in energy efficiency are designated.

12 CFR 615.5200 - Capital planning.

Code of Federal Regulations, 2010 CFR

2010-01-01

... the capital adequacy plan: (1) Capability of management and the board of directors; (2) Quality of... of Directors of each Farm Credit System institution shall determine the amount of total capital, core surplus, total surplus, and unallocated surplus needed to assure the institution's continued financial...

12 CFR 615.5200 - Capital planning.

Code of Federal Regulations, 2011 CFR

2011-01-01

... the capital adequacy plan: (1) Capability of management and the board of directors; (2) Quality of... of Directors of each Farm Credit System institution shall determine the amount of total capital, core surplus, total surplus, and unallocated surplus needed to assure the institution's continued financial...

Social Capital, Depressive Symptoms, and HIV Viral Suppression Among Young Black, Gay, Bisexual and Other Men Who Have Sex with Men Living with HIV.

PubMed

Hussen, Sophia A; Easley, Kirk A; Smith, Justin C; Shenvi, Neeta; Harper, Gary W; Camacho-Gonzalez, Andres F; Stephenson, Rob; Del Rio, Carlos

2018-04-04

Social capital, the sum of an individual's resource-containing social network connections, has been proposed as a facilitator of successful HIV care engagement. We explored relationships between social capital, psychological covariates (depression, stigma and internalized homonegativity), and viral suppression in a sample of young Black gay, bisexual and other men who have sex with men (YB-GBMSM). We recruited 81 HIV-positive YB-GBMSM 18-24 years of age from a clinic setting. Participants completed a cross-sectional survey, and HIV-1 viral load (VL) measurements were extracted from the medical record. Sixty-five percent (65%) were virally suppressed (HIV-1 VL ≤ 40 copies/ml). Forty-seven percent (47%) had a positive depression screen. Depressive symptoms affected viral suppression differently in YB-GBMSM with lower vs. higher social capital (p = 0.046, test for statistical interaction between depression and social capital). The odds of viral suppression among YB-GBMSM with lower social capital was 93% lower among those with depressive symptoms (OR 0.07, p = 0.002); however, there was no association between depressive symptoms and viral suppression among those with higher social capital. Our results suggest that social capital may buffer the strong negative effects of depressive symptoms on clinical outcomes in YB-GBMSM living with HIV. In addition to treating depression, there is a role for interventions to augment social capital among YB-GBMSM living with HIV as a strategy for enhancing care engagement.

Medicare capitation model, functional status, and multiple comorbidities: model accuracy

PubMed Central

Noyes, Katia; Liu, Hangsheng; Temkin-Greener, Helena

2012-01-01

Objective This study examined financial implications of CMS-Hierarchical Condition Categories (HCC) risk-adjustment model on Medicare payments for individuals with comorbid chronic conditions. Study Design The study used 1992-2000 data from the Medicare Current Beneficiary Survey and corresponding Medicare claims. The pairs of comorbidities were formed based on the prior evidence about possible synergy between these conditions and activities of daily living (ADL) deficiencies and included heart disease and cancer, lung disease and cancer, stroke and hypertension, stroke and arthritis, congestive heart failure (CHF) and osteoporosis, diabetes and coronary artery disease, CHF and dementia. Methods For each beneficiary, we calculated the actual Medicare cost ratio as the ratio of the individual’s annualized costs to the mean annual Medicare cost of all people in the study. The actual Medicare cost ratios, by ADLs, were compared to the HCC ratios under the CMS-HCC payment model. Using multivariate regression models, we tested whether having the identified pairs of comorbidities affects the accuracy of CMS-HCC model predictions. Results The CMS-HCC model underpredicted Medicare capitation payments for patients with hypertension, lung disease, congestive heart failure and dementia. The difference between the actual costs and predicted payments was partially explained by beneficiary functional status and less than optimal adjustment for these chronic conditions. Conclusions Information about beneficiary functional status should be incorporated in reimbursement models since underpaying providers for caring for population with multiple comorbidities may provide severe disincentives for managed care plans to enroll such individuals and to appropriately manage their complex and costly conditions. PMID:18837646

Analysis of capital spending and capital financing among large US nonprofit health systems.

PubMed

Stewart, Louis J

2012-01-01

This article examines the recent trends (2006 to 2009) in capital spending among 25 of the largest nonprofit health systems in the United States and analyzes the financing sources that these large nonprofit health care systems used to fund their capital spending. Total capital spending for these 25 nonprofit health entities exceeded $41 billion for the four-year period of this study. Less than 3 percent of total capital spending resulted in mergers and acquisition activities. Total annual capital spending grew at an average annual rate of 17.6 percent during the first three year of this study's period of analysis. Annual capital spending for 2009 fell by more than 22 percent over prior year's level due to the impact of widespread disruption in US tax-exempt variable rate debt markets. While cash inflow from long-term debt issues was a significant source of capital financing, this study's primary finding was that operating cash flow was the predominant source of capital spending funding. Key words: nonprofit, mergers and acquisitions (M&A), capital spending, capital financing.

Fully Capitated Payment Breakeven Rate for a Mid-Size Pediatric Practice.

PubMed

Farmer, Steven A; Shalowitz, Joel; George, Meaghan; McStay, Frank; Patel, Kavita; Perrin, James; Moghtaderi, Ali; McClellan, Mark

2016-08-01

Payers are implementing alternative payment models that attempt to align payment with high-value care. This study calculates the breakeven capitated payment rate for a midsize pediatric practice and explores how several different staffing scenarios affect the rate. We supplemented a literature review and data from >200 practices with interviews of practice administrators, physicians, and payers to construct an income statement for a hypothetical, independent, midsize pediatric practice in fee-for-service. The practice was transitioned to full capitation to calculate the breakeven capitated rate, holding all practice parameters constant. Panel size, overhead, physician salary, and staffing ratios were varied to assess their impact on the breakeven per-member per-month (PMPM) rate. Finally, payment rates from an existing health plan were applied to the practice. The calculated breakeven PMPM was $24.10. When an economic simulation allowed core practice parameters to vary across a broad range, 80% of practices broke even with a PMPM of $35.00. The breakeven PMPM increased by 12% ($3.00) when the staffing ratio increased by 25% and increased by 23% ($5.50) when the staffing ratio increased by 38%. The practice was viable, even with primary care medical home staffing ratios, when rates from a real-world payer were applied. Practices are more likely to succeed in capitated models if pediatricians understand how these models alter practice finances. Staffing changes that are common in patient-centered medical home models increased the breakeven capitated rate. The degree to which team-based care will increase panel size and offset increased cost is unknown. Copyright © 2016 by the American Academy of Pediatrics.

77 FR 72341 - Combined Notice of Filings #1

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-05

.... Applicants: Capital Research and Management Company. Description: Request for Amended Order Under Section 203 of the Federal Power Act of Capital Research and Management Company, et. al. Filed Date: 11/28/12... Authorization Under Section 203 of the Federal Power Act and Request for Expedited Consideration. Filed Date: 11...

77 FR 16280 - Capital Research and Management Company, et al.; Notice of Application

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-20

.... APPLICANTS: American Funds Insurance Series (``AFIS''), Capital Research and Management Company (``CRMC.../search.htm or by calling (202) 551-8090. Applicants' Representations 1. AFIS is organized as a... extent necessary to permit any existing or future series of AFIS and any other existing or future...

77 FR 22622 - AP Henderson Group, BPO Management Services, Inc., Capital Mineral Investors, Inc...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-16

... SECURITIES AND EXCHANGE COMMISSION [File No. 500-1] AP Henderson Group, BPO Management Services, Inc., Capital Mineral Investors, Inc., CardioVascular BioTherapeutics, Inc., and 1st Centennial... that there is a lack of current and accurate information concerning the securities of 1st Centennial...

Measuring Strategic Value-Drivers for Managing Intellectual Capital

ERIC Educational Resources Information Center

Bose, S.; Oh, K. B.

2004-01-01

In an evolving business environment characterised by globalisation and a challenging competitive paradigm, it is imperative for strategic management processes to focus on the financial perspectives of value and risk in intellectual capital to create sustainability in long-term value. This paper presents the key issues pertaining to the strategic…

30 CFR 220.020 - Calculation of the allowance for capital recovery.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 2 2010-07-01 2010-07-01 false Calculation of the allowance for capital recovery. 220.020 Section 220.020 Mineral Resources MINERALS MANAGEMENT SERVICE, DEPARTMENT OF THE INTERIOR MINERALS REVENUE MANAGEMENT ACCOUNTING PROCEDURES FOR DETERMINING NET PROFIT SHARE PAYMENT FOR OUTER...

20 CFR 627.430 - Grant payments.

Code of Federal Regulations, 2011 CFR

2011-04-01

... in accordance with the Cash Management Improvement Act of 1990 (31 U.S.C. 6501, et seq.), Department... provided by the Cash Management Improvement Act (31 U.S.C. 6501, et seq.) and implementing regulations at... working capital, the awarding agency may provide cash on a working capital advance payment basis. Under...

The work and challenges of care managers in the implementation of collaborative care: A qualitative study.

PubMed

Overbeck, G; Kousgaard, M B; Davidsen, A S

2018-04-01

WHAT IS KNOWN ON THE SUBJECT?: In collaborative care models between psychiatry and general practice, mental health nurses are used as care managers who carry out the treatment of patients with anxiety or depression in general practice and establish a collaborating relationship with the general practitioner. Although the care manager is the key person in the collaborative care model, there is little knowledge about this role and the challenges involved in it. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Our study shows that before the CMs could start treating patients in a routine collaborative relationship with GPs, they needed to carry out an extensive amount of implementation work. This included solving practical problems of location and logistics, engaging GPs in the intervention, and tailoring collaboration to meet the GP's particular preferences. Implementing the role requires high commitment and an enterprising approach on the part of the care managers. The very experienced mental health nurses of this study had these skills. However, the same expertise cannot be presumed in a disseminated model. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: When introducing new collaborative care interventions, the care manager role should be well defined and be well prepared, especially as regards the arrival of the care manager in general practice, and supported during implementation by a coordinated leadership established in collaboration between hospital psychiatry and representatives from general practice. Introduction In collaborative care models for anxiety and depression, the care manager (CM), often a mental health nurse, has a key role. However, the work and challenges related to this role remain poorly investigated. Aim To explore CMs' experiences of their work and the challenges they face when implementing their role in a collaborative care intervention in the Capital Region of Denmark. Methods Interviews with eight CMs, a group interview with five CMs and a recording of one supervision session were analysed by thematic analysis. Results The CM carried out considerable implementation work. This included finding suitable locations; initiating and sustaining communication with the GPs and maintaining their engagement in the model; adapting to the patient population in general practice; dealing with personal security issues, and developing supportive peer relations and meaningful supervision. Discussion We compare our findings to previous studies of collaborative care and advanced nursing roles in general practice. The importance of organizational leadership to support the CM's bridge-building role is emphasized. Implications for practice The planners of new collaborative care interventions should not only focus on the CM's clinical tasks but also on ensuring the sufficient organizational conditions for carrying out the role. © 2017 John Wiley & Sons Ltd.

Alternative Fuels for Military Applications

DTIC Science & Technology

2011-01-01

HEALTH CARE INFRASTRUCTURE AND TRANSPORTATION INTERNATIONAL AFFAIRS LAW AND BUSINESS NATIONAL SECURITY POPULATION AND AGING PUBLIC SAFETY SCIENCE AND...refinery, UOP LLC reports a hydrogen requirement of 2.5 to 3.8 percent by weight and capital costs (inside battery limits) of between $6.00 and $11.00...environmental permitting requirements. 15 The key assumptions underlying this cost estimate are that (1) total capital costs are twice ISBL capital costs

Applying a private sector capitation model to the management of type 2 diabetes in the South African public sector: a cost-effectiveness analysis.

PubMed

Volmink, Heinrich C; Bertram, Melanie Y; Jina, Ruxana; Wade, Alisha N; Hofman, Karen J

2014-09-30

Diabetes mellitus contributes substantially to the non-communicable disease burden in South Africa. The proposed National Health Insurance system provides an opportunity to consider the development of a cost-effective capitation model of care for patients with type 2 diabetes. The objective of the study was to determine the potential cost-effectiveness of adapting a private sector diabetes management programme (DMP) to the South African public sector. Cost-effectiveness analysis was undertaken with a public sector model of the DMP as the intervention and a usual practice model as the comparator. Probabilistic modelling was utilized for incremental cost-effectiveness ratio analysis with life years gained selected as the outcome. Secondary data were used to design the model while cost information was obtained from various sources, taking into account public sector billing. Modelling found an incremental cost-effectiveness ratio (ICER) of ZAR 8 356 (USD 1018) per life year gained (LYG) for the DMP against the usual practice model. This fell substantially below the Willingness-to-Pay threshold with bootstrapping analysis. Furthermore, a national implementation of the intervention could potentially result in an estimated cumulative gain of 96 997 years of life (95% CI 71 073 years - 113 994 years). Probabilistic modelling found the capitation intervention to be cost-effective, with an ICER of ZAR 8 356 (USD 1018) per LYG. Piloting the service within the public sector is recommended as an initial step, as this would provide data for more accurate economic evaluation, and would also allow for qualitative analysis of the programme.

75 FR 61790 - Capital Southwest Corporation; Notice of Application

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-06

... Southwest Corporation; Notice of Application September 29, 2010. AGENCY: Securities and Exchange Commission... Southwest Corporation (``Capital Southwest''), requests an order to permit it to issue restricted shares of... Representations 1. Capital Southwest, a Texas corporation, is an internally managed, non-diversified, closed-end...

Does workplace social capital buffer the effects of job stress? A cross-sectional, multilevel analysis of cigarette smoking among U.S. manufacturing workers

PubMed Central

Sapp, Amy L.; Kawachi, Ichiro; Sorensen, Glorian; LaMontagne, Anthony D.; Subramanian, S.V.

2010-01-01

Objective To investigate whether workplace social capital buffers the association between job stress and smoking status. Methods As part of the Harvard Cancer Prevention Project’s Healthy Directions-Small Business Study, interviewer-administered questionnaires were completed by 1740 workers and 288 managers in 26 manufacturing firms (84% and 85% response). Social capital was assessed by multiple items measured at the individual-level among workers, and contextual-level among managers. Job stress was operationalized by the demand-control model. Multilevel logistic regression was used to estimate associations between job stressors and smoking, and test for effect modification by social capital measures. Results Workplace social capital (both summary measures) buffered associations between high job demands and smoking. One compositional item—worker trust in managers—buffered associations between job strain and smoking. Conclusion Workplace social capital may modify the effects of psychosocial working conditions on health behaviors. PMID:20595910

Differentiated strategy, business performance, and intellectual capital: Evidence small medium enterprise from Indonesia

NASA Astrophysics Data System (ADS)

Hariyati; Venusita, L.; Dyani, Z. F.

2018-01-01

Small and Medium Enterprises (SMEs) have a very important position in Indonesian economics. Implementation of the differentiated strategy has been impacted on improving the business performance of SMEs where the role of intellectual capital strongly supports the success of the implementation of the differentiated strategy. This study applied quantitative research which used survey method. This research examines the relationship between differentiated strategy to the performance of SMEs with mediated by intellectual capital. The results of this study show that intellectual capital mediates the relationship between differentiation strategies and business performance of SMEs. This study theoretically proves the importance of contextual variables in contingency theory. The practical results of this study contribute to raising awareness of business unit managers or other equivalent positions, especially managers in East Java to understand the importance of the role of intellectual capital, this is because intellectual capital meets the criteria as a unique source of the company that is able to create competitive advantage and increase the firm’s value.

The corporate practice of health care ... a panel discussion.

PubMed

Calhoun, M J; Collins, M; Hasan, M; Klein, J I; Lundberg, G D; Mulligan, D H; Restuccia, R; Sapers, C M; Schram, R B; Woolhandler, S

1996-06-01

The pros and cons of treating health care as a profit-making business got a lively airing in Boston May 16, when the Harvard School of Public Health's "Second Conference on Strategic Alliances in the Evolving Health Care Market" presented what was billed as a "Socratic panel." The moderator was Charles R. Nesson, J.D., a Harvard Law School professor of 30 years' standing whose knack for guiding lively discussions is well known to viewers of such Public Broadcasting Service series as "The Constitution: That Delicate Balance. "As one panelist mentioned, Boston was an interesting place for this conversation. With a large and eminent medical establishment consisting mostly of traditionally not-for-profit institutions, the metropolis of the only state carried in 1972 by liberal Presidential candidate George McGovern is in one sense a skeptical holdout against the wave of aggressive investment capitalism that has been sweeping the health care industry since the 1994 failure of the Clinton health plan. In another sense, though, managed care-heavy Boston is an innovative crucible of change, just like its dominant HMO, the not-for-profit but merger-minded Harvard Pilgrim Health Care. Both of these facets of Beantown's health care psychology could be discerned in the comments heard during the panel discussion. With the permission of the Harvard School of Public Health--and asking due indulgence for the limitations of tape-recording technology in a room often buzzing with amateur comment--MANAGED CARE is pleased to present selections from the discussion in the hope that they will shed light on the business of health care.

Stories and metaphors in the sensemaking of multiple primary health care organizational identities.

PubMed

Rodríguez, Charo; Bélanger, Emmanuelle

2014-03-04

The Quebec primary health care delivery system has experienced numerous reforms over the last 15 years. In this study, we sought to examine how managers and primary care providers made sense of the creation of successive new primary care organizational forms. We conducted a longitudinal qualitative case study in a primary care practice group located in Montreal, Quebec, for over 6 years (2002 to 2008). The data sources for the study include 31 semi-structured interviews with key informants, in-situ observations of group meetings, as well as documents and field notes. Textual material was submitted to narrative and metaphor analysis. The core metaphor of the journey came from a set of stories in which the members of this primary care group depicted the processes undertaken towards developing a multidisciplinary cooperative practice, which include an uneasy departure, uncertainty about the destination, conflict among members who jump ship or stay on board, negotiations about the itinerary, and, finally, enduring challenges in leading the way and being pioneers of change in the organization of primary care in their institutional context. Identification with the initial family medicine unit identity was persistent over time, but successive reforms further enriched its meaning as it became a multidisciplinary primary care practice pioneering organizational change. In order to support primary care reforms in complex institutional fields, this study proposes that decision-makers undertake a journey in which they recognize both the need to capitalize on existing meaningful and legitimated organizational identities, as well as the necessity for collective leadership in the management of multiple organizational identities over time.

The company you keep: spreading effects of financial fraud on investor trust.

PubMed

Bernet, Patrick Michael; Getzen, Thomas E

2007-01-01

Investor trust is valuable to health care organizations. Without it, they may face higher capital costs. This study explores recent cases of fraud and the appearance of impropriety by health care organizations, focusing on the manners in which trust was violated, the systems that allowed those violations, and the effects on financial markets. Increases in the incidence and scale of such transgressions may be harbingers of worse times ahead. This article examines how recent events have affected the cost of capital, and what health care organizations can do to avoid being judged by the company they keep.

Unlicensed assistive personnel and lay caregivers in the home.

PubMed

Barter, M

1996-01-01

As a result of the changes in the health care delivery system, professional home health agency staff must provide clinical assessments, care planning, and patient outcome evaluation to higher acuity patients with limited resources. Because the number of home visits per patient is closely monitored by managed care companies, duplication of services may not be reimbursed, causing financial loss to home care agencies. Every aspect of care from admission to discharge must be coordinated to ensure that each patient receives the best care available within the limitation of the number of reimbursable or capitated visits. Professionals on an interdisciplinary team must know the legal scope of practice as well as the competencies of all members of the team. Decisions relating to delegation of patient care tasks to UAP and to lay caregivers are complex. Professional staff must consider the patient's condition, the caregiving environment, and the amount of social support available for the patient and family. The knowledge, skills, and abilities of the caregivers must then be matched to the needs of the patient. Because on-site supervision in the home setting is limited, nurses and therapists are required to know how to safely delegate patient care tasks and supervise others.

The process of implementation of emergency care units in Brazil.

PubMed

O'Dwyer, Gisele; Konder, Mariana Teixeira; Reciputti, Luciano Pereira; Lopes, Mônica Guimarães Macau; Agostinho, Danielle Fernandes; Alves, Gabriel Farias

2017-12-11

To analyze the process of implementation of emergency care units in Brazil. We have carried out a documentary analysis, with interviews with twenty-four state urgency coordinators and a panel of experts. We have analyzed issues related to policy background and trajectory, players involved in the implementation, expansion process, advances, limits, and implementation difficulties, and state coordination capacity. We have used the theoretical framework of the analysis of the strategic conduct of the Giddens theory of structuration. Emergency care units have been implemented after 2007, initially in the Southeast region, and 446 emergency care units were present in all Brazilian regions in 2016. Currently, 620 emergency care units are under construction, which indicates expectation of expansion. Federal funding was a strong driver for the implementation. The states have planned their emergency care units, but the existence of direct negotiation between municipalities and the Union has contributed with the significant number of emergency care units that have been built but that do not work. In relation to the urgency network, there is tension with the hospital because of the lack of beds in the country, which generates hospitalizations in the emergency care unit. The management of emergency care units is predominantly municipal, and most of the emergency care units are located outside the capitals and classified as Size III. The main challenges identified were: under-funding and difficulty in recruiting physicians. The emergency care unit has the merit of having technological resources and being architecturally differentiated, but it will only succeed within an urgency network. Federal induction has generated contradictory responses, since not all states consider the emergency care unit a priority. The strengthening of the state management has been identified as a challenge for the implementation of the urgency network.

The process of implementation of emergency care units in Brazil

PubMed Central

O'Dwyer, Gisele; Konder, Mariana Teixeira; Reciputti, Luciano Pereira; Lopes, Mônica Guimarães Macau; Agostinho, Danielle Fernandes; Alves, Gabriel Farias

2017-01-01

ABSTRACT OBJECTIVE To analyze the process of implementation of emergency care units in Brazil. METHODS We have carried out a documentary analysis, with interviews with twenty-four state urgency coordinators and a panel of experts. We have analyzed issues related to policy background and trajectory, players involved in the implementation, expansion process, advances, limits, and implementation difficulties, and state coordination capacity. We have used the theoretical framework of the analysis of the strategic conduct of the Giddens theory of structuration. RESULTS Emergency care units have been implemented after 2007, initially in the Southeast region, and 446 emergency care units were present in all Brazilian regions in 2016. Currently, 620 emergency care units are under construction, which indicates expectation of expansion. Federal funding was a strong driver for the implementation. The states have planned their emergency care units, but the existence of direct negotiation between municipalities and the Union has contributed with the significant number of emergency care units that have been built but that do not work. In relation to the urgency network, there is tension with the hospital because of the lack of beds in the country, which generates hospitalizations in the emergency care unit. The management of emergency care units is predominantly municipal, and most of the emergency care units are located outside the capitals and classified as Size III. The main challenges identified were: under-funding and difficulty in recruiting physicians. CONCLUSIONS The emergency care unit has the merit of having technological resources and being architecturally differentiated, but it will only succeed within an urgency network. Federal induction has generated contradictory responses, since not all states consider the emergency care unit a priority. The strengthening of the state management has been identified as a challenge for the implementation of the urgency network. PMID:29236876

Looking Through a Social Lens: Conceptualising Social Aspects of Knowledge Management for Global Health Practitioners.

PubMed

Limaye, Rupali J; Sullivan, Tara M; Dalessandro, Scott; Jenkins, Ann Hendrix

2017-04-13

Knowledge management plays a critical role in global health. Global health practitioners require knowledge in every aspect of their jobs, and in resource-scarce contexts, practitioners must be able to rely on a knowledge management system to access the latest research and practice to ensure the highest quality of care. However, we suggest that there is a gap in the way knowledge management is primarily utilized in global health, namely, the systematic incorporation of human and social factors. In this paper, we briefly outline the evolution of knowledge management and then propose a conceptualization of knowledge management that incorporates human and social factors for use within a global health context. Our conceptualization of social knowledge management recognizes the importance of social capital, social learning, social software and platforms, and social networks , all within the context of a larger social system and driven by social benefit . We then outline the limitations and discuss future directions of our conceptualization, and suggest how this new conceptualization is essential for any global health practitioner in the business of managing knowledge.

Pregnant women's expectations about pain intensity during childbirth and their attitudes towards pain management: Findings from an Icelandic national study.

PubMed

Karlsdottir, Sigfridur Inga; Sveinsdottir, Herdis; Olafsdottir, Olof Asta; Kristjansdottir, Hildur

2015-12-01

Pregnant women expect childbirth to be painful. However, little is known about their expectations of the intensity of pain in childbirth (EIPC) and their attitudes to pain management. The design was a cross-sectional survey, with self-reported questionnaires used to collect data from low-risk pregnant women (N = 1111) early in pregnancy at 26 of the largest primary health care centres in Iceland. This consecutive national sample was stratified by residency. The mean score for the EIPC was 5.58 (SD = 1.38) measured on a 7 point scale. The strongest predictors of a high EIPC score were: negative attitude to the impending childbirth (OR = 2.39), low manifestation of a sense of security (OR = 1.80), and a positive attitude to pain management with medication (OR = 1.63). Women living outside the capital area were less likely to have a high EIPC (OR = 0.68). Most women (77%) had a positive attitude towards pain management without medication and 35% had a positive attitude to pain management with medication. The study detected multiple predictors of women's EIPC and attitude to pain management. Early and throughout pregnancy, midwives and health care professionals need to address these predictors in order to assist women to prepare themselves for the pain of labour. Copyright © 2015 Elsevier B.V. All rights reserved.

Academic Health Systems Management: The Rationale Behind Capitated Contracts

PubMed Central

Taheri, Paul A.; Butz, David A.; Greenfield, Lazar J.

2000-01-01

Objective To determine why hospitals enter into “capitated” contracts, which often generate accounting losses. The authors’ hypothesis is that hospitals coordinate contracts to keep beds full and that in principal, capitated contracts reflect sound capacity management. Summary Background Data In high-overhead industries, different consumers pay different prices for similar services (e.g., full-fare vs. advanced-purchase plane tickets, full tuition vs. financial aid). Some consumers gain access by paying less than total cost. Hospitals, like other high-overhead business enterprises, must optimize the use of their capacity, amortizing overhead over as many patients as possible. This necessity for enhanced throughput forces hospitals and health systems to discount empty beds, sometimes to the point where they incur accounting losses serving some payors. Methods The authors analyzed the cost accounting system at their university teaching hospital to compare hospital and intensive care unit (ICU) lengths of stay (LOS), variable direct costs (VDC), overhead of capitated patients, and reimbursement versus other payors for all hospital discharges (n = 29,036) in fiscal year 1998. The data were analyzed by diagnosis-related groups (DRGs), length of stay (LOS), insurance carrier, proximity to hospital, and discharge disposition. Patients were then distinguished across payor categories based on their resource utilization, proximity to the hospital, DRG, LOS, and discharge status. Results The mean cost for capitated patients was $4,887, less than half of the mean cost of $10,394 for the entire hospitalized population. The mean capitated reimbursement was $928/day, exceeding the mean daily VDC of $616 but not the total cost of $1,445/day. Moreover, the mean total cost per patient day of treating a capitated patient was $400 less than the mean total cost per day for noncapitated patients. The hospital’s capitated health maintenance organization (HMO) patients made up 16.0% of the total admissions but only 9.4% of the total patient days. Both the mean LOS of 3.4 days and the mean ICU LOS of 0.3 days were significantly different from the overall values of 5.8 days and 1 day, respectively, for the noncapitated population. For patients classified with a DRG with complication who traveled from more than 60 miles away, the mean LOS was 10.7 days and the mean total cost was $21,658. This is in contrast to all patients who traveled greater than 60 miles, who had an LOS of 7.2 days and a mean total cost of $12,569. Conclusion The capitated payor directed the bulk of its subscribers to one hospital (other payors transferred their sicker patients). This was reflected in the capitated group’s lower costs and LOS. This stable stream of relatively low-acuity patients enhanced capacity utilization. For capitated patients, the hospital still benefits by recovering the incremental cost (VDC) of treating these patients, and only a portion of the assigned overhead. Thus, in the short run, capitated patients provide a positive economic benefit. Other payors’ higher-acuity patients arrive more randomly, place greater strains on capacity, and generate higher overhead costs. This results in differential reimbursement to cover this incremental overhead. Having a portfolio of contracts allows the hospital to optimize capacity both in terms of patient flows and acuity. One risk of operating near capacity is that capitated patients could displace other higher-paying patients. PMID:10816628

The Mexican Social Security counterreform: pensions for profit.

PubMed

Laurell, A C

1999-01-01

The social security counterreform, initiated in 1997, forms part of the neoliberal reorganization of Mexican society. The reform implies a profound change in the guiding principles of social security, as the public model based on integrality, solidarity, and redistribution is replaced by a model based on private administration of funds and services, individualization of entitlement, and reduction of rights. Its economic purpose is to move social services and benefits into the direct sphere of private capital accumulation. Although these changes will involve the whole social security system--old-age and disability pensions, health care, child care, and workers' compensation--they are most immediately evident in the pension scheme. The pay-as-you-go scheme is being replaced by privately managed individual retirement accounts which especially favor the big financial groups. These groups are gaining control over huge amounts of capital, are authorized to charge a high commission, and run no financial risks. The privatization of the system requires decisive state intervention with a legal change and a sizable state subsidy (1 to 1.5 percent of GNP) over five decades. The supposed positive impact on economic growth and employment is uncertain. A review of the new law and of the estimates of future annuities reveals shrinking pension coverage and inadequate incomes from pensions.

The impact of the hospital work environment on social support from physicians in breast cancer care.

PubMed

Ansmann, Lena; Wirtz, Markus; Kowalski, Christoph; Pfaff, Holger; Visser, Adriaan; Ernstmann, Nicole

2014-09-01

Research on determinants of a good patient-physician interaction mainly disregards systemic factors, such as the work environment in healthcare. This study aims to identify stressors and resources within the work environment of hospital physicians that enable or hinder the physicians' provision of social support to patients. Four data sources on 35 German breast cancer center hospitals were matched: structured hospital quality reports and surveys of 348 physicians, 108 persons in hospital leadership, and 1844 patients. Associations between hospital structures, physicians' social resources as well as job demands and control and patients' perceived support from physicians have been studied in multilevel models. Patients feel better supported by their physicians in hospitals with high social capital, a high percentage of permanently employed physicians, and less physically strained physicians. The results highlight the importance of the work environment for a good patient-physician interaction. They can be used to develop interventions for redesigning the hospital work environment, which in turn may improve physician satisfaction, well-being, and performance and consequently the quality of care. Health policy and hospital management could create conditions conducive to better patient-physician interaction by strengthening the social capital and by increasing job security for physicians. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

The Carle Clinic.

PubMed

Schraeder, C; Britt, T

1997-03-01

Confronting the challenge of effective, efficient health care for the elderly has led to many variations in service delivery modalities. The approach employed by the Community Nursing Organization (CNO) is based on nurse coordinated care. Nurses are integrally involved in the authorization, coordination, evaluation and payment of services. The nursing role encompasses case management, including coordination of non-CNO covered services as well as those provided through the capitated payment schedule. Thus, in addition to authorizing CNO services, the nurse also may coordinate services such as physician visits, home repair, transportation, respite services and home-delivered meals, even though they are not covered financially under the auspices of the CNO. Preliminary findings indicate that this model may be successful clinically and financially by determining and utilizing an appropriate mix, intensity and duration of services.

48 CFR 301.607-72 - Applicability.

Code of Federal Regulations, 2010 CFR

2010-10-01

... construction capital investment acquisitions. Consistent with OFPP guidance, HHS requires FAC-P/PM Level III certification for Program and Project Managers responsible for major IT and construction capital investments—i.e... capital investment. Also, HHS requires that an individual obtain FAC-P/PM Level II or I certification for...

Implementing a Capital Plan.

ERIC Educational Resources Information Center

Daigneau, William A.

2003-01-01

Addresses four questions regarding implementation of a long-term capital plan to manage a college's facilities portfolio: When should the projects be implemented? How should the capital improvements be implemented? What will it actually cost in terms of project costs as well as operating costs? Who will implement the plan? (EV)

13 CFR 120.472 - Higher individual minimum capital requirement.

Code of Federal Regulations, 2012 CFR

2012-01-01

... requirement. 120.472 Section 120.472 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION BUSINESS LOANS Lenders Small Business Lending Companies (sblc) § 120.472 Higher individual minimum capital... capital level, and the performance of its SBA loan portfolio; (e) The management views of the SBLC's...

13 CFR 120.472 - Higher individual minimum capital requirement.

Code of Federal Regulations, 2013 CFR

2013-01-01

... requirement. 120.472 Section 120.472 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION BUSINESS LOANS Lenders Small Business Lending Companies (sblc) § 120.472 Higher individual minimum capital... capital level, and the performance of its SBA loan portfolio; (e) The management views of the SBLC's...

13 CFR 120.472 - Higher individual minimum capital requirement.

Code of Federal Regulations, 2014 CFR

2014-01-01

... requirement. 120.472 Section 120.472 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION BUSINESS LOANS Lenders Small Business Lending Companies (sblc) § 120.472 Higher individual minimum capital... capital level, and the performance of its SBA loan portfolio; (e) The management views of the SBLC's...

Competition in health care: strategies from other industries.

PubMed

Himmelsbach, W A

1984-11-01

Health care managers can learn to adjust to competition by observing companies in other deregulated industries. Six basic strategies will separate the winners from the losers: Increase market share. This strategy requires not only increasing the share of current markets but also introducing new products and services into new markets. Scrutinize operations. Managers must be knowledgeable about strategic planning, adept at product line analysis, and skillful in using management information systems. Prune where necessary. Operations must be periodically reviewed to assess whether programs, products, and services continue to be profitable. Increase productivity. Productivity in this labor-intensive industry is essential. Wages may have to be reduced and staffing levels changed in the future to permit better control of labor costs. Increasing the volume of service, investing in nonclinical technology, and encouraging employee ideas also should be considered in seeking higher productivity. Strengthen the balance sheet. Hospitals should avoid incurring both long- and short-term debt, and they should attempt to accelerate repayment of long-term debt. Not-for-profit hospitals should investigate joint ventures, which spread the financial risk among investors, as means to raise capital to expand their operations. Increase cash. Prudent organizations will establish reserve funds, adopt fund-raising programs, and initiate improved cash collection systems. Health care executives also should reflect on how deregulation may affect their employees, the poor, and access to sophisticated medical procedures. The successful health care organization eventually will position itself in line not only with its markets but also with its mission and values.

The Productive Ward Program™: A Two-Year Implementation Impact Review Using a Longitudinal Multilevel Study.

PubMed

Van Bogaert, Peter; Van Heusden, Danny; Verspuy, Martijn; Wouters, Kristien; Slootmans, Stijn; Van der Straeten, Johnny; Van Aken, Paul; White, Mark

2017-03-01

Aim To investigate the impact of the quality improvement program "Productive Ward - Releasing Time to Care™" using nurses' and midwives' reports of practice environment, burnout, quality of care, job outcomes, as well as workload, decision latitude, social capital, and engagement. Background Despite the requirement for health systems to improve quality and the proliferation of quality improvement programs designed for healthcare, the empirical evidence supporting large-scale quality improvement programs impacting patient satisfaction, staff engagement, and quality care remains sparse. Method A longitudinal study was performed in a large 600-bed acute care university hospital at two measurement intervals for nurse practice environment, burnout, and quality of care and job outcomes and three measurement intervals for workload, decision latitude, social capital, and engagement between June 2011 and November 2014. Results Positive results were identified in practice environment, decision latitude, and social capital. Less favorable results were identified in relation to perceived workload, emotional exhaustion. and vigor. Moreover, measures of quality of care and job satisfaction were reported less favorably. Conclusion This study highlights the need to further understand how to implement large-scale quality improvement programs so that they integrate with daily practices and promote "quality improvement" as "business as usual."

Primary care reform and service use by people with serious mental illness in Ontario.

PubMed

Steele, Leah S; Durbin, Anna; Lin, Elizabeth; Charles Victor, J; Klein-Geltink, Julie; Glazier, Richard H; Zagorski, Brandon; Kopp, Alexander

2014-01-01

To examine service use by adults with serious mental illness (SMI) rostered in new primary care models: enhanced fee-for-service (FFS), blended-capitation (CAP) and team-based capitation (TBC) models with and without mental health workers (MHW) in Ontario. This cross-sectional study used administrative health service databases to compare use of mental health and general health services among persons with SMI enrolled in new models (n = 125,233). Relative to persons rostered in enhanced FFS, those in CAP and TBC had fewer mental health primary care visits (adjusted rate ratios and 95% confidence limits: CAP: 0.77 [0.74, 0.81]; TBC with MHW: 0.72 [0.68, 0.76]; TBC with no MHW: 0.81 [0.72, 0.93]). Compared to patients in enhanced FFS, those in TBC models also had more mental health hospital admissions (TBC with MHW: 1.12 [1.05, 1.20]; TBC with no MHW: 1.22 [1.05, 1.41]). Patterns of use of general services were similar. Further attention to financial incentives in capitation that influence care of persons with SMI is necessary to determine if they are aligned with aims of primary care reform. Copyright © 2014 Longwoods Publishing.

An evaluation of gender equity in different models of primary care practices in Ontario

PubMed Central

2010-01-01

Background The World Health Organization calls for more work evaluating the effect of health care reforms on gender equity in developed countries. We performed this evaluation in Ontario, Canada where primary care models resulting from reforms co-exist. Methods This cross sectional study of primary care practices uses data collected in 2005-2006. Healthcare service models included in the study consist of fee for service (FFS) based, salaried, and capitation based. We compared the quality of care delivered to women and men in practices of each model. We performed multi-level, multivariate regressions adjusting for patient socio-demographic and economic factors to evaluate vertical equity, and adjusting for these and health factors in evaluating horizontal equity. We measured seven dimensions of health service delivery (e.g. accessibility and continuity) and three dimensions of quality of care using patient surveys (n = 5,361) and chart abstractions (n = 4,108). Results Health service delivery measures were comparable in women and men, with differences ≤ 2.2% in all seven dimensions and in all models. Significant gender differences in the health promotion subjects addressed were observed. Female specific preventive manoeuvres were more likely to be performed than other preventive care. Men attending FFS practices were more likely to receive influenza immunization than women (Adjusted odds ratio: 1.75, 95% confidence intervals (CI) 1.05, 2.92). There was no difference in the other three prevention indicators. FFS practices were also more likely to provide recommended care for chronic diseases to men than women (Adjusted difference of -11.2%, CI -21.7, -0.8). A similar trend was observed in Community Health Centers (CHC). Conclusions The observed differences in the type of health promotion subjects discussed are likely an appropriate response to the differential healthcare needs between genders. Chronic disease care is non equitable in FFS but not in capitation based models. We recommend that efforts to monitor and address gender based differences in the delivery of chronic disease management in primary care be pursued. PMID:20331861

A Systems Engineering Approach to Address Human Capital Management Issues in the Shipbuilding Industry

DTIC Science & Technology

2008-09-01

gathering and prioritization of their inputs, system development and implementation would become chaotic at best, and the developmental cost 74...for shipbuilding. This study investigated current DoD Human Capital Management (HCM) strategies for attracting, developing , retaining and managing...employed by these stakeholders. The result of the analysis was the development , via a functional analysis, of a notional HCM architecture for the

Ten-year experience in managing a capitated ophthalmology carve-out by an academic eye center.

PubMed

Olson, R J

1997-01-01

A 10-year experience of managing a capitated opthalmology carve-out by an academic health unit is presented. Lessons learned regarding pricing, utilization, and managing this contract are discussed. Handling the cost of education and remaining competitive is presented as a not-insurmountable hurdle. Academic health units can compete in today's environment; however, the learning curve is steep and the problems many.

PREMChlor: Probabilistic Remediation Evaluation Model for Chlorinated Solvents

DTIC Science & Technology

2010-03-01

Council O&M Operation & Management PAT pump-and-treat PCE tetrachloroethylene PDFs Probability density functions PRBs Permeable reactive barriers...includes a one-time capital cost and a total operation & management (O&M) cost in present net value (NPV) for a certain remediation period. The...Generally, the costs of plume treatment include the capital cost (treatment volume multiply by the unit cost) and the annual operation & Management (O&M

Mitigating risks related to facilities management.

PubMed

O'Neill, Daniel P; Scarborough, Sydney

2013-07-01

By looking at metrics focusing on the functionality, age, capital investment, transparency, and sustainability (FACTS) of their organizations' facilities, facilities management teams can build potential business cases to justify upgrading the facilities. A FACTS analysis can ensure that capital spent on facilities will produce a higher or more certain ROI than alternatives. A consistent process for managing spending helps to avoid unexpected spikes that cost the enterprise more in the long run.

Striving for the impossible dream: a community-based multi-practice collaborative model of diabetes management.

PubMed

Distiller, L A; Brown, M A; Joffe, B I; Kramer, B D

2010-02-01

In 1994 the Centre for Diabetes and Endocrinology (CDE) based in Johannesburg, South Africa established a novel community-based capitation and risk-sharing model for diabetes management. We here describe the model and present a recent survey of the performance/outcomes of this unique diabetes care programme. Data on 17 043 patients managed by the CDE Diabetes Management Programme at its Centre and its 262 affiliated Centres were analysed from its national database. From this total cohort, 1520 Type 1 and 8026 Type 2 diabetes patients have been in the Programme for > 5 years. The 5-year outcome data on hospital admission rates, glycaemic control (HbA(1c)), and microvascular complication rates were assessed in this subgroup of patients. Major reductions in hospital admission rates for both acute metabolic emergencies and all causes (40% overall) were achieved in patients enrolled onto the Diabetes Management Programme. The mean HBA(1c) on enrolment was 9.2% for subjects with Type 1 and 8.8% for those with Type 2 diabetes. After 1 year, mean HbA(1c) fell to 7.6% and 7.3% for the Type 1 and Type 2 subjects, respectively. At 5 years the HbA(1c) remained similar at 7.7% for the Type 1 subjects and 7.4% for the Type 2 subjects, demonstrating sustained improvement. Progression of microvascular complications appears to have been delayed. This managed care model of diabetes care in the context of the South African Private Health Care System achieved long-term improvement in glycaemic control and all-cause hospital admission rates. This may be due to the cost-containment being in the hands of the treating doctor, supported by an annual training programme. This programme is based on an individualized and holistic approach encompassing intensive patient education to facilitate self-empowerment and including prompting for the management of risk factors.

Capital management helps hospitals face hard times.

PubMed

Harris, J; Pitts, K

1989-03-01

Financial officers of healthcare organizations in severe financial distress must map out an effective capital management strategy to help their institutions avoid disaster. An executive's plan of action should include streamlining and restructuring the organization, studying long- and short-term assets to improve cash flow, and investigating ways to refinance debt. Healthcare organizations must develop warning signals for impending financial difficulties and contingency plans that address operating and capital responses to such a crisis. Learning to guide an organization through financial difficulties may be an executive's most important financial skill in the decade to come.

Health care administrators' perspectives on the role of absorptive capacity for strategic change initiatives: a qualitative study.

PubMed

Kash, Bita A; Spaulding, Aaron; Gamm, Larry; Johnson, Christopher E

2013-01-01

The dimensions of absorptive capacity (ACAP) are defined, and the importance of ACAP is established in the management literature, but the concept has not been applied to health care organizations attempting to implement multiple strategic initiatives. The aim of this study was to test the utility of ACAP by analyzing health care administrators' experiences with multiple strategic initiatives within two health systems. Results are drawn from administrators' assessments of multiple initiatives within two health systems using in-depth personal interviews with a total of 61 health care administrators. Data analysis was performed following deductive qualitative analysis guidelines. Interview transcripts were coded based on the four dimensions of ACAP: acquiring, assimilating, internalizing/transforming, and exploiting knowledge. Furthermore, we link results related to utilization of management resources, including number of key personnel involved and time consumption, to dimensions of ACAP. Participants' description of multiple strategic change initiatives confirmed the importance of the four ACAP dimensions. ACAP can be a useful framework to assess organizational capacity with respect to the organization's ability to concurrently implement multiple strategic initiatives. This capacity specifically revolves around human capital requirements from upper management based on the initiatives' location or stage within the ACAP framework. Strategic change initiatives in health care can be usefully viewed from an ACAP perspective. There is a tendency for those strategic initiatives ranking higher in priority and time consumption to reflect more advanced dimensions of ACAP (assimilate and transform), whereas few initiatives were identified in the ACAP "exploit" dimension. This may suggest that health care leaders tend to no longer identify as strategic initiatives those innovations that have moved to the exploitation stage or that less attention is given to the exploitation elements of a strategic initiative than to the earlier stages.

75 FR 68615 - Notice of Submission of Proposed Information Collection to OMB; Public Housing Capital Fund...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-08

... below has been submitted to the Office of Management and Budget (OMB) for review, as required by the..., development, financing, and management improvements. The funds are allocated based on a complex formula. The... any Mixed-Finance and Capital Fund Financing transactions. Respondents include the approximately 3,200...

Advanced Technologies and Data Management Practices in Environmental Science: Lessons from Academia

ERIC Educational Resources Information Center

Hernandez, Rebecca R.; Mayernik, Matthew S.; Murphy-Mariscal, Michelle L.; Allen, Michael F.

2012-01-01

Environmental scientists are increasing their capitalization on advancements in technology, computation, and data management. However, the extent of that capitalization is unknown. We analyzed the survey responses of 434 graduate students to evaluate the understanding and use of such advances in the environmental sciences. Two-thirds of the…

ePortfolios in the Workplace for Human Capital Management: A Multiple Case Study

ERIC Educational Resources Information Center

Lievens, Ronald

2015-01-01

This study researches whether the ePortfolio is a suitable instrument for human capital management in the business environment. The implementation of ePortfolio systems in five different organizations is analyzed. It considers whether ePortfolio implementations were successful, and relevant critical success factors were identified. For the latter…

Retaining Educational Fundraisers: Reducing Turnover by Investing in Human Capital Management

ERIC Educational Resources Information Center

Thomas, Christy

2010-01-01

This article outlines an approach to reducing gift officer turnover during comprehensive campaigns by investing in the human capital management (HCM) program. While many universities have begun to create HCM programs, I suggest creating a position specifically focused on the retention of gift offices to ensure that universities and non-profits can…

Network-Based Leadership Development: A Guiding Framework and Resources for Management Educators

ERIC Educational Resources Information Center

Cullen-Lester, Kristin L.; Woehler, Meredith L.; Willburn, Phil

2016-01-01

Management education and leadership development has traditionally focused on improving human capital (i.e., knowledge, skills, and abilities). Social capital, networks, and networking skills have received less attention. When this content has been incorporated into learning and development experiences, it has often been more ad hoc and has…

12 CFR 208.3 - Application and conditions for membership in the Federal Reserve System.

Code of Federal Regulations, 2010 CFR

2010-01-01

...: (1) Financial condition and management. The financial history and condition of the applying bank and the general character of its management. (2) Capital. The adequacy of the bank's capital in accordance....3(c)(1); (iii) The application contains a material error or is otherwise deficient; or (iv) The...

78 FR 42796 - 30-Day Notice of Proposed Information Collection: Submission Requirements for the Capital Advance...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-17

... Information Collection: Submission Requirements for the Capital Advance Program Section 202/811 AGENCY: Office... information collection requirement described below to the Office of Management and Budget (OMB) for review, in... OMB Control Number and should be sent to: HUD Desk Officer, Office of Management and Budget, New...