Sample records for care benefit program

  1. 76 FR 57637 - TRICARE; Continued Health Care Benefit Program Expansion

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-16

    ... TRICARE; Continued Health Care Benefit Program Expansion AGENCY: Office of the Secretary, Department of... Continued Health Care Benefit Program (CHCBP) coverage under certain circumstances that terminate their MHS.... Introduction and Background CHCBP is the program that provides continued health care coverage for eligible...

  2. 76 FR 49458 - TRICARE, Formerly Known as the Civilian Health and Medical Program of the Uniformed Services...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-10

    ... Medical Program of the Uniformed Services (CHAMPUS); Fiscal Year 2012 Continued Health Care Benefit... Health Care Benefit Program premiums for Fiscal Year 2012. CHCBP is a premium-based health care program...) set forth rules to implement the Continued Health Care Benefit Program (CHCBP) required by 10 United...

  3. An Evaluation of the AirCare Program Based on Cost-Benefit and Cost-Effectiveness Analyses

    ERIC Educational Resources Information Center

    Bi, Hsiaotao T.; Wang, Dianle

    2006-01-01

    A cost-benefit analysis of the AirCare program in the province of British Columbia on the basis of emissions cost factors from the literature showed a benefit outweighing the cost. Furthermore, a cost-effectiveness analysis comparing the AirCare program with a hybrid-car rebate program revealed that the AirCare program is more effective in…

  4. 78 FR 58291 - TRICARE; Fiscal Year 2014 Continued Health Care Benefit Program Premium Update

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-23

    ... DEPARTMENT OF DEFENSE Office of the Secretary TRICARE; Fiscal Year 2014 Continued Health Care... Health Care Benefit Program Premiums for Fiscal Year 2014. SUMMARY: This notice provides the updated Continued Health Care Benefit Program Premiums for Fiscal Year 2014. DATES: The Fiscal Year 2014 rates...

  5. Restructuring Military Medical Care

    DTIC Science & Technology

    1995-07-01

    providers, perhaps under an approach such as the Federal Employees Health Benefits (FEHB) program , discussed later in this chapter. Effects on DoD’s...CARE July 1995 Military Family Association, would give beneficiaries access to care through the Federal Employees Health Benefits program as well as...enrollment levels and BOX 6. THE FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM The Federal Employees Health Benefits (FEHB) program is the source of health

  6. Employer Supported Child Care: An Idea Whose Time Has Come. A Conference on Child Care as an Employee Benefit (Costs and Benefits, Successful Programs, Company Options, Current Issues). Conference Proceedings.

    ERIC Educational Resources Information Center

    Haiman, Peter, Ed.; Sud, Gian, Ed.

    Many aspects of employer-sponsored child care programs--including key issues, costs and benefits, programmatic options, and implementation strategies--are discussed in these conference proceedings. Public policy issues, legal aspects of child care as an employee benefit, tax incentives for corporate child care, and funding sources for child care…

  7. Applying the chronic care model to an employee benefits program: a qualitative inquiry.

    PubMed

    Schauer, Gillian L; Wilson, Mark; Barrett, Barbara; Honeycutt, Sally; Hermstad, April K; Kegler, Michelle C

    2013-12-01

    To assess how employee benefits programs may strengthen and/or complement elements of the chronic care model (CCM), a framework used by health systems to improve chronic illness care. A qualitative inquiry consisting of semi-structured interviews with employee benefit administrators and partners from a self-insured, self-administered employee health benefits program was conducted at a large family-owned business in southwest Georgia. Results indicate that the employer adapted and used many health system-related elements of the CCM in the design of their benefit program. Data also suggest that the employee benefits program contributed to self-management skills and to informing and activating patients to interact with the health system. Findings suggest that employee benefits programs can use aspects of the CCM in their own benefit design, and can structure their benefits to contribute to patient-related elements from the CCM.

  8. 77 FR 56631 - TRICARE, Formerly Known as the Civilian Health and Medical Program of the Uniformed Services...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-09-13

    ... Medical Program of the Uniformed Services; Fiscal Year 2013 Continued Health Care Benefit Program Premium Update AGENCY: Office of the Secretary, DoD. ACTION: Notice of updated continued health care benefit program premiums for fiscal year 2013. SUMMARY: This notice provides the updated Continued Health Care...

  9. Identifying Indirect Benefits of Federal Health Care Emergency Preparedness Grant Funding to Coalitions: A Content Analysis.

    PubMed

    Priest, Chad; Stryckman, Benoit

    2015-12-01

    This study aimed to identify the indirect benefits of health care preparedness funding as perceived by current and former recipients of the US Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response's Hospital Preparedness Program. This was a qualitative inductive content analysis of telephone interviews conducted with regional stakeholders from several health care coalitions to identify their perceptions of the indirect benefits of preparedness funding. Content analysis of interviewee responses resulted in 2 main categories of indirect benefits of federal health care preparedness funding: (1) dual-use technology and programs and (2) impact of relationships on day-to-day operations. Within the dual-use technology and programs category, 3 subcategories were identified: (1) information systems, (2) clinical technology, and (3) health care operations. Similarly, 3 subcategories relating to the indirect benefits in the impact of relationships on day-to-day operations category were identified: (1) cooperation, (2) information sharing, and (3) sense of community. This study identified indirect benefits of federal investment in hospital and health care preparedness in day-to-day operations. Major categories of these benefits included dual-use technology and programs and impact of relationships on day-to-day operations. Coalition members placed a high value on these benefits, even though they were not direct outcomes of grant programs. Further research is needed to quantify the economic value of these indirect benefits to more accurately measure the total return on investment from federal grant funding.

  10. 5 CFR 792.200 - What are the benefits of the child care subsidy program law?

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES' HEALTH AND COUNSELING PROGRAMS Agency... at Federal child care centers, non-Federal child care centers, and in family child care homes for... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false What are the benefits of the child care...

  11. Estimating the net benefit of a specialized return-to-work program for workers on short-term disability related to a mental disorder: an example exploring investment in collaborative care.

    PubMed

    Dewa, Carolyn S; Hoch, Jeffrey S

    2014-06-01

    This article estimates the net benefit for a company incorporating a collaborative care model into its return-to-work program for workers on short-term disability related to a mental disorder. Employing a simple decision model, the net benefit and uncertainty were explored. The breakeven point occurs when the average short-term disability episode is reduced by at least 7 days. In addition, 85% of the time, benefits could outweigh costs. Model results and sensitivity analyses indicate that organizational benefits can be greater than the costs of incorporating a collaborative care model into a return-to-work program for workers on short-term disability related to a mental disorder. The results also demonstrate how the probability of a program's effectiveness and the magnitude of its effectiveness are key factors that determine whether the benefits of a program outweigh its costs.

  12. 42 CFR 460.90 - PACE benefits under Medicare and Medicaid.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PACE Services § 460.90 PACE benefits under Medicare and Medicaid. If a Medicare...

  13. Philanthropy and Beyond: Creating Shared Value to Promote Well-Being for Individuals in Their Communities.

    PubMed

    Kottke, Thomas E; Pronk, Nico; Zinkel, Andrew R; Isham, George J

    2017-01-01

    Health care organizations can magnify the impact of their community service and other philanthropic activities by implementing programs that create shared value. By definition, shared value is created when an initiative generates benefit for the sponsoring organization while also generating societal and community benefit. Because the programs generate benefit for the sponsoring organizations, the magnitude of any particular initiative is limited only by the market for the benefit and not the resources that are available for philanthropy.In this article we use three initiatives in sectors other than health care to illustrate the concept of shared value. We also present examples of five types of shared value programs that are sponsored by health care organizations: telehealth, worksite health promotion, school-based health centers, green and healthy housing, and clean and green health services. On the basis of the innovativeness of health care organizations that have already implemented programs that create shared value, we conclude that the opportunities for all health care organizations to create positive impact for individuals and communities through similar programs is large, and the limits have yet to be defined.

  14. European Long-Term Care Programs: Lessons for Community Living Assistance Services and Supports?

    PubMed Central

    Nadash, Pamela; Doty, Pamela; Mahoney, Kevin J; von Schwanenflugel, Matthias

    2012-01-01

    Objective To uncover lessons from abroad for Community Living Assistance Services and Supports (CLASS), a federally run voluntary public long-term care (LTC) insurance program created under the Accountable Care Act of 2010. Data Sources Program administrators and policy researchers from Austria, England, France, Germany, and the Netherlands. Study Design Qualitative methods focused on key parameters of cash for care: how programs set benefit levels; project expenditures; control administrative costs; regulate the use of benefits; and protect workers. Data Collection/Extraction Methods Structured discussions were conducted during an international conference of LTC experts, followed by personal meetings and individual correspondence. Principal Findings Germany's self-financing mandate and tight targeting of benefits have resulted in a solvent program with low premiums. Black markets for care are likely in the absence of regulation; France addresses this via a unique system ensuing legal payment of workers. Conclusions Programs in the five countries studied have lessons, both positive and negative, relevant to CLASS design. PMID:22091672

  15. A unique approach to mental health services in an HMO: indemnity benefit and service program.

    PubMed

    Craig, T J; Patterson, D Y

    1981-02-01

    Three years' experience with a unique combination of an indemnity benefit plus an in-house service program in a prepaid group practice plan's psychiatric department demonstrates enhanced accessibility and increased utilization among formerly unserved segments of the membership plus the flexibility of freedom of choice in choosing service provider and the ability to tailor treatment to patient needs. Overall costs were similar to those reported for other prepaid plans despite the addition of benefits for long-term therapy outside the plan. Flexible use of inpatient and day hospital services enabled the program to migrate, to a large extent, major increases in hospital charges while providing greater continuity of care. This combination of benefits offers the advantages of both an indemnity benefit (Freedom of choice in treatment) and an in-house service program (greater continuity of care, more flexible use of resources, reduction of reliance on hospital care).

  16. In the Public Interest: The Benefits of High Quality Child Care. [Videotape].

    ERIC Educational Resources Information Center

    Toronto Univ. (Ontario). Centre for Urban and Community Studies.

    Noting that, in Canada, 10,000 child care programs serve children and families of diverse cultural and socioeconomic backgrounds, this video examines the characteristics and benefits of high quality programs. The 22-minute video first cites two reasons why quality child care is a current issue: the increasing number of women in the workforce and…

  17. Medicaid Benefits

    MedlinePlus

    ... Monitoring Review Plans Program Integrity National Correct Coding Initiative Affordable Care Act Program Integrity Provisions Cost Sharing ... to Care Living Well Quality of Care Improvement Initiatives Medicaid Managed Care Performance Measurement Releases & Announcements Enrollment ...

  18. Are You Making an Impact? Evaluating the Population Health Impact of Community Benefit Programs.

    PubMed

    Rains, Catherine M; Todd, Greta; Kozma, Nicole; Goodman, Melody S

    The Patient Protection and Affordable Care Act includes a change to the IRS 990 Schedule H, requiring nonprofit hospitals to submit a community health needs assessment every 3 years. Such health care entities are challenged to evaluate the effectiveness of community benefit programs addressing the health needs identified. In an effort to determine the population health impact of community benefit programs in 1 hospital outreach department, researchers and staff conducted an impact evaluation to develop priority areas and overarching goals along with program- and department-level objectives. The longitudinal impact evaluation study design consists of retrospective and prospective secondary data analyses. As an urban pediatric hospital, St Louis Children's Hospital provides an array of community benefit programs to the surrounding community. Hospital staff and researchers came together to form an evaluation team. Data from program evaluation and administrative data for analysis were provided by hospital staff. Impact scores were calculated by scoring objectives as met or unmet and averaged across goals to create impact scores that measure how closely programs meet the overarching departmental mission and goals. Over the 4-year period, there is an increasing trend in program-specific impact scores across all programs except one, Healthy Kids Express Asthma, which had a slight decrease in year 4 only. Current work in measuring and assessing the population health impact of community benefit programs is mostly focused on quantifying dollars invested into community benefit work rather than measuring the quality and impact of services. This article provides a methodology for measuring population health impact of community benefit programs that can be used to evaluate the effort of hospitals in providing community benefit. This is particularly relevant in our changing health care climate, as hospitals are being asked to justify community benefit and make meaningful contributions to population health. The Patient Protection and Affordable Care Act includes a change to the IRS 990 Schedule H, requiring nonprofit hospitals to submit a community health needs assessment every 3 years, and requires evaluation of program effectiveness; yet, it does not require any quantification of the impact of community benefit programs. The IRS Schedule H 990 policies could be strengthened by requiring an impact evaluation such as outlined in this article. As hospitals are being asked to justify community benefit and make meaningful contributions to population health, impact evaluations can be utilized to demonstrate the cumulative community benefit of programs and assess population health impact of community benefit programs.

  19. Comparative Benefit-Cost Analysis of the Abecedarian Program and Its Policy Implications

    ERIC Educational Resources Information Center

    Barnett, W. S.; Masse, Leonard N.

    2007-01-01

    Child care and education are to some extent joint products of preschool programs, but public policy and research frequently approach these two goals independently. We present a benefit-cost analysis of a preschool program that provided intensive education during full-day child care. Data were obtained from a randomized trial with longitudinal…

  20. Philanthropy and Beyond: Creating Shared Value to Promote Well-Being for Individuals in Their Communities

    PubMed Central

    Kottke, Thomas E; Pronk, Nico; Zinkel, Andrew R; Isham, George J

    2017-01-01

    Health care organizations can magnify the impact of their community service and other philanthropic activities by implementing programs that create shared value. By definition, shared value is created when an initiative generates benefit for the sponsoring organization while also generating societal and community benefit. Because the programs generate benefit for the sponsoring organizations, the magnitude of any particular initiative is limited only by the market for the benefit and not the resources that are available for philanthropy. In this article we use three initiatives in sectors other than health care to illustrate the concept of shared value. We also present examples of five types of shared value programs that are sponsored by health care organizations: telehealth, worksite health promotion, school-based health centers, green and healthy housing, and clean and green health services. On the basis of the innovativeness of health care organizations that have already implemented programs that create shared value, we conclude that the opportunities for all health care organizations to create positive impact for individuals and communities through similar programs is large, and the limits have yet to be defined. PMID:28488982

  1. Emergency medical service providers' role in the early heart attack care program: prevention and stratification strategies.

    PubMed

    MacDonald, G S; Steiner, S R

    1997-01-01

    Emergency Medical Services-Early Heart Attack Care (EMS-EHAC) is a community-based program where paramedics increase the consumer's awareness about early chest pain symptom recognition. EMS-EHAC prevention, along with seamless chest pain care (between the paramedic and chest pain emergency department) can be the basis for an outcome-based study to examine the impact of advanced life support EMS. Studies that show the impact of care given by paramedics on the outcome of patient care must be designed to demonstrate the value and the cost benefit of providing advanced life support (ALS). Third party payers are going to examine if there are significant quality differences between ALS and basic life support (BLS) services. If significant benefits of ALS care cannot be demonstrated, the cost differences could potentially place the future of advanced life support paramedic programs in jeopardy. A positive outcome resulting in a lower acute cardiac event, and the realization of the cost benefits from the EMS-EHAC program could be utilized by EMS management to justify or expand advanced life support programs.

  2. Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA); interpretation of "federal public benefit"--HHS. Notice with comment period.

    PubMed

    1998-08-04

    This notice with comment period interprets the term "Federal public benefit" as used in Title IV of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), Pub. L. 104-193, and identifies the HHS programs that provide such benefits under this interpretation. According to section 401 if PRWORA, aliens who are not "qualified aliens" are not eligible for any "Federal public benefit," unless the "Federal public benefit" falls within a specified exception. A "Federal public benefit" includes "any grant, contract, loan, professional license, or commercial license" provided to an individual, and also "any retirement, welfare, health, disability, public or assisted housing, postsecondary education, food assistance, unemployment benefit, or any other similar benefit for which payments or assistance are provided to an individual, household, or family eligibility unit." Under section 432, providers of a non-exempt "Federal public benefit" must verify that a person applying for the benefit is a qualified alien and is eligible to receive the benefit. The HHS programs that provide "Federal public benefits" and are not otherwise excluded from the definition by the exceptions provided in section 401(b) are: Adoption Assistance Administration on Developmental Disabilities (ADD)-State Developmental Disabilities Councils (direct services only) ADD-Special Projects (direct services only) ADD-University Affiliated Programs (clinical disability assessment services only) Adult Programs/Payments to Territories Agency for Health Care Policy and Research Dissertation Grants Child Care and Development Fund Clinical Training Grant for Faculty Development in Alcohol & Drug Abuse Foster Care Health Profession Education and Training Assistance Independent Living Program Job Opportunities for Low Income Individuals (JOLI) Low Income Home Energy Assistance Program (LIHEAP) Medicare Medicaid (except assistance for an emergency medical condition) Mental Health Clinical Training Grants Native Hawaiian Loan Program Refugee Cash Assistance Refugee Medical Assistance Refugee Preventive Health Services Program Refugee Social Services Formula Program Refugee Social Services Discretionary Program Refugee Targeted Assistance Formula Program Refugee Targeted Assistance Discretionary Program Refugee Unaccompanied Minors Program Refugee Voluntary Agency Matching Grant Program Repatriation Program Residential Energy Assistance Challenge Option (REACH) Social Services Block Grant (SSBG) State Child Health Insurance Program (CHIP) Temporary Assistance for Needy Families (TANF) While all of these programs provide "Federal public benefits" this does not mean that all benefits or services provided under these programs are "Federal public benefits." As discussed in sections II and III below, some benefits or services under these programs may not be provided to an "individual, household, or family eligibility unit" and, therefore, do not constitute "Federal public benefits" as defined by PRWORA.

  3. Compassionate Care Leave & Benefits. CAUT Briefing Note

    ERIC Educational Resources Information Center

    Canadian Association of University Teachers, 2016

    2016-01-01

    Compassionate care leave and benefits were introduced in 2003/04 to help employees cope with this difficult work-life balance challenge. Employment Standards legislation and the Employment Insurance program (EI) were amended to provide leave without pay, with payment of EI benefits for compassionate care leave. Collective agreements have been…

  4. Health Plans Respond to Parity: Managing Behavioral Health Care in the Federal Employees Health Benefits Program

    PubMed Central

    Ridgely, M Susan; Burnam, M Audrey; Barry, Colleen L; Goldman, Howard H; Hennessy, Kevin D

    2006-01-01

    The government often uses the Federal Employees Health Benefits (FEHB) Program as a model for both public and private health policy choices. In 2001, the U.S. Office of Personnel Management (OPM) implemented full parity, requiring that FEHB carriers offer mental health and substance abuse benefits equal to general medical benefits. OPM instructed carriers to alter their benefit design but permitted them to determine whether they would manage care and what structures or processes they would use. This article reports on the experience of 156 carriers and the government-wide BlueCross and BlueShield Service Benefit Plan. Carriers dropped cost-restraining benefit limits. A smaller percentage also changed the management of the benefit, but these changes affected the care of many enrollees, making the overall parity effect noteworthy. PMID:16529573

  5. Health plans respond to parity: managing behavioral health care in the Federal Employees Health Benefits Program.

    PubMed

    Ridgely, M Susan; Burnam, M Audrey; Barry, Colleen L; Goldman, Howard H; Hennessy, Kevin D

    2006-01-01

    The government often uses the Federal Employees Health Benefits (FEHB) Program as a model for both public and private health policy choices. In 2001, the U.S. Office of Personnel Management (OPM) implemented full parity, requiring that FEHB carriers offer mental health and substance abuse benefits equal to general medical benefits. OPM instructed carriers to alter their benefit design but permitted them to determine whether they would manage care and what structures or processes they would use. This article reports on the experience of 156 carriers and the government-wide BlueCross and BlueShield Service Benefit Plan. Carriers dropped cost-restraining benefit limits. A smaller percentage also changed the management of the benefit, but these changes affected the care of many enrollees, making the overall parity effect noteworthy.

  6. 42 CFR 1001.2 - Definitions.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... (other than the Federal Employees Health Benefits Program), or any State health care program as defined... Department of Health and Human Services. Patient means any individual who is receiving health care items or... primary care services to Federal or State health care program beneficiaries within a defined service area...

  7. 42 CFR 1001.2 - Definitions.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... (other than the Federal Employees Health Benefits Program), or any State health care program as defined... Department of Health and Human Services. Patient means any individual who is receiving health care items or... primary care services to Federal or State health care program beneficiaries within a defined service area...

  8. 42 CFR 1001.2 - Definitions.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... (other than the Federal Employees Health Benefits Program), or any State health care program as defined... Department of Health and Human Services. Patient means any individual who is receiving health care items or... primary care services to Federal or State health care program beneficiaries within a defined service area...

  9. 42 CFR 1001.2 - Definitions.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... (other than the Federal Employees Health Benefits Program), or any State health care program as defined... Department of Health and Human Services. Patient means any individual who is receiving health care items or... primary care services to Federal or State health care program beneficiaries within a defined service area...

  10. 5 CFR 875.414 - Will benefits be coordinated with other coverage?

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... SERVICE REGULATIONS (CONTINUED) FEDERAL LONG TERM CARE INSURANCE PROGRAM Coverage § 875.414 Will benefits... coordination of benefits (COB) guidelines set by the National Association of Insurance Commissioners. The total benefits from all plans that pay a long term care benefit to you should not exceed the actual costs you...

  11. 20 CFR 402.65 - Health care information.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false Health care information. 402.65 Section 402.65 Employees' Benefits SOCIAL SECURITY ADMINISTRATION AVAILABILITY OF INFORMATION AND RECORDS TO THE PUBLIC § 402.65 Health care information. We have some information about health care programs under titles...

  12. 20 CFR 402.65 - Health care information.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Health care information. 402.65 Section 402.65 Employees' Benefits SOCIAL SECURITY ADMINISTRATION AVAILABILITY OF INFORMATION AND RECORDS TO THE PUBLIC § 402.65 Health care information. We have some information about health care programs under titles...

  13. 20 CFR 402.65 - Health care information.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false Health care information. 402.65 Section 402.65 Employees' Benefits SOCIAL SECURITY ADMINISTRATION AVAILABILITY OF INFORMATION AND RECORDS TO THE PUBLIC § 402.65 Health care information. We have some information about health care programs under titles...

  14. 20 CFR 402.65 - Health care information.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false Health care information. 402.65 Section 402.65 Employees' Benefits SOCIAL SECURITY ADMINISTRATION AVAILABILITY OF INFORMATION AND RECORDS TO THE PUBLIC § 402.65 Health care information. We have some information about health care programs under titles...

  15. 20 CFR 402.65 - Health care information.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false Health care information. 402.65 Section 402.65 Employees' Benefits SOCIAL SECURITY ADMINISTRATION AVAILABILITY OF INFORMATION AND RECORDS TO THE PUBLIC § 402.65 Health care information. We have some information about health care programs under titles...

  16. Employer-Assisted Dependent Care in Texas: A Report.

    ERIC Educational Resources Information Center

    Meyer, Jill

    By offering benefits that assist workers in attaining a better balance between work and family, employers can improve the quality of work produced for their companies and the quality of life for employees. This report discusses the benefits of dependent care programs, describes the process involved in selecting appropriate programs, and discusses…

  17. Medicaid Home Care Services and Survival in New York City

    ERIC Educational Resources Information Center

    Albert, Steven M.; Simone, Bridget; Brassard, Andrea; Stern, Yaakov; Mayeux, Richard

    2005-01-01

    Purpose: New York City's Medicaid Home Care Services Program provides an integrated program of housekeeping and personal assistance care along with regular nursing assessments. We sought to determine if this program of supportive care offers a survival benefit to older adults. Design and Methods: Administrative data from New York City's Medicaid…

  18. Data warehousing in disease management programs.

    PubMed

    Ramick, D C

    2001-01-01

    Disease management programs offer the benefits of lower disease occurrence, improved patient care, and lower healthcare costs. In such programs, the key mechanism used to identify individuals at risk for targeted diseases is the data warehouse. This article surveys recent warehousing techniques from HMOs to map out critical issues relating to the preparation, design, and implementation of a successful data warehouse. Discussions of scope, data cleansing, and storage management are included in depicting warehouse preparation and design; data implementation options are contrasted. Examples are provided of data warehouse execution in disease management programs that identify members with preexisting illnesses, as well as those exhibiting high-risk conditions. The proper deployment of successful data warehouses in disease management programs benefits both the organization and the member. Organizations benefit from decreased medical costs; members benefit through an improved quality of life through disease-specific care.

  19. 32 CFR 199.20 - Continued Health Care Benefit Program (CHCBP).

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...) § 199.20 Continued Health Care Benefit Program (CHCBP). (a) Purpose. The CHCBP is a premium based... institution of higher learning; or (2) Is incapable of self-support because of a mental or physical incapacity... retired or retainer pay of a member or former member or an annuity based on the retainer pay of the member...

  20. 76 FR 21431 - Medicare Program; Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-15

    ...This final rule makes revisions to the Medicare Advantage (MA) program (Part C) and Prescription Drug Benefit Program (Part D) to implement provisions specified in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the Affordable Care Act) (ACA) and make other changes to the regulations based on our experience in the administration of the Part C and Part D programs. These latter revisions clarify various program participation requirements; make changes to strengthen beneficiary protections; strengthen our ability to identify strong applicants for Part C and Part D program participation and remove consistently poor performers; and make other clarifications and technical changes.

  1. An effectiveness and cost-benefit analysis of a hospital-based discharge transition program for elderly Medicare recipients.

    PubMed

    Saleh, Shadi S; Freire, Chris; Morris-Dickinson, Gwendolyn; Shannon, Trip

    2012-06-01

    To investigate the business case of postdischarge care transition (PDCT) among Medicare beneficiaries by conducting a cost-benefit analysis. Randomized controlled trial. A general hospital in upstate New York State. Elderly Medicare beneficiaries being treated from October 2008 through December 2009 were randomly selected to receive services as part of a comprehensive PDCT program (intervention--173 patients) or regular discharge process (control--160 patients) and followed for 12 months. The intervention comprised five activities: development of a patient-centered health record, a structured discharge preparation checklist of critical activities, delivery of patient self-activation and management sessions, follow-up appointments, and coordination of data flow. Cost-benefit ratio of the PDCT program; self-management skills and abilities. The 1-year readmission analysis revealed that control participants were more likely to be readmitted than intervention participants (58.2% vs 48.2%; P = .08); with most of that difference observed in the 91 to 365 days after discharge. Findings from the cost-benefit analysis revealed a cost-benefit ratio of 1.09, which indicates that, for every $1 spent on the program, a saving of $1.09 was realized. In addition, participating in a care transition program significantly enhanced self-management skills and abilities. Postdischarge care transition programs have a dual benefit of enhancing elderly adults' self-management skills and abilities and producing cost savings. This study builds a case for the inclusion of PDCT programs as a reimbursable service in benefit packages. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.

  2. Comparing mandated health care reforms: the Affordable Care Act, accountable care organizations, and the Medicare ESRD program.

    PubMed

    Watnick, Suzanne; Weiner, Daniel E; Shaffer, Rachel; Inrig, Jula; Moe, Sharon; Mehrotra, Rajnish

    2012-09-01

    In addition to extending health insurance coverage, the Affordable Care Act of 2010 aims to improve quality of care and contain costs. To this end, the act allowed introduction of bundled payments for a range of services, proposed the creation of accountable care organizations (ACOs), and established the Centers for Medicare and Medicaid Innovation to test new care delivery and payment models. The ACO program began April 1, 2012, along with demonstration projects for bundled payments for episodes of care in Medicaid. Yet even before many components of the Affordable Care Act are fully in place, the Medicare ESRD Program has instituted legislatively mandated changes for dialysis services that resemble many of these care delivery reform proposals. The ESRD program now operates under a fully bundled, case-mix adjusted prospective payment system and has implemented Medicare's first-ever mandatory pay-for-performance program: the ESRD Quality Incentive Program. As ACOs are developed, they may benefit from the nephrology community's experience with these relatively novel models of health care payment and delivery reform. Nephrologists are in a position to assure that the ACO development will benefit from the ESRD experience. This article reviews the new ESRD payment system and the Quality Incentive Program, comparing and contrasting them with ACOs. Better understanding of similarities and differences between the ESRD program and the ACO program will allow the nephrology community to have a more influential voice in shaping the future of health care delivery in the United States.

  3. Flexible benefits and managed care: making it work.

    PubMed

    Sperling, K L

    1991-01-01

    The concept of integrating flexible benefits and managed care may seem contradictory. Flexible benefits seek to maximize choice, while managed care attempts to restrict choice. Can these two disciplines be intertwined without delivering conflicting messages to employees? The answer is definitely yes. By following some basic ground rules in design, flexible benefits and managed care can be combined effectively in a way that is attractive to both employers and employees. This article presents some general guidelines for designing a successful "managed flex" program and raises other issues as well, including financial, administrative and communication concerns.

  4. Incomes and Outcomes: Social Security Disability Benefits in First-Episode Psychosis.

    PubMed

    Rosenheck, Robert A; Estroff, Sue E; Sint, Kyaw; Lin, Haiqun; Mueser, Kim T; Robinson, Delbert G; Schooler, Nina R; Marcy, Patricia; Kane, John M

    2017-09-01

    Social Security Administration (SSA) disability benefits are an important source of income for people with psychoses and confer eligibility for health insurance. The authors examined the impact of coordinated specialty care on receipt of such benefits in first-episode psychosis, along with the correlates and consequences of receiving them. The Recovery After an Initial Schizophrenia Episode-Early Treatment Program (RAISE-ETP) study, a 34-site cluster-randomized trial, compared NAVIGATE, a coordinated specialty care program, to usual community care over 2 years. Receipt of SSA benefits and clinical outcomes were assessed at program entry and every 6 months for 2 years. Piecewise regression analysis was used to identify relative change in outcome trajectories after receipt of disability benefits. Among 399 RAISE-ETP participants, 36 (9%) were receiving SSA disability benefits at baseline; of the remainder, 124 (34.1%) obtained benefits during the 2-year study period. The NAVIGATE intervention improved quality of life, symptoms, and employment but did not significantly reduce the likelihood of receiving SSA disability benefits. Obtaining benefits was predicted by more severe psychotic symptoms and greater dysfunction and was followed by increased total income but fewer days of employment, reduced motivation (e.g., sense of purpose, greater anhedonia), and fewer days of intoxication. A 2-year coordinated specialty care intervention did not reduce receipt of SSA disability benefits. There were some advantages for those who obtained SSA disability benefits over the 2-year treatment period, but there were also some unintended adverse consequences. Providing income supports without impeding recovery remains an important policy challenge.

  5. Employer Child Care Resources: A Guide to Developing Effective Child Care Programs and Policies.

    ERIC Educational Resources Information Center

    Women's Bureau (DOL), Washington, DC.

    Increasing numbers of employers are responding to employee child care needs by revising their benefit packages, work schedules, and recruitment plans to include child care options. This guide details ways to develop effective child care programs and policies. Section 1 of the guide describes employees' growing child care needs and employers'…

  6. Perceived benefits and proposed solutions for teen pregnancy: qualitative interviews with youth care workers.

    PubMed

    Boustani, Maya Mroué; Frazier, Stacy L; Hartley, Chelsey; Meinzer, Michael; Hedemann, Erin

    2015-01-01

    The purpose of this article is to examine youth care workers' perceptions of the specific and unique sexual health needs of youth at risk for foster care. Semistructured interviews were conducted with youth care workers (N = 10) at a shelter for youth in or at risk for foster care. Youth care workers perceive that youth have unique experiences and needs related to sexual health programming and pregnancy prevention. Reflecting a great deal of family dysfunction, 3 themes emerged that revealed perceived benefits of teen pregnancy: youths' effort to prove themselves as adults, opportunity to secure their relationship with a partner, and desire to create an emotional connection with a baby. Lack of knowledge and accumulation of risk factors were viewed as most problematic. Current pregnancy prevention programs assume teen pregnancies are unwanted and emphasize the costs of sexual risk taking. Current findings suggest that sexual health programming for youth in or at risk for foster care should account for 3 perceived benefits of teen pregnancy. New opportunities for improving the reach and effectiveness of intervention for youth in or at risk for foster care are discussed.

  7. Mobile health care operations and return on investment in predominantly underserved children with asthma: the breathmobile program.

    PubMed

    Morphew, Tricia; Scott, Lyne; Li, Marilyn; Galant, Stanley P; Wong, Webster; Garcia Lloret, Maria I; Jones, Felita; Bollinger, Mary Elizabeth; Jones, Craig A

    2013-08-01

    Underserved populations have limited access to care. Improved access to effective asthma care potentially improves quality of life and reduces costs associated with emergency department (ED) visits. The purpose of this study is to examine return on investment (ROI) for the Breathmobile Program in terms of improved patient quality-adjusted life years saved and reduced costs attributed to preventable ED visits for 2010, with extrapolation to previous years of operation. It also examines cost-benefit related to reduced morbidity (ED visits, hospitalizations, and school absenteeism) for new patients to the Breathmobile Program during 2008-2009 who engaged in care (≥3 visits). This is a retrospective analysis of data for 15,986 pediatric patients, covering 88,865 visits, participating in 4 Southern California Breathmobile Programs (November 16, 1995-December 31, 2010). The ROI calculation expressed the cost-benefit ratio as the net benefits (ED costs avoided+relative value of quality-adjusted life years saved) over the per annum program costs (∼$500,000 per mobile). The ROI across the 4 California programs in 2010 was $6.73 per dollar invested. Annual estimated emergency costs avoided in the 4 regions were $2,541,639. The relative value of quality-adjusted life years saved was $24,381,000. For patients new to the Breathmobile Program during 2008-2009 who engaged in care (≥3 visits), total annual morbidity costs avoided per patient were $1395. This study suggests that mobile health care is a cost-effective strategy to deliver medical care to underserved populations, consistent with the Triple Aims of Therapy.

  8. Perceived benefits and barriers and self-efficacy affecting the attendance of health education programs among uninsured primary care patients.

    PubMed

    Kamimura, Akiko; Nourian, Maziar M; Jess, Allison; Chernenko, Alla; Assasnik, Nushean; Ashby, Jeanie

    2016-12-01

    Lifestyle interventions have shown to be effective in improving health status, health behaviors, and self-efficacy. However, recruiting participants to health education programs and ensuring the continuity of health education for underserved populations is often challenging. The goals of this study are: to describe the attendance of health education programs; to identify stages of change to a healthy lifestyle; to determine cues to action; and to specify factors affecting perceived benefits and barriers to healthy food choices and physical activity among uninsured primary care patients. Uninsured primary care patients utilizing a free clinic (N=621) completed a self-administered survey from September to December of 2015. US born English speakers, non-US born English speakers, and Spanish speakers reported different kinds of cues to action in attending health education programs. While self-efficacy increases perceived benefits and decreases perceived barriers for physical activity, it increases both perceived benefits and perceived barriers for healthy food choices. The participants who had attended health education programs did not believe that there were benefits for healthy food choices and physical activity. This study adds to the body of literature on health education for underserved populations. Copyright © 2016 Elsevier Ltd. All rights reserved.

  9. Child Care: A Business Investment That Works.

    ERIC Educational Resources Information Center

    Children's Action Alliance, Phoenix, AZ.

    This publication explains to Arizona employers the effect of child care difficulties on the work force and profitablity and describes ways to help employees meet their child care needs. Discussion concerns the benefits of employee child care assistance programs, program options available to employees, and the steps required to implement the…

  10. 75 FR 68799 - Medicare Program; Inpatient Hospital Deductible and Hospital and Extended Care Services...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-09

    ... 0938-AP86 Medicare Program; Inpatient Hospital Deductible and Hospital and Extended Care Services.... SUMMARY: This notice announces the inpatient hospital deductible and the hospital and extended care... extended care services in a skilled nursing facility in a benefit period. DATES: Effective Date: This...

  11. Implementation of evidence-based patient navigation programs.

    PubMed

    Freund, Karen M

    2017-02-01

    Patient navigation refers to a direct patient care role that links patients with clinical providers and their support system and provides individualized support during cancer care, ensuring that patients have access to the knowledge and resources necessary to complete recommended treatment. While most reports have studied the role of patient navigators during the cancer screening or diagnostic process, emerging evidence indicates the benefits of patient navigation during active cancer treatment. Reports in the literature are conflicting on the impact of patient navigation during cancer care and on the benefits to timely or quality care in all populations. Recent sub-analyses of the Patient Navigation Research Program data demonstrated specifically the benefits of targeting patient navigation to the most vulnerable populations, including those with low educational attainment, low income and unstable housing, less social support, multiple comorbidities, and minority race/ethnicity. The implications of the Patient Navigation Research Program are that this resource is best utilized when directed to support the care of patients at locations with known challenges to timely care and for specific patients with risk factors for delays in care, including comorbidities, low educational attainment and low income. Implementation of patient navigation programs requires the following processes: needs assessment, selection of a navigator to meet the community and care needs, supervision and integration of the navigator into clinical processes, and systems support to facilitate the identification and tracking of those patients requiring patient navigation. There is a need for ongoing research on methods to fund and sustain patient navigation programs.

  12. Agenda-setting for Canadian caregivers: using media analysis of the maternity leave benefit to inform the compassionate care benefit

    PubMed Central

    2014-01-01

    The Compassionate Care Benefit was implemented in Canada in 2004 to support employed informal caregivers, the majority of which we know are women given the gendered nature of caregiving. In order to examine how this policy might evolve over time, we examine the evolution of a similar employment insurance program, Canada’s Maternity Leave Benefit. National media articles were reviewed (n = 2,698) and, based on explicit criteria, were analyzed using content analysis. Through the application of Kingdon’s policy agenda-setting framework, the results define key recommendations for the Compassionate Care Benefit, as informed by the developmental trajectory of the Maternity Leave Benefit. Recommendations for revising the Compassionate Care Benefit are made. PMID:24758563

  13. Agenda-setting for Canadian caregivers: using media analysis of the maternity leave benefit to inform the compassionate care benefit.

    PubMed

    Dykeman, Sarah; Williams, Allison M

    2014-04-24

    The Compassionate Care Benefit was implemented in Canada in 2004 to support employed informal caregivers, the majority of which we know are women given the gendered nature of caregiving. In order to examine how this policy might evolve over time, we examine the evolution of a similar employment insurance program, Canada's Maternity Leave Benefit. National media articles were reviewed (n = 2,698) and, based on explicit criteria, were analyzed using content analysis. Through the application of Kingdon's policy agenda-setting framework, the results define key recommendations for the Compassionate Care Benefit, as informed by the developmental trajectory of the Maternity Leave Benefit. Recommendations for revising the Compassionate Care Benefit are made.

  14. Incremental Net Benefit of Early Intervention for Preschool-Aged Children with Emotional and Behavioral Problems in Foster Care.

    PubMed

    Lynch, Frances L; Dickerson, John F; Saldana, Lisa; Fisher, Phillip A

    2014-01-01

    Of 1 million cases of child maltreatment identified every year in the United States, one-fifth result in foster care. Many of these children suffer from significant emotional and behavioral conditions. Decision-makers must allocate highly constrained budgets to serve these children. Recent evidence suggests that Multidimensional Treatment Foster Care for Preschoolers can reduce negative outcomes for these children, but the relative benefits and costs of the program have not been evaluated. The objective of this study was to assess net benefit, over 24 months, of Multidimensional Treatment Foster Care for Preschoolers compared to regular foster care. Data were from a randomized controlled trial of 117 young children entering a new foster placement. A subsample exhibited placement instability (n = 52). Intervention services including parent training, lasted 9-12 months. Multidimensional Treatment Foster Care for Preschoolers significantly increased permanent placements for the placement instability sample. Average total cost for the new intervention sample was significantly less than for regular foster care (full sample: $27,204 vs. $30,090; P = .004; placement instability sample: $29,595 vs. $36,061; P = .045). Incremental average net benefit was positive at all levels of willingness to pay of zero or greater, indicating that the value of benefits exceeded costs. Multidimensional Treatment Foster Care for Preschoolers has significant benefit for preschool children in foster care with emotional and behavioral disorders compared to regular foster care services. At even modest levels of willingness to pay, benefits exceed costs indicating a strong likeliness that this program is an efficient choice for improving outcomes for young children with emotional and behavioral disorders in foster care.

  15. Incremental Net Benefit of Early Intervention for Preschool-Aged Children with Emotional and Behavioral Problems in Foster Care

    PubMed Central

    Lynch, Frances L.; Dickerson, John F.; Saldana, Lisa; Fisher, Phillip A.

    2017-01-01

    Of 1 million cases of child maltreatment identified every year in the United States, one-fifth result in foster care. Many of these children suffer from significant emotional and behavioral conditions. Decision-makers must allocate highly constrained budgets to serve these children. Recent evidence suggests that Multidimensional Treatment Foster Care for Preschoolers can reduce negative outcomes for these children, but the relative benefits and costs of the program have not been evaluated. The objective of this study was to assess net benefit, over 24 months, of Multidimensional Treatment Foster Care for Preschoolers compared to regular foster care. Data were from a randomized controlled trial of 117 young children entering a new foster placement. A subsample exhibited placement instability (n = 52). Intervention services including parent training, lasted 9–12 months. Multidimensional Treatment Foster Care for Preschoolers significantly increased permanent placements for the placement instability sample. Average total cost for the new intervention sample was significantly less than for regular foster care (full sample: $27,204 vs. $30,090; P = .004; placement instability sample: $29,595 vs. $36,061; P = .045). Incremental average net benefit was positive at all levels of willingness to pay of zero or greater, indicating that the value of benefits exceeded costs. Multidimensional Treatment Foster Care for Preschoolers has significant benefit for preschool children in foster care with emotional and behavioral disorders compared to regular foster care services. At even modest levels of willingness to pay, benefits exceed costs indicating a strong likeliness that this program is an efficient choice for improving outcomes for young children with emotional and behavioral disorders in foster care. PMID:29097828

  16. 20 CFR 10.506 - May the employer monitor the employee's medical care?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 1 2011-04-01 2011-04-01 false May the employer monitor the employee's medical care? 10.506 Section 10.506 Employees' Benefits OFFICE OF WORKERS' COMPENSATION PROGRAMS, DEPARTMENT OF LABOR FEDERAL EMPLOYEES' COMPENSATION ACT CLAIMS FOR COMPENSATION UNDER THE FEDERAL EMPLOYEES' COMPENSATION ACT, AS AMENDED Continuing Benefit...

  17. 20 CFR 10.506 - May the employer monitor the employee's medical care?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false May the employer monitor the employee's medical care? 10.506 Section 10.506 Employees' Benefits OFFICE OF WORKERS' COMPENSATION PROGRAMS, DEPARTMENT OF LABOR FEDERAL EMPLOYEES' COMPENSATION ACT CLAIMS FOR COMPENSATION UNDER THE FEDERAL EMPLOYEES' COMPENSATION ACT, AS AMENDED Continuing Benefit...

  18. 20 CFR 725.707 - Reports of physicians and supervision of medical care.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... medical care. 725.707 Section 725.707 Employees' Benefits OFFICE OF WORKERS' COMPENSATION PROGRAMS, DEPARTMENT OF LABOR FEDERAL COAL MINE HEALTH AND SAFETY ACT OF 1969, AS AMENDED CLAIMS FOR BENEFITS UNDER PART C OF TITLE IV OF THE FEDERAL MINE SAFETY AND HEALTH ACT, AS AMENDED Medical Benefits and...

  19. Dateline Child Care.

    ERIC Educational Resources Information Center

    Child Care Information Exchange, 1987

    1987-01-01

    Discusses developmental trends influencing child care programs. They include growing popularity of flexible benefit plans for employees; American children's quality of life; state and local child care initiatives; children's uses of computers; and lack of after-school programs for low income children. Growth of accredited centers is also…

  20. 75 FR 81241 - Proposed Collection; Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-27

    ... requirement is used by TRICARE to determine reimbursement for health care services or supplies rendered by... beneficiary eligibility, appropriateness and costs of care, other health insurance liability and whether... care providers under the TRICARE Program. TRICARE is a health benefits entitlement program for active...

  1. Disability and employee benefits receipt: evidence from the U.S. Vocational Rehabilitation Services Program.

    PubMed

    Sosulski, Marya R; Donnell, Chandra; Kim, Woo Jong

    2012-01-01

    Studies indicate positive effects of the U.S. Vocational Rehabilitation Services (VRS) in assisting people with disabilities to find independent employment. Underemployment continues to impact access to adequate health care and other benefits. Workers with disabilities receive fewer benefits, overall. With data from the Longitudinal Study of Vocational Rehabilitation Services Program (LSVRSP), the authors compare the rates of receipt of 6 types of benefits for people with physical, mental, and sensory impairments. Although those with physical disabilities are most likely to receive benefits, all groups lack adequate access to health care, sick leave, and vacation. The authors discuss implications for services provision in the current job market.

  2. Day Care: A Program in Search of a Policy.

    ERIC Educational Resources Information Center

    Bikales, Gerda

    This report examines current issues relating to day care and challenges many of the policy assumptions that underlie a major public program of subsidized day care for children. A historical perspective of day care is presented and various types of day care are described. The costs and benefits of day care are examined and the relation of day care…

  3. 75 FR 19948 - TRICARE, Formerly Known as the Civilian Health and Medical Program of the Uniformed Services...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-16

    ... on Federal Employee Health Benefit Program employee and agency contributions required for a... DEPARTMENT OF DEFENSE Office of the Secretary TRICARE, Formerly Known as the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); Fiscal Year 2011 Continued Health Care Benefit...

  4. The Dollars and Cents of Investing Early: Cost-Benefit Analysis in Early Care and Education

    ERIC Educational Resources Information Center

    Heckman, James; Grunewald, Rob; Reynolds, Arthur

    2006-01-01

    Heckman et al. discuss how cost-benefit analysis of prekindergarten education programs demonstrates that the highest per child benefits stem from programs that focus on economically disadvantaged children. Indeed, studies have shown that these children make significant gains in cognition, social-emotional development, and educational performance…

  5. The measurement of community benefit: issues, options, and questions for further research.

    PubMed

    Longo, D R

    1994-01-01

    Community benefit from a conceptual perspective can be traced to the philanthropic and humanitarian spirit that dominated the earliest foundations of the hospital as a social institution. However, the measurement of community benefit is a recent development and one rarely addressed in the literature in any detail. This article outlines the various concepts integral to community benefit measurement that must be taken into account for a program to demonstrate community accountability in an era where hospitals and health care institutions are increasingly required to evaluate and document their value to society. The perspective taken is that of a practicing health care executive. The use of the discussed concepts will assist health care executives and their staff in designing and evaluating programs, and will also assist academics in preparing students for this important professional responsibility.

  6. Health care spending accounts: a flexible solution for Canadian employers.

    PubMed

    Smithies, R; Steeves, L

    1996-01-01

    Flexible benefits plans have grown more slowly in Canada than in the United States, largely because of certain legal and regulatory considerations. Health care spending accounts (HCSAs) provide a cost-effective way for Canadian employers to address the health care benefit needs of a diverse workforce. A flexible health care spending account is a versatile and cost-effective instrument that can be used by Canadian employers that wish to provide a full range of health care benefits to employees. The health care alternatives available through an HCSA can provide employees with an opportunity to customize and optimize their benefits program. Regulatory requirements that an HCSA must meet in order to qualify for available tax advantages are discussed, as are the range of health care services that may be covered.

  7. Comprehensive managed care evaluation.

    PubMed

    Bushick, B

    1992-01-01

    To optimize the benefits of managed care delivery systems, employers must identify and reward those systems that are most efficient and effective. At the same time, their deeper involvement in system design and management exposes employers to greater potential liability. Employers thus need to better evaluate their managed care programs in order to enhance the benefits and minimize the risks.

  8. Medicaid and Children's Health Insurance Programs; Mental Health Parity and Addiction Equity Act of 2008; the Application of Mental Health Parity Requirements to Coverage Offered by Medicaid Managed Care Organizations, the Children's Health Insurance Program (CHIP), and Alternative Benefit Plans. Final rule.

    PubMed

    2016-03-30

    This final rule will address the application of certain requirements set forth in the Public Health Service Act, as amended by the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, to coverage offered by Medicaid managed care organizations, Medicaid Alternative Benefit Plans, and Children’s Health Insurance Programs.

  9. Benefits for employees with children with ADHD: findings from the Collaborative Employee Benefit Study.

    PubMed

    Perrin, James M; Fluet, Chris; Kuhlthau, Karen A; Anderson, Betsy; Wells, Nora; Epstein, Susan; Allen, Debby; Tobias, Carol

    2005-02-01

    Parents of most children with attention-deficit hyperactivity disorder (ADHD) are employed. Employers have interest in decreasing employee absenteeism and improving workplace productivity, partly through employee benefits. The authors interviewed employers to (1) determine how they view the needs of employees with children with ADHD and (2) identify benefits that might help employees with children with ADHD. The authors carried out a systematic interview study of mainly family-friendly, large employers in four U.S. urban markets (Boston, Cleveland, Miami, Seattle). Multidisciplinary interview teams used a protocol to gather basic company information, benefit philosophy, current insurance and other employee benefits, and knowledge of ADHD and its impacts on employees. Initially, the interview team and then the larger project team reviewed all protocols for common themes. The authors interviewed staff of 41 employers (human resource managers, work/life program directors, benefits directors). Only 15 of 41 interviewees knew about ADHD, its prevalence, or its effects on parents. They had little knowledge of how differences in managed behavioral health may affect families' access to diagnostic and treatment services for ADHD, although most had experience with primary care management of depression among employees. Employers offer a variety of other benefits, including work/life and employee assistance programs, occasionally providing employees help with caring for a child with a mental health condition, on-site parent training programs, or assistance with child care. Other potentially useful employee benefits include flexible work and leave policies and information and referral services that can link parents with community programs. Although employers have limited awareness of ADHD and its potential effect on employees' work, this study identified opportunities to improve both health insurance and other benefits for employees with children with ADHD.

  10. Determining the benefits and objectives of a child health residency program for Canadian rural family physicians: An international qualitative research study

    PubMed Central

    Keegan, David; Bannister, Susan

    2010-01-01

    OBJECTIVES: To clarify the need for an advanced child health training program for Canadian rural family physicians, and to determine the key learning objectives to enable graduates to become community leaders in child and youth health care. DESIGN: Qualitative educational research study. Setting: Canada and Australia. METHODS: To gather data, the authors carried out semistructured interviews and focus groups with child care consultants, Canadian rural family physicians, child patients and parents, family medicine residents and Australian rural family physicians. Standards of qualitative methodology were applied to identify themes and subthemes. RESULTS: It was determined that a family medicine child health program would provide the following benefits: enhanced care by family physicians, improved access to child care, increased attractiveness of family medicine as a career and reduced ‘specialty burden’. Five key learning objectives for graduates were identified: the ability to provide child-centred care, to care for acutely or critically ill children, to care for children with complex needs, to recognize and act on ‘red flags’, and to provide behavioural and mental health care. The Australian general practitioners confirmed that their training provided most of these benefits, and enabled them to achieve the objectives identified. CONCLUSION: The present study showed that multiple stakeholders believed that advanced training in child health for rural family physicians would provide better care for children. The study also identified key learning objectives for the program. The present research led to the establishment of a Family Medicine Child Health Residency Program (www.familymedicineuwo.ca/PostGrad/PGY3/ChildHealth.aspx) at The University of Western Ontario (London, Ontario). PMID:21731414

  11. 76 FR 63017 - Medicare Program; Proposed Changes to the Medicare Advantage and the Medicare Prescription Drug...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-11

    ... to the Medicare Advantage and the Medicare Prescription Drug Benefit Programs for Contract Year 2013 and Other Proposed Changes; Considering Changes to the Conditions of Participation for Long Term Care... to the Medicare Advantage and the Medicare Prescription Drug Benefit Programs for Contract Year 2013...

  12. Tribal Benefits Counseling Program: Expanding Health Care Opportunities for Tribal Members

    PubMed Central

    Friedsam, Donna; Haug, Gretchen; Rust, Mike; Lake, Amy

    2003-01-01

    American Indian tribal clinics hired benefits counselors to increase the number of patients with public and private insurance coverage, expand the range of health care options available to tribal members, and increase third-party revenues for tribal clinics. Benefits counselors received intensive training, technical assistance, and evaluation over a 2-year period. Six tribal clinics participated in the full training program, including follow-up, process evaluation, and outcomes reporting. Participating tribal sites experienced a 78% increase in Medicaid enrollment among pregnant women and children, compared with a 26% enrollment increase statewide during the same period. Trained benefits counselors on-site at tribal clinics can substantially increase third-party insurance coverage among patients. PMID:14534213

  13. A revolutionary approach to health care cost control: leveraging the power of Web-enabled employee "consumerism".

    PubMed

    Rozzi, M V

    2001-09-01

    The confluence of two trends--health care "consumerism" and employee self-service benefits programs--offers employers a promising opportunity for health care cost control. To take advantage of this opportunity, employers must take a fresh look at the health care cost dilemma and find ways to simultaneously offer employees a new kind of benefit and implement more effective cost-control measures.

  14. Working toward financial sustainability of integrated behavioral health services in a public health care system.

    PubMed

    Monson, Samantha Pelican; Sheldon, J Christopher; Ivey, Laurie C; Kinman, Carissa R; Beacham, Abbie O

    2012-06-01

    The need, benefit, and desirability of behavioral health integration in primary care is generally accepted and has acquired widespread positive regard. However, in many health care settings the economics, business aspects, and financial sustainability of practice in integrated care settings remains an unsolved puzzle. Organizational administrators may be reluctant to expand behavioral health services without evidence that such programs offer clear financial benefits and financial sustainability. The tendency among mental health professionals is to consider positive clinical outcomes (e.g., reduced depression) as being globally valued indicators of program success. Although such outcomes may be highly valued by primary care providers and patients, administrative decision makers may require demonstration of more tangible financial outcomes. These differing views require program developers and evaluators to consider multiple outcome domains including clinical/psychological symptom reduction, potential cost benefit, and cost offset. The authors describe a process by which a pilot demonstration project is being implemented to demonstrate programmatic outcomes with a focus on the following: 1) clinician efficiency, 2) improved health outcomes, and 3) direct revenue generation associated with the inclusion of integrated primary care in a public health care system. The authors subsequently offer specific future directions and commentary regarding financial evaluation in each of these domains.

  15. 76 FR 56767 - Request for Information Regarding State Flexibility To Establish a Basic Health Program Under the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-14

    ... essential health benefits described in section 1302(b) of the Affordable Care Act to eligible individuals in... Affordable Care Act; (2) covers at least the essential health benefits described in section 1302(b) of the Affordable Care Act; and (3) in the case of a plan that provides health insurance coverage offered by a...

  16. 45 CFR 400.116 - Service for unaccompanied minors.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ..., ADMINISTRATION FOR CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES REFUGEE RESETTLEMENT PROGRAM... unaccompanied minors with the same range of child welfare benefits and services available in foster care cases to other children in the State. Allowable benefits and services may include foster care maintenance...

  17. 45 CFR 400.116 - Service for unaccompanied minors.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ..., ADMINISTRATION FOR CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES REFUGEE RESETTLEMENT PROGRAM... unaccompanied minors with the same range of child welfare benefits and services available in foster care cases to other children in the State. Allowable benefits and services may include foster care maintenance...

  18. 45 CFR 400.116 - Service for unaccompanied minors.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ..., ADMINISTRATION FOR CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES REFUGEE RESETTLEMENT PROGRAM... unaccompanied minors with the same range of child welfare benefits and services available in foster care cases to other children in the State. Allowable benefits and services may include foster care maintenance...

  19. 45 CFR 400.116 - Service for unaccompanied minors.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ..., ADMINISTRATION FOR CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES REFUGEE RESETTLEMENT PROGRAM... unaccompanied minors with the same range of child welfare benefits and services available in foster care cases to other children in the State. Allowable benefits and services may include foster care maintenance...

  20. The Benefits of Physician Training Programs for Rural Communities: Lessons Learned from the Teaching Health Center Graduate Medical Education Program.

    PubMed

    Lee, Marshala; Newton, Helen; Smith, Tracey; Crawford, Malena; Kepley, Hayden; Regenstein, Marsha; Chen, Candice

    2016-01-01

    Rural communities disproportionately face preventable chronic diseases and death from treatable conditions. Health workforce shortages contribute to limited health care access and health disparities. Efforts to address workforce shortages have included establishing graduate medical education programs with the goal of recruiting and retaining physicians in the communities in which they train. However, rural communities face a number of challenges in developing and maintaining successful residency programs, including concerns over financial sustainability and the integration of resident trainees into existing clinical practices. Despite these challenges, rural communities are increasingly interested in investing in residency programs; those that are successful see additional benefits in workforce recruitment, access, and quality of care that have immediate and direct impact on the health of rural communities. This commentary examines the challenges and benefits of rural residency programs, drawing from lessons learned from the Health Resources and Services Administration's Teaching Health Center Graduate Medical Education program.

  1. A Cost-Benefit Analysis of a State-Funded Healthy Homes Program for Residents With Asthma: Findings From the New York State Healthy Neighborhoods Program.

    PubMed

    Gomez, Marta; Reddy, Amanda L; Dixon, Sherry L; Wilson, Jonathan; Jacobs, David E

    Despite considerable evidence that the economic and other benefits of asthma home visits far exceed their cost, few health care payers reimburse or provide coverage for these services. To evaluate the cost and savings of the asthma intervention of a state-funded healthy homes program. Pre- versus postintervention comparisons of asthma outcomes for visits conducted during 2008-2012. The New York State Healthy Neighborhoods Program operates in select communities with a higher burden of housing-related illness and associated risk factors. One thousand households with 550 children and 731 adults with active asthma; 791 households with 448 children and 551 adults with asthma events in the previous year. The program provides home environmental assessments and low-cost interventions to address asthma trigger-promoting conditions and asthma self-management. Conditions are reassessed 3 to 6 months after the initial visit. Program costs and estimated benefits from changes in asthma medication use, visits to the doctor for asthma, emergency department visits, and hospitalizations over a 12-month follow-up period. For the asthma event group, the per person savings for all medical encounters and medications filled was $1083 per in-home asthma visit, and the average cost of the visit was $302, for a benefit to program cost ratio of 3.58 and net benefit of $781 per asthma visit. For the active asthma group, per person savings was $613 per asthma visit, with a benefit to program cost ratio of 2.03 and net benefit of $311. Low-intensity, home-based, environmental interventions for people with asthma decrease the cost of health care utilization. Greater reductions are realized when services are targeted toward people with more poorly controlled asthma. While low-intensity approaches may produce more modest benefits, they may also be more feasible to implement on a large scale. Health care payers, and public payers in particular, should consider expanding coverage, at least for patients with poorly controlled asthma or who may be at risk for poor asthma control, to include services that address triggers in the home environment.

  2. Charitable remainder trust strategies for health care organizations.

    PubMed

    Goeppele, H A

    1998-01-01

    While availability of tax-exempt financing and exemption from income and property taxes have been viewed as the primary benefits of tax exemption, an underutilized benefit is the eligibility to receive charitable contributions. This article, using acquisition of a medical practice as an example, demonstrates one way planned giving can benefit both the health care organization and its physicians, and how such giving programs can be tailored to individual donor needs. Rather than selling a medical practice directly to a hospital, both the physician and the tax-exempt health care organization realize greater benefits through the illustrated charitable remainder trust strategy.

  3. 42 CFR 409.62 - Lifetime maximum on inpatient psychiatric care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Lifetime maximum on inpatient psychiatric care. 409.62 Section 409.62 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM HOSPITAL INSURANCE BENEFITS Scope of Hospital Insurance Benefits § 409...

  4. Managing a palliative oncology program: the role of a business plan.

    PubMed

    Walsh, D; Gombeski, W R; Goldstein, P; Hayes, D; Armour, M

    1994-02-01

    Today's health-care environment demands that palliative-care programs operate in a businesslike manner. This report summarizes the business plan and the process followed to develop the Palliative Care Program at the Cleveland Clinic Foundation (CCF). The benefits generated from this effort and the lessons learned that may be helpful to other program managers are described. By disciplining itself to focus on financial, marketing, and operational issues, the Palliative Care Program is in a better position to advance its clinical services within the organization and in its market area, and can thereby serve its patients more effectively.

  5. Planning and Decision Making for Medical Education: An Analysis of Costs and Benefits.

    ERIC Educational Resources Information Center

    Wing, Paul

    This paper clarifies the role of medical education in the large health care system, estimates the resources required to carry on medical education programs and the benefits that accrue from medical education, and answers a few fundamental policy questions. Cost estimates are developed on a program-by-program basis, using empirical economic…

  6. 32 CFR 199.20 - Continued Health Care Benefit Program (CHCBP).

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... program. However, unlike the Standard program there is a cost for enrollment to the CHCBP and these premium costs are payable by enrollees before any care may be provided. (b) General provisions. Except for... 55 or transitional healthcare under 10 U.S.C. 1145, and (iii) Who would otherwise not be eligible for...

  7. 32 CFR 199.20 - Continued Health Care Benefit Program (CHCBP).

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... program. However, unlike the Standard program there is a cost for enrollment to the CHCBP and these premium costs are payable by enrollees before any care may be provided. (b) General provisions. Except for... 55 or transitional healthcare under 10 U.S.C. 1145, and (iii) Who would otherwise not be eligible for...

  8. 32 CFR 199.20 - Continued Health Care Benefit Program (CHCBP).

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... program. However, unlike the Standard program there is a cost for enrollment to the CHCBP and these premium costs are payable by enrollees before any care may be provided. (b) General provisions. Except for... 55 or transitional healthcare under 10 U.S.C. 1145, and (iii) Who would otherwise not be eligible for...

  9. Financial analysis of cardiovascular wellness program provided to self-insured company from pharmaceutical care provider's perspective.

    PubMed

    Wilson, Justin B; Osterhaus, Matt C; Farris, Karen B; Doucette, William R; Currie, Jay D; Bullock, Tammy; Kumbera, Patty

    2005-01-01

    To perform a retrospective financial analysis on the implementation of a self-insured company's wellness program from the pharmaceutical care provider's perspective and conduct sensitivity analyses to estimate costs versus revenues for pharmacies without resident pharmacists, program implementation for a second employer, the second year of the program, and a range of pharmacist wages. Cost-benefit and sensitivity analyses. Self-insured employer with headquarters in Canton, N.C. 36 employees at facility in Clinton, Iowa. Pharmacist-provided cardiovascular wellness program. Costs and revenues collected from pharmacy records, including pharmacy purchasing records, billing records, and pharmacists' time estimates. All costs and revenues were calculated for the development and first year of the intervention program. Costs included initial and follow-up screening supplies, office supplies, screening/group presentation time, service provision time, documentation/preparation time, travel expenses, claims submission time, and administrative fees. Revenues included initial screening revenues, follow-up screening revenues, group session revenues, and Heart Smart program revenues. For the development and first year of Heart Smart, net benefit to the pharmacy (revenues minus costs) amounted to dollars 2,413. All sensitivity analyses showed a net benefit. For pharmacies without a resident pharmacist, the net benefit was dollars 106; for Heart Smart in a second employer, the net benefit was dollars 6,024; for the second year, the projected net benefit was dollars 6,844; factoring in a lower pharmacist salary, the net benefit was dollars 2,905; and for a higher pharmacist salary, the net benefit was dollars 1,265. For the development and first year of Heart Smart, the revenues of the wellness program in a self-insured company outweighed the costs.

  10. Determining the value of disease management programs.

    PubMed

    Selby, Joe V; Scanlon, Dennis; Lafata, Jennifer Elston; Villagra, Victor; Beich, Jeff; Salber, Patricia R

    2003-09-01

    Increasing prevalence, rising costs, and persisting deficiencies in quality of care for chronic diseases pose economic and policy challenges to providers and purchasers. Disease management (DM) programs may address these challenges, but neither purchasers nor providers can assess their value. The potpourri of current quality indicators provides limited insight into the actual clinical benefit achieved. A conference sponsored by the Agency for Healthcare Research and Quality (AHRQ) and held in October 2002 explored new approaches to measuring and reporting the value of DM for diabetes mellitus. Quantifying the value of DM requires measuring clinical benefit and net impact on health care costs for the entire population with diabetes. If quality is measured with indicators that are clearly linked to outcomes, clinical benefit can be estimated. Natural history models combine the expected benefits of improvements in multiple indicators to yield a single, composite measure, the quality-adjusted life-year. Such metrics could fairly express, in terms of survival and complications prevention, relatively disparate DM programs' benefits. Measuring and comparing health care costs requires data validation and appropriate case-mix adjustment. Comparing value across programs may provide more accurate assessments of performance, enhance quality improvement efforts within systems, and contribute generalizable knowledge on the utility of DM approaches. Conference attendees recommended pilot projects to further explore use of natural history models for measuring and reporting the value of DM.

  11. The 2015 Long-Term Budget Outlook

    DTIC Science & Technology

    2015-06-17

    and an increasing number of recipients of exchange subsidies and Medicaid benefits attributable to the Affordable Care Act would push up spending...for Social Security and the government’s major health care programs—Medicare, Medicaid , the Children’s Health Insurance Program, and subsidies for...number of recipients of exchange subsidies and Medicaid benefits attributable to the Affordable Care Act.  The government’s net outlays for

  12. Evaluation of the Child Care Class for Older Adults.

    ERIC Educational Resources Information Center

    Gallegos, Sandra

    In 1986, the Ability Based on Older Dependable Experience (ABODE) Program was developed at De Anza College to train older adults to serve as a temporary source of child care on an emergency basis. The program was sponsored by Tandem Computers, Incorporated, out of a desire to provide better employee benefits with respect to child care. The program…

  13. Medicare Hospice Benefits

    MedlinePlus

    ... Choosing to start hospice care is a difficult decision. The information in this booklet and support from a doctor ... may need hospice care in all health care decisions. The information in this booklet describes the Medicare Program at ...

  14. Drug-usage evaluation and the patient-care pharmacist: a synergistic combination.

    PubMed

    Gayman, J; Tapley, D J

    1991-07-01

    The Joint Commission requires a continuous monitoring program to assure quality pharmaceutical care. The only way to achieve compliance with this standard is to enlist the help of the patient-care pharmacists. Equally important to the pharmacy manager is the way a DUE program can benefit the patient-care pharmacists. The key to an effective program is to assist the patient-care pharmacists in taking responsibility for the quality of drug therapy provided to their patients. Through education, encouragement, and recognition, the DUE Coordinator can elevate the practice of the patient-care pharmacists. The outcome is a synergistic program that enriches the practice of the patient-care pharmacists who, in turn, enrich the quality of pharmaceutical care received by their patients.

  15. A blueprint for community benefit. A CHA-AAHA (Catholic Health Association-American Association of Homes for the Aging) document helps long-term care providers plan for and implement needed services.

    PubMed

    Forschner, B; Trocchio, J

    1993-05-01

    A collaborative effort of the Catholic Health Association (CHA) and the American Association of Homes for the Aging, The Social Accountability Program: Continuing the Community Benefit Tradition of Not-for-Profit Homes and Services for the Aging helps long-term care organizations plan and report community benefit activities. The program takes long-term care providers through five sequential tasks: reaffirming commitment to the elderly and others in the community; developing a community service plan; developing and providing community services; reporting community services; and evaluating the community service role. To help organizations reaffirm commitment, the Social Accountability Program presents a process facilities can use to review their historical roots and purposes and evaluate whether current policies and procedures are consistent with the organizational philosophy. Once this step is completed, providers can develop a community service plan by identifying target populations and the services they need. For facilities developing and implementing such services, the program suggests ways of measuring and monitoring them for budgetary purposes. Once they have implemented services, not-for-profit healthcare organizations must account for their impact on the community. The Social Accountability Program lists elements to be included in community service reports. It also provides guidelines for evaluating these services' effectiveness and the organization's overall community benefit role.

  16. Disease management programs for heart failure: not just for the 'sick' heart failure population.

    PubMed

    McDonald, Ken; Conlon, Carmel; Ledwidge, Mark

    2007-02-01

    The development of disease management programs has been a major advance in heart failure care, bringing about significant improvements for the heart failure population, with reduction in readmission, better use of guideline therapy and improved survival. However, at present, the majority of such programs focus their attention only on the sicker segment of this population, with little application of this important service to the broader heart failure population, where potentially benefits may be even more impressive. This has led to an imbalance in the care of patients with heart failure, where aspects of management such as regular structured review and education are preferentially given to the group at the later stages of the natural history of the syndrome. This paper argues for a far wider application of the disease management program concept in heart failure care so as to bring the benefits of specialist care, patient education and follow-up to patients at an earlier stage in the natural history of heart failure.

  17. Workplace Financial Wellness Programs Help Employees Manage Health Care Changes.

    PubMed

    Meyer, Cynthia; Smith, Michael C

    Employers and employees are navigating major changes in health insurance benefits, including the move to high-deductible health plans in conjunction with health savings accounts (HSAs). The HSA offers unique benefits that could prove instrumental in helping workers both navigate current health care expenses and build a nest egg for much larger health care costs in retirement. Yet employees often don't understand the HSA and how to best use it. How can employers help employees make wise benefits choices that work for their personal financial circumstances?

  18. Perceived Benefits and Barriers of a Community-Based Diabetes Prevention and Management Program.

    PubMed

    Shawley-Brzoska, Samantha; Misra, Ranjita

    2018-03-13

    This study examined the perceptions of benefits of and barriers to participating in a community-based diabetes program to improve program effectiveness. The Diabetes Prevention and Management (DPM) program was a twenty-two session, 1-year program, modeled after the evidence-based National Diabetes Prevention Program and AADE7 Self-Care Behaviors framework. Community-based participatory research approach was used to culturally tailor the curriculum. Participants included overweight or obese adults with dysglycemia. A benefits and barriers survey was developed to gather information on participants' perception of the program, as well as information on demographics and health literacy levels. Eighty-nine adults participated in the DPM program (73% females; 62% diabetic; 77% had adequate health literacy); 79% of participants completed the benefits and barriers survey. Principal component analysis indicated two components representing benefits (Cronbach's α = 0.83) and barriers (α = 0.65). The majority perceived high benefits and low barriers to program participation; benefits included helpful interaction with health coach or program leader (73%), improved lifestyle modification (65%) due to the program, and satisfaction with the program (75%). Open-ended questions confirmed themes related to benefits of program participation, suggestion for programmatic improvements as well as barriers to participation. Participant feedback could be used to guide interventions and tailor future program implementation.

  19. Perceived Benefits and Barriers of a Community-Based Diabetes Prevention and Management Program

    PubMed Central

    Shawley-Brzoska, Samantha; Misra, Ranjita

    2018-01-01

    This study examined the perceptions of benefits of and barriers to participating in a community-based diabetes program to improve program effectiveness. The Diabetes Prevention and Management (DPM) program was a twenty-two session, 1-year program, modeled after the evidence-based National Diabetes Prevention Program and AADE7 Self-Care Behaviors framework. Community-based participatory research approach was used to culturally tailor the curriculum. Participants included overweight or obese adults with dysglycemia. A benefits and barriers survey was developed to gather information on participants’ perception of the program, as well as information on demographics and health literacy levels. Eighty-nine adults participated in the DPM program (73% females; 62% diabetic; 77% had adequate health literacy); 79% of participants completed the benefits and barriers survey. Principal component analysis indicated two components representing benefits (Cronbach’s α = 0.83) and barriers (α = 0.65). The majority perceived high benefits and low barriers to program participation; benefits included helpful interaction with health coach or program leader (73%), improved lifestyle modification (65%) due to the program, and satisfaction with the program (75%). Open-ended questions confirmed themes related to benefits of program participation, suggestion for programmatic improvements as well as barriers to participation. Participant feedback could be used to guide interventions and tailor future program implementation. PMID:29534005

  20. Cost-benefit and cost-savings analyses of antiarrhythmic medication monitoring.

    PubMed

    Snider, Melissa; Carnes, Cynthia; Grover, Janel; Davis, Rich; Kalbfleisch, Steven

    2012-09-15

    The economic impact of pharmacist-managed antiarrhythmic drug therapy monitoring on an academic medical center's electrophysiology (EP) program was investigated. Data were collected for the initial two years of patient visits (n = 816) to a pharmacist-run clinic for antiarrhythmic drug therapy monitoring. A retrospective cost analysis was conducted to assess the direct costs associated with three appointment models: (1) a clinic office visit only, (2) a clinic visit involving electrocardiography and basic laboratory tests, and (3) a clinic visit including pulmonary function testing and chest x-rays in addition to electrocardiography and laboratory testing. A subset of patient cases (n = 18) were included in a crossover analysis comparing pharmacist clinic care and usual care in an EP physician clinic. The primary endpoints were the cost benefits and cost savings associated with pharmacy-clinic care versus usual care. A secondary endpoint was improvement of overall EP program efficiency. The payer mix was 61.6% (n = 498) Medicare, 33.2% (n = 268) managed care, and 5.2% (n = 42) other. Positive contribution margins were demonstrated for all appointment models. The pharmacist-managed clinic also yielded cost savings by reducing overall patient care charges by 21% relative to usual care. By the second year, the pharmacy clinic improved EP program efficiency by scheduling an average of 24 patients per week, in effect freeing up one day per week of EP physician time to spend on other clinical activities. Pharmacist monitoring of antiarrhythmic drug therapy in an out-patient clinic provided cost benefits, cost savings, and improved overall EP program efficiency.

  1. Basic health program: state administration of basic health programs; eligibility and enrollment in standard health plans; essential health benefits in standard health plans; performance standards for basic health programs; premium and cost sharing for basic health programs; federal funding process; trust fund and financial integrity. Final rule.

    PubMed

    2014-03-12

    This final rule establishes the Basic Health Program (BHP), as required by section 1331 of the Affordable Care Act. The BHP provides states the flexibility to establish a health benefits coverage program for low-income individuals who would otherwise be eligible to purchase coverage through the Affordable Insurance Exchange (Exchange, also called Health Insurance Marketplace). The BHP complements and coordinates with enrollment in a QHP through the Exchange, as well as with enrollment in Medicaid and the Children's Health Insurance Program (CHIP). This final rule also sets forth a framework for BHP eligibility and enrollment, benefits, delivery of health care services, transfer of funds to participating states, and federal oversight. Additionally, this final rule amends another rule issued by the Secretary of the Department of Health and Human Services (Secretary) in order to clarify the applicability of that rule to the BHP.

  2. Implementation of a comprehensive pharmaceutical care program for an underserved population.

    PubMed

    Mascardo, Lisa A; Spading, Kimberly A; Abramowitz, Paul W

    2012-07-15

    The implementation of a prescription benefit program for low-income patients emphasizing clinical pharmacist services and strict formulary control is described, with a review of program expenditures and cost avoidance. In 2006, University of Iowa Hospitals and Clinics (UIHC) launched a program to provide a limited prescription benefit to indigent patients under the IowaCare Medicaid demonstration waiver. Sudden dramatic growth in IowaCare enrollment, combined with sharp budget cuts, forced UIHC pharmacy leaders to implement creative cost-control strategies: (1) the establishment of an ambulatory care clinic staffed by a clinical pharmacy specialist, (2) increased reliance on an almost exclusively generic formulary, (3) collaboration with social services staff to help secure medication assistance for patients requiring brand-name drugs, (4) optimized purchasing through the federal 340B Drug Pricing Program, and (5) the imposition of medication copayments and mailing fees for prescription refills. Now in its seventh year, the UIHC pharmacy program has expanded indigent patients' access to pharmaceutical care services while reducing their use of hospital and emergency room services and lowering program medication costs by an estimated 50% (from $2.6 million in fiscal year 2009 to $1.3 million in fiscal year 2010). The UIHC ambulatory care pharmacy implemented a prescription program in collaboration with social service workers to address the medication needs of the state's low-income and uninsured patients in a fiscally responsible manner by managing purchasing contracts, revising a generic formulary, implementing copayments and mailing fees, and reviewing medication profiles.

  3. Perceived barriers, benefits, and motives for physical activity: two primary-care physical activity prescription programs.

    PubMed

    Patel, Asmita; Schofield, Grant M; Kolt, Gregory S; Keogh J, W L

    2013-01-01

    This study examined whether perceived barriers, benefits, and motives for physical activity differed based on allocation to 2 different types of primary-care activity-prescription programs (pedometer-based vs. time-based Green Prescription). Eighty participants from the Healthy Steps study completed a questionnaire that assessed their perceived barriers, benefits, and motives for physical activity. Factor analysis was carried out to identify common themes of barriers, benefits, and motives for physical activity. Factor scores were then used to explore between-groups differences for perceived barriers, benefits, and motives based on group allocation and demographic variables. No significant differences were found in factor scores based on allocation. Demographic variables relating to the existence of chronic health conditions, weight status, and older age were found to significantly influence perceived barriers, benefits, and motives for physical activity. Findings suggest that the addition of a pedometer to the standard Green Prescription does not appear to increase perceived motives or benefits or decrease perceived barriers for physical activity in low-active older adults.

  4. 78 FR 78258 - Duty Periods for Establishing Eligibility for Health Care

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-26

    ...; 64.009, Veterans Medical Care Benefits; 64.010, Veterans Nursing Home Care; 64.014, Veterans State Domiciliary Care; 64.015, Veterans State Nursing Home Care; 64.018, Sharing Specialized Medical Resources; 64...; Health professions; Health records; Homeless; Mental health programs; Nursing homes; Philippines...

  5. 38 CFR 17.272 - Benefits limitations/exclusions.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... MEDICAL Civilian Health and Medical Program of the Department of Veterans Affairs (champva)-Medical Care... required to provide necessary medical care. (7) Services and supplies related to an inpatient admission... center (RTC). (10) Custodial care. (11) Inpatient stays primarily for domiciliary care purposes. (12...

  6. 38 CFR 17.272 - Benefits limitations/exclusions.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... MEDICAL Civilian Health and Medical Program of the Department of Veterans Affairs (champva)-Medical Care... required to provide necessary medical care. (7) Services and supplies related to an inpatient admission... center (RTC). (10) Custodial care. (11) Inpatient stays primarily for domiciliary care purposes. (12...

  7. Food Assistance: Efforts To Control Fraud and Abuse in the Child and Adult Care Food Program Should Be Strengthened. United States General Accounting Office Report to Congressional Committees.

    ERIC Educational Resources Information Center

    Robertson, Robert E.

    The Child and Adult Care Food Program provides over $1.5 billion in benefits annually to children and adults in day care. In order to address the longstanding problems of fraud and abuse present in the program, state agencies have been charged with the responsibility for implementing Food and Nutrition Service's (FNS) regulations to prevent and…

  8. The Sitter Service in Scotland: A Study of the Costs and Benefits. Insight.

    ERIC Educational Resources Information Center

    Wilson, Valerie; Hall, Stuart; Rankin, Nicola; Davidson, Julia; Schad, Dominic

    This report presents the findings of an examination of the costs, benefits, and characteristics of Sitter Services, a program in Scotland offering child care in the child's home to parents working atypical hours or respite care for families of children with developmental disabilities. The study also explored users' and providers' knowledge of the…

  9. Corporate Financial Assistance for Child Care. The Conference Board Research Bulletin No. 177.

    ERIC Educational Resources Information Center

    Friedman, Dana

    Described are four different corporate initiatives that help employees pay for work-related child care expenses: vouchers, discounts, flexible benefit programs and comprehensive cafeteria plans, and flexible spending accounts with salary reduction. Several other options, such as corporate contributions to community programs, subsidizing on-site…

  10. 78 FR 61848 - Agency Information Collection Activities: Proposed Collection; Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-04

    ...) Procedures and Supporting Regulations CMS-R-244 Programs for All-inclusive Care of the Elderly (PACE) and..., Summary of Benefits marketing information) for the purpose of beneficiary education and enrollment. Form... Information Collection: Programs for All-inclusive Care of the Elderly (PACE) and Supporting Regulations; Use...

  11. Iatrogenic disease management: moderating medication errors and risks in a pharmacy benefit management environment.

    PubMed

    Nair, Vinit; Salmon, J Warren; Kaul, Alan F

    2007-12-01

    Disease Management (DM) programs have advanced to address costly chronic disease patterns in populations. This is in part due to the programs' significant clinical and economical value, coupled with interest by pharmaceutical manufacturers, managed care organizations, and pharmacy benefit management firms. While cost containment realizations for many such interventions have been less than anticipated, this article explores potentials in marrying Medication Error Risk Reduction into DM programs within managed care environments. Medication errors are an emergent serious problem now gaining attention in US health policy. They represent a failure within population-based health programs because they remain significant cost drivers. Therefore, medication errors should be addressed in an organized fashion, with DM being a worthy candidate for piggybacking such programs to achieve the best synergistic effects.

  12. Patient Protection and Affordable Care Act; HHS notice of benefit and payment parameters for 2016. Final rule.

    PubMed

    2015-02-27

    This final rule sets forth payment parameters and provisions related to the risk adjustment, reinsurance, and risk corridors programs; cost sharing parameters and cost-sharing reductions; and user fees for Federally-facilitated Exchanges. It also finalizes additional standards for the individual market annual open enrollment period for the 2016 benefit year, essential health benefits, qualified health plans, network adequacy, quality improvement strategies, the Small Business Health Options Program, guaranteed availability, guaranteed renewability, minimum essential coverage, the rate review program, the medical loss ratio program, and other related topics.

  13. 45 CFR 149.200 - Use of reimbursements.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS.... (a) A sponsor must use the proceeds under this program: (1) To reduce the sponsor's health benefit premiums or health benefit costs, (2) To reduce health benefit premium contributions, copayments...

  14. 76 FR 9646 - Copayments for Medications After June 30, 2010

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-22

    ...; 64.008, Veterans Domiciliary Care; 64.009, Veterans Medical Care Benefits; 64.010, Veterans Nursing... Prosthetic Appliances; 64.014, Veterans State Domiciliary Care; 64.015, Veterans State Nursing Home Care; 64...; Medical research; Mental health programs; Nursing homes; Philippines, Reporting and recordkeeping...

  15. The effect of a walking program on perceived benefits and barriers to exercise in postmenopausal African American women.

    PubMed

    Williams, Bernadette R; Bezner, Janet; Chesbro, Steven B; Leavitt, Ronnie

    2006-01-01

    Rates of exercise participation among African Americans is low. Identifying and overcoming perceived benefits/ barriers unique to African American women (AAW) may increase their exercise participation. The purpose of this study was to describe perceived benefits/barriers to exercise in AAW before and after participation in a walking program. Thirty-five postmenopausal AAW participated in a 7-week structured walking program with 2 walking goals. Perceived benefits and barriers to exercise were assessed using the Exercise Benefits/Barriers Scale at the beginning and end of the program. Participants engaged in a postintervention interview to further assess benefits/barriers to exercise participation. Perceived benefits/barriers to exercise did not change significantly with participation in a walking program. Lack of time due to work and family responsibilities affected achievement of the brisk walking goal. Postmenopausal AAW in this study strongly believed in the benefits of exercising and had increased levels of participation in a walking program when lack of time was not a barrier. Overcoming this barrier is the true challenge to health care professionals.

  16. Value-Based Insurance Design Pharmacy Benefits for Children and Youth With Special Health Care Needs: Principles and Opportunities.

    PubMed

    Helm, Mark E

    2017-05-01

    Value-based insurance design (VBID) represents an innovative approach to health insurance coverage. In the context of pharmacy benefits, the goal of VBID is to minimize access barriers to the most effective and appropriate treatments for specific medical conditions. Both private and public insurance programs have explored VBID pharmacy projects primarily for medical conditions affecting adults. To date, evidence for VBID pharmacy programs for children and youth with special health care needs (CYSHCN) appears lacking. There appears to be potential for VBID concepts to be applied to pharmacy coverage benefiting CYSHCN. An overview of VBID pharmacy principles and guiding principles are presented. Opportunities for the creation of pharmacy programs with a value-based orientation and challenges to the redesign of pharmacy benefits are identified. VBID pharmacy coverage principles may be helpful to improve medication use and important clinical outcomes while lowering barriers to medication use for the population of CYSHCN. Pilot projects of VBID pharmacy benefits for children and youth should be explored. However, many questions remain. Copyright © 2017 by the American Academy of Pediatrics.

  17. Cost-benefit study of school nursing services.

    PubMed

    Wang, Li Yan; Vernon-Smiley, Mary; Gapinski, Mary Ann; Desisto, Marie; Maughan, Erin; Sheetz, Anne

    2014-07-01

    In recent years, across the United States, many school districts have cut on-site delivery of health services by eliminating or reducing services provided by qualified school nurses. Providing cost-benefit information will help policy makers and decision makers better understand the value of school nursing services. To conduct a case study of the Massachusetts Essential School Health Services (ESHS) program to demonstrate the cost-benefit of school health services delivered by full-time registered nurses. Standard cost-benefit analysis methods were used to estimate the costs and benefits of the ESHS program compared with a scenario involving no school nursing service. Data from the ESHS program report and other published studies were used. A total of 477 163 students in 933 Massachusetts ESHS schools in 78 school districts received school health services during the 2009-2010 school year. School health services provided by full-time registered nurses. Costs of nurse staffing and medical supplies incurred by 78 ESHS districts during the 2009-2010 school year were measured as program costs. Program benefits were measured as savings in medical procedure costs, teachers' productivity loss costs associated with addressing student health issues, and parents' productivity loss costs associated with student early dismissal and medication administration. Net benefits and benefit-cost ratio were calculated. All costs and benefits were in 2009 US dollars. During the 2009-2010 school year, at a cost of $79.0 million, the ESHS program prevented an estimated $20.0 million in medical care costs, $28.1 million in parents' productivity loss, and $129.1 million in teachers' productivity loss. As a result, the program generated a net benefit of $98.2 million to society. For every dollar invested in the program, society would gain $2.20. Eighty-nine percent of simulation trials resulted in a net benefit. The results of this study demonstrated that school nursing services provided in the Massachusetts ESHS schools were a cost-beneficial investment of public money, warranting careful consideration by policy makers and decision makers when resource allocation decisions are made about school nursing positions.

  18. The German Long-Term Care Insurance Program: Evolution and Recent Developments.

    PubMed

    Nadash, Pamela; Doty, Pamela; von Schwanenflügel, Matthias

    2018-05-08

    Since 1995, Germany has operated one of the longest-running public programs providing universal support for the cost of long term services and supports (LTSS). Its self-funding, social insurance approach provides basic supports to nearly all Germans. We discuss its design and development, including recent reforms expanding the program and ensuring its ongoing sustainability. The study reviews legislative and programmatic changes, using program data, as well as legislative documents and program reports. The program is widely accepted among citizens and has achieved many of its original goals: ensuring access to LTSS and reducing reliance on the locally-funded safety-net social assistance program, which can be used to cover nursing home costs. It also strengthened the LTSS provider infrastructure and expanded access to home care. Recent reforms have addressed some of the program's key issues: the benefit's decreasing value, the eligibility and benefit structure that largely excluded cognitive impairment, and the program's longer-term financial sustainability-particularly its ability to sustain newly expanded benefits, which provide stronger protections to caregivers, index-link benefits, and more systematically incorporate cognitive impairment via a new assessment system. It has addressed financing issues by increasing premiums, introducing subsidies for the purchase of private insurance, and creating a "demographic reserve fund." The reforms constitute a significant strengthening of the program, remarkable in an era of retrenchment. Overall, the program provides evidence for the financial viability of a social insurance model, although longer-term challenges may yet arise.

  19. Patient Protection and Affordable Care Act; establishment of the Multi-State Plan Program for the Affordable Insurance Exchanges. Final rule.

    PubMed

    2014-02-24

    The U.S. Office of Personnel Management (OPM) is issuing a final rule implementing modifications to the Multi-State Plan (MSP) Program based on the experience of the Program to date. OPM established the MSP Program pursuant to the Affordable Care Act. This rule clarifies the approach used to enforce the applicable standards of the Affordable Care Act with respect to health insurance issuers that contract with OPM to offer MSP options; amends MSP standards related to coverage area, benefits, and certain contracting provisions under section 1334 of the Affordable Care Act; and makes non-substantive technical changes.

  20. Cost considerations for long-term ecological monitoring

    USGS Publications Warehouse

    Caughlan, L.; Oakley, K.L.

    2001-01-01

    For an ecological monitoring program to be successful over the long-term, the perceived benefits of the information must justify the cost. Financial limitations will always restrict the scope of a monitoring program, hence the program's focus must be carefully prioritized. Clearly identifying the costs and benefits of a program will assist in this prioritization process, but this is easier said than done. Frequently, the true costs of monitoring are not recognized and are, therefore, underestimated. Benefits are rarely evaluated, because they are difficult to quantify. The intent of this review is to assist the designers and managers of long-term ecological monitoring programs by providing a general framework for building and operating a cost-effective program. Previous considerations of monitoring costs have focused on sampling design optimization. We present cost considerations of monitoring in a broader context. We explore monitoring costs, including both budgetary costs--what dollars are spent on--and economic costs, which include opportunity costs. Often, the largest portion of a monitoring program budget is spent on data collection, and other, critical aspects of the program, such as scientific oversight, training, data management, quality assurance, and reporting, are neglected. Recognizing and budgeting for all program costs is therefore a key factor in a program's longevity. The close relationship between statistical issues and cost is discussed, highlighting the importance of sampling design, replication and power, and comparing the costs of alternative designs through pilot studies and simulation modeling. A monitoring program development process that includes explicit checkpoints for considering costs is presented. The first checkpoint occur during the setting of objectives and during sampling design optimization. The last checkpoint occurs once the basic shape of the program is known, and the costs and benefits, or alternatively the cost-effectiveness, of each program element can be evaluated. Moving into the implementation phase without careful evaluation of costs and benefits is risky because if costs are later found to exceed benefits, the program will fail. The costs of development, which can be quite high, will have been largely wasted. Realistic expectations of costs and benefits will help ensure that monitoring programs survive the early, turbulent stages of development and the challenges posed by fluctuating budgets during implementation.

  1. 49 CFR 25.440 - Health and insurance benefits and services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 1 2011-10-01 2011-10-01 false Health and insurance benefits and services. 25.440... Basis of Sex in Education Programs or Activities Prohibited § 25.440 Health and insurance benefits and... coverage health service shall provide gynecological care. ...

  2. Advantages of the net benefit regression framework for economic evaluations of interventions in the workplace: a case study of the cost-effectiveness of a collaborative mental health care program for people receiving short-term disability benefits for psychiatric disorders.

    PubMed

    Hoch, Jeffrey S; Dewa, Carolyn S

    2014-04-01

    Economic evaluations commonly accompany trials of new treatments or interventions; however, regression methods and their corresponding advantages for the analysis of cost-effectiveness data are not well known. To illustrate regression-based economic evaluation, we present a case study investigating the cost-effectiveness of a collaborative mental health care program for people receiving short-term disability benefits for psychiatric disorders. We implement net benefit regression to illustrate its strengths and limitations. Net benefit regression offers a simple option for cost-effectiveness analyses of person-level data. By placing economic evaluation in a regression framework, regression-based techniques can facilitate the analysis and provide simple solutions to commonly encountered challenges. Economic evaluations of person-level data (eg, from a clinical trial) should use net benefit regression to facilitate analysis and enhance results.

  3. Mobile Technology Applications in Cancer Palliative Care.

    PubMed

    Freire de Castro Silva, Sandro Luís; Gonçalves, Antônio Augusto; Cheng, Cezar; Fernandes Martins, Carlos Henrique

    2018-01-01

    Mobile devices frequently used in other specialties can find great utility in palliative care. For healthcare professionals, the use of mobile technology not only can bring additional resources to the care, but it can actually radically change the cancer remote care practices. The Brazilian National Cancer Institute (INCA) has developed the largest cancer home care program in Latin America, which currently benefits more than 500 patients. The purpose of this paper is to show the development of an ICT environment of mobile applications developed to support the palliative cancer care program at INCA.

  4. Broadening Your Employee Benefit Portfolio.

    ERIC Educational Resources Information Center

    Blaski, Nancy J.; And Others

    1989-01-01

    Cost increases and realization of the diverse needs of employees have prompted organizations to review the cost and value of employee benefits. Examines alternatives including "cafeteria plans," managed care programs, and disability income plans. (MLF)

  5. Unique issues raised by drug benefit design.

    PubMed

    Berndt, Ernst R

    2004-01-01

    In this Perspective on the preceding paper by Joseph Newhouse, I point out a number of features of the pharmaceutical industry that differentiate it from other health care sectors. These differences help explain why it has proved to be so very difficult to construct policies that simultaneously contain health care costs, provide patients with high-quality care, and generate continued incentives for innovation. I then summarize Newhouse's preferred Medicare prescription drug benefit program and the issues it raises.

  6. Strategic and Sustainable Communications in Support of Elder Care Benefits (Part 2 of a Working Caregivers Feature)

    ERIC Educational Resources Information Center

    Federico, Richard

    2004-01-01

    Many employers today have work/life programs and benefits in place to assist their employees in maintaining a healthy balance between their job duties and the responsibilities they bear in their daily lives. One such responsibility with which aging baby boomers are increasingly being charged is caring for an elderly loved one. Although many…

  7. Understanding the Impacts of the Medicare Modernization Act: Concerns of Congressional Staff

    ERIC Educational Resources Information Center

    Mueller, Keith J.; Coburn, Andrew F.; MacKinney, Clinton; McBride, Timothy D.; Slifkin, Rebecca T.; Wakefield, Mary K.

    2005-01-01

    Sweeping changes to the Medicare program embodied in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), including a new prescription drug benefit, changes in payment policies, and reform of the Medicare managed-care program, have major implications for rural health care. The most efficient mechanism for research to…

  8. Do You See What I See? Understanding Filipino Elderly's Needs, Benefits, and Expectations from an Adult Continuing Education Program

    ERIC Educational Resources Information Center

    Escolar Chua, Rowena L.; de Guzman, Allan B.

    2014-01-01

    As the elderly population increases, encouraging older adults to participate in lifelong learning has become a priority for many countries. Properly structured lifelong learning programs have consistently yielded numerous benefits to older adults; therefore, careful attention and effort should be exerted to ensure its effectiveness by involving…

  9. Nurse-midwives in federally funded health centers: understanding federal program requirements and benefits.

    PubMed

    Carter, Martha

    2012-01-01

    Midwives are working in federally funded health centers in increasing numbers. Health centers provide primary and preventive health care to almost 20 million people and are located in every US state and territory. While health centers serve the entire community, they also serve as a safety net for low-income and uninsured individuals. In 2010, 93% of health center patients had incomes below 200% of the Federal Poverty Guidelines, and 38% were uninsured. Health centers, including community health centers, migrant health centers, health care for the homeless programs, and public housing primary care programs, receive grant funding and enjoy other benefits due to status as federal grantees and designation as federally qualified health centers. Clinicians working in health centers are also eligible for financial and professional benefits because of their willingness to serve vulnerable populations and work in underserved areas. Midwives, midwifery students, and faculty working in, or interacting with, health centers need to be aware of the regulations that health centers must comply with in order to qualify for and maintain federal funding. This article provides an overview of health center regulations and policies affecting midwives, including health center program requirements, scope of project policy, provider credentialing and privileging, Federal Tort Claims Act malpractice coverage, the 340B Drug Pricing Program, and National Health Service Corps scholarship and loan repayment programs. © 2012 by the American College of Nurse-Midwives.

  10. Coordination of health coverage for Medicare enrollees: living with HIV/AIDS in California.

    PubMed

    Eichner, J; Kahn, J G

    2001-08-01

    Because Medicare does not cover a large part of the health care that its enrollees living with HIV/AIDS require, they need other coverage to supplement Medicare. Medicaid is a major source of that supplemental coverage. In California, Medicare enrollees with HIV/AIDS who were also enrolled in Medi-Cal (California's Medicaid program) had total payments from both programs of $177 million, or an average of $28,956 per person in the fee-for-service-system in 1998. Of that total, Medicare paid for 38 percent, mainly for inpatient visits and ambulatory care, while Medi-Cal paid 62 percent, mainly for prescription drugs. For these dual enrollees, many of Medicare's benefit gaps--including a large share of prescription drugs, nursing facility services and home care--are being filled by Medi-Cal. Data in this Medicare Brief indicate that the incremental cost to the federal government of filling gaps in the Medicare benefits package would be considerably less than the full cost of the additional benefits. Through Medicaid and other programs, the federal government is already paying a substantial part of public program expenditures for dual enrollees with HIV/AIDS. Other issues to consider are how the dual Medicare-Medicaid funding streams affect the programs' cost efficiency, and from the perspective of Medicare enrollees and providers, how well the dual programs coordinate to meet the needs of people with HIV/AIDS and other chronic conditions.

  11. Taking Care of the Kids: The Corporate Role in Providing Child Care.

    ERIC Educational Resources Information Center

    Friedman, Dana E.

    1985-01-01

    More and more people are beginning to look to their employers for a solution to the child care dilemma. Various types of employer supported child care are described, including day care centers, after school programs, summer day camps, financial assistance, flexible benefit plans, and information and referral services. (CB)

  12. Who Cares for Kids? A Report on Child Care Providers.

    ERIC Educational Resources Information Center

    Benson, Carolyn

    This study offers a profile of child care workers in family day care homes and child care centers, reporting general statistics and examining their wages, benefits, training, working conditions, and turnover rates. In addition, it looks at government regulation and licensing, employer-sponsored programs, child abuse, insurance rates, and federal…

  13. 42 CFR 409.31 - Level of care requirement.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Level of care requirement. 409.31 Section 409.31... PROGRAM HOSPITAL INSURANCE BENEFITS Requirements for Coverage of Posthospital SNF Care § 409.31 Level of... the supervision of, such personnel. (b) Specific conditions for meeting level of care requirements. (1...

  14. Access to Federal Employees Health Benefits (FEHB) for Employees of Certain Indian Tribal Employers. Final rule.

    PubMed

    2016-12-28

    This final rule makes Federal employee health insurance accessible to employees of certain Indian tribal entities. Section 409 of the Indian Health Care Improvement Act (codified at 25 U.S.C. 1647b) authorizes Indian tribes, tribal organizations, and urban Indian organizations that carry out certain programs to purchase coverage, rights, and benefits under the Federal Employees Health Benefits (FEHB) Program for their employees. Tribal employers and tribal employees will be responsible for the full cost of benefits, plus an administrative fee.

  15. 42 CFR 403.702 - Definitions and terms.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... means individuals who are grounded in the religious beliefs of the RNHCI, trained and experienced in the... PROVISIONS SPECIAL PROGRAMS AND PROJECTS Religious Nonmedical Health Care Institutions-Benefits, Conditions... for religious reasons. Excepted medical care means medical care that is received involuntarily or...

  16. 42 CFR 403.702 - Definitions and terms.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... means individuals who are grounded in the religious beliefs of the RNHCI, trained and experienced in the... PROVISIONS SPECIAL PROGRAMS AND PROJECTS Religious Nonmedical Health Care Institutions-Benefits, Conditions... for religious reasons. Excepted medical care means medical care that is received involuntarily or...

  17. 42 CFR 403.702 - Definitions and terms.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... means individuals who are grounded in the religious beliefs of the RNHCI, trained and experienced in the... PROVISIONS SPECIAL PROGRAMS AND PROJECTS Religious Nonmedical Health Care Institutions-Benefits, Conditions... for religious reasons. Excepted medical care means medical care that is received involuntarily or...

  18. 42 CFR 403.702 - Definitions and terms.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... means individuals who are grounded in the religious beliefs of the RNHCI, trained and experienced in the... PROVISIONS SPECIAL PROGRAMS AND PROJECTS Religious Nonmedical Health Care Institutions-Benefits, Conditions... for religious reasons. Excepted medical care means medical care that is received involuntarily or...

  19. 42 CFR 403.702 - Definitions and terms.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... means individuals who are grounded in the religious beliefs of the RNHCI, trained and experienced in the... PROVISIONS SPECIAL PROGRAMS AND PROJECTS Religious Nonmedical Health Care Institutions-Benefits, Conditions... for religious reasons. Excepted medical care means medical care that is received involuntarily or...

  20. Pharmacy Utilization and the Medicare Modernization Act

    PubMed Central

    Maio, Vittorio; Pizzi, Laura; Roumm, Adam R; Clarke, Janice; Goldfarb, Neil I; Nash, David B; Chess, David

    2005-01-01

    To control expenditures and use medications appropriately, the Medicare drug coverage program has established pharmacy utilization management (PUM) measures. This article assesses the effects of these strategies on the care of seniors. The literature suggests that although caps on drug benefits lower pharmaceutical costs, they may also increase the use of other health care services and hurt health outcomes. Our review raises concerns regarding the potential unintended effects of the Medicare drug program's PUM policies for beneficiaries. Therefore, the economic and clinical impact of PUM measures on seniors should be studied further to help policymakers design better drug benefit plans. PMID:15787955

  1. 78 FR 42159 - Medicaid and Children's Health Insurance Programs: Essential Health Benefits in Alternative...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-15

    ...This final rule implements provisions of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the Affordable Care Act. This final rule finalizes new Medicaid eligibility provisions; finalizes changes related to electronic Medicaid and the Children's Health Insurance Program (CHIP) eligibility notices and delegation of appeals; modernizes and streamlines existing Medicaid eligibility rules; revises CHIP rules relating to the substitution of coverage to improve the coordination of CHIP coverage with other coverage; and amends requirements for benchmark and benchmark- equivalent benefit packages consistent with sections 1937 of the Social Security Act (which we refer to as ``alternative benefit plans'') to ensure that these benefit packages include essential health benefits and meet certain other minimum standards. This rule also implements specific provisions including those related to authorized representatives, notices, and verification of eligibility for qualifying coverage in an eligible employer-sponsored plan for Affordable Insurance Exchanges. This rule also updates and simplifies the complex Medicaid premium and cost sharing requirements, to promote the most effective use of services, and to assist states in identifying cost sharing flexibilities. It includes transition policies for 2014 as applicable.

  2. 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

  3. Effectiveness of a video-based aging services technology education program for health care professionals.

    PubMed

    Weakley, Alyssa; Tam, Joyce W; Van Son, Catherine; Schmitter-Edgecombe, Maureen

    2017-01-19

    Health care professionals (HCPs) are a critical source of recommendations for older adults. Aging services technologies (ASTs), which include devices to support the health-care needs of older adults, are underutilized despite evidence for improving functional outcomes and safety and reducing caregiver burden and health costs. This study evaluated a video-based educational program aimed at improving HCP awareness of ASTs. Sixty-five HCPs viewed AST videos related to medication management, daily living, and memory. Following the program, participants' objective and perceived AST knowledge improved, as did self-efficacy and anticipated AST engagement. About 95% of participants stated they were more likely to recommend ASTs postprogram. Participants benefitted equally regardless of years of experience or previous AST familiarity. Furthermore, change in self-efficacy and perceived knowledge were significant predictors of engagement change. Overall, the educational program was effective in improving HCPs' awareness of ASTs and appeared to benefit all participants regardless of experience and prior knowledge.

  4. 77 FR 71174 - Proposed Collection; Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-29

    ...-0039. Title; Associated Form; and OMB Number: Continued Health Care Benefit Program, DD Form 2837; OMB... order to be eligible for health care coverage under CHCBP, an individual must first enroll in CHCBP. DD...

  5. Aquatic exercise for residential aged care adults with dementia: benefits and barriers to participation.

    PubMed

    Henwood, Timothy; Neville, Christine; Baguley, Chantelle; Beattie, Elizabeth

    2017-09-01

    Pilot work by our group has demonstrated that aquatic exercise has valuable functional and psychosocial benefits for adults living in the residential aged care setting with dementia. The aim of the currents study was to advance this work by delivering the Watermemories Swimming Club aquatic exercise program to a more representative population of older, institutionalized adults with dementia. The benefits of 12 weeks of twice weekly participation in the Watermemories Swimming Club aquatic exercise program were assessed among an exercise and usual care control group of residential aged care adults with advanced dementia. A battery of physical and psychosocial measures were collected before and after the intervention period, and program implementation was also investigated. Seven residential aged care facilities of 24 approached, agreed to participate and 56 residents were purposefully allocated to exercise or control. Twenty-three participants per group were included in the final analysis. Both groups experienced decreases in skeletal muscle index and lean mass (p < 0.001), but exercise stifled losses in muscle strength and transition into sarcopenic. Behavioral and psychological symptoms of dementia and activities of daily living approached significance (p = 0.06) with positive trends observed across other psychosocial measures. This study demonstrates the value of exercise participation, and specifically aquatic exercise in comparison to usual care for older, institutionalized adults with advanced dementia. However, it also highlights a number of barriers to participation. To overcome these barriers and ensure opportunity to residents increased provider and sector support is required.

  6. Medicaid and Children's Health Insurance Programs: essential health benefits in alternative benefit plans, eligibility notices, fair hearing and appeal processes, and premiums and cost sharing; exchanges: eligibility and enrollment. Final rule.

    PubMed

    2013-07-15

    This final rule implements provisions of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the Affordable Care Act. This final rule finalizes new Medicaid eligibility provisions; finalizes changes related to electronic Medicaid and the Children's Health Insurance Program (CHIP) eligibility notices and delegation of appeals; modernizes and streamlines existing Medicaid eligibility rules; revises CHIP rules relating to the substitution of coverage to improve the coordination of CHIP coverage with other coverage; and amends requirements for benchmark and benchmark-equivalent benefit packages consistent with sections 1937 of the Social Security Act (which we refer to as ``alternative benefit plans'') to ensure that these benefit packages include essential health benefits and meet certain other minimum standards. This rule also implements specific provisions including those related to authorized representatives, notices, and verification of eligibility for qualifying coverage in an eligible employer-sponsored plan for Affordable Insurance Exchanges. This rule also updates and simplifies the complex Medicaid premium and cost sharing requirements, to promote the most effective use of services, and to assist states in identifying cost sharing flexibilities. It includes transition policies for 2014 as applicable.

  7. 78 FR 12427 - Medicare Program; Medical Loss Ratio Requirements for the Medicare Advantage and the Medicare...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-22

    ...This proposed rule would implement medical loss ratio (MLR) requirements for the Medicare Advantage Program and the Medicare Prescription Drug Benefit Program under the Patient Protection and Affordable Care Act.

  8. Health Promotion: Contributions of Nursing; Benefits for Clients. Midwest Alliance in Nursing Annual Program Meeting (6th, St. Louis, Missouri, April 18-19, 1985).

    ERIC Educational Resources Information Center

    Minckley, Barbara B., Ed.; Young, Lu Ann, Ed.

    Focusing on innovative and cost-effective alternatives to traditional, custodial, and institutional health care systems, the papers in these proceedings identify the contributions of nursing and the benefits for patients of the new national emphasis on cost-effective health care. The proceedings contain: (1) "Trends in Health Promotion:…

  9. The evolving role of health care organizations in research.

    PubMed

    Tuttle, W C; Piland, N F; Smith, H L

    1988-01-01

    Many hospitals and health care organizations are contending with fierce financial and competitive pressures. Consequently, programs that do not make an immediate contribution to master strategy are often overlooked in the strategic management process. Research programs are a case in point. Basic science, clinical, and health services research programs may help to create a comprehensive and fundamentally sound master strategy. This article discusses the evolving role of health care organizations in research relative to strategy formulation. The primary costs and benefits from participating in research programs are examined. An agenda of questions is presented to help health care organizations determine whether they should incorporate health-related research as a key element in their strategy.

  10. A Great Place to Work: Improving Conditions for Staff in Young Children's Programs.

    ERIC Educational Resources Information Center

    Jorde-Bloom, Paula

    This book discusses important issues of the day care profession. Topics include evaluation of the work place and the improvement of the day care environment for the benefit of staff, parents, and children. Organizational climate is considered in terms of the different types of early childhood programs and their relationship to current knowledge…

  11. Modernizing Medicare's Benefit Design and Low-Income Subsidies to Ensure Access and Affordability.

    PubMed

    Schoen, Cathy; Davis, Karen; Buttorff, Christine; Andersen, Martin

    2015-07-01

    Insurance coverage through the traditional Medicare program is complex, fragmented, and incomplete. Beneficiaries must purchase supplemental private insurance to fill in the gaps. While impoverished beneficiaries may receive supplemental coverage through Medicaid and subsidies for prescription drugs, help is limited for people with incomes above the poverty level. This patchwork quilt leads to confusion for beneficiaries and high administrative costs, while also undermining coverage and care coordination. Most important, Medicare's benefits fail to limit out-of-pocket costs or ensure adequate financial protection, especially for beneficiaries with low incomes and serious health problems. This brief, part of a series about Medicare's past, present, and future, presents options for an integrated benefit for enrollees in traditional Medicare. The new benefit would not only reduce cost burdens but also could potentially strengthen the Medicare program and enhance its role in stimulating and supporting innovations throughout the health care delivery system.

  12. 78 FR 76061 - Authorization for Non-VA Medical Services

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-16

    ..., Health professions, Health records, Homeless, Mental health programs, Nursing homes, Reporting and... final rule adopts the proposed rule without changes. We received several comments urging VA to expand....009, Veterans Medical Care Benefits; 64.010, Veterans Nursing Home Care; 64.011, Veterans Dental Care...

  13. Behavioral economics holds potential to deliver better results for patients, insurers, and employers.

    PubMed

    Loewenstein, George; Asch, David A; Volpp, Kevin G

    2013-07-01

    Many programs being implemented by US employers, insurers, and health care providers use incentives to encourage patients to take better care of themselves. We critically review a range of these efforts and show that many programs, although well-meaning, are unlikely to have much impact because they require information, expertise, and self-control that few patients possess. As a result, benefits are likely to accrue disproportionately to patients who already are taking adequate care of their health. We show how these programs could be made more effective through the use of insights from behavioral economics. For example, incentive programs that offer patients small and frequent payments for behavior that would benefit the patients, such as medication adherence, can be more effective than programs with incentives that are far less visible because they are folded into a paycheck or used to reduce a monthly premium. Deploying more-nuanced insights from behavioral economics can lead to policies with the potential to increase patient engagement and deliver dividends for patients and favorable cost-effectiveness ratios for insurers, employers, and other relevant commercial entities.

  14. Misperceptions of medicaid ineligibility persist among African American caregivers of Alzheimer's dementia care recipients.

    PubMed

    Kingsberry, Sheridan Quarless; Mindler, Philinda

    2012-06-01

    African American caregivers of the elderly, including those who care for patients with Alzheimer's and other forms of dementia, remain underserved by Medicaid Assistance Programs. The purpose of this exploratory study was to ascertain to what degree participants in an Alzheimer's Association program that primarily targeted African Americans applied for and received Medicaid assistance, in particular for adult day care, in-home care, and respite care. Secondary data from the Delaware Regional Office of the Alzheimer's Association's 2006 Caregiver Survey of 38 caregivers were reviewed using descriptive, chi-square, and logistic regression analysis. Results indicate that 20 caregivers applied for Medicaid services, 12 of whom were approved. However, 18 caregivers did not apply for Medicaid mainly because they perceived that they would not qualify for benefits, without investigating their eligibility. Clearly more education is needed in African American communities about the eligibility requirements and benefits of Medicaid Assistance Programs because services such as adult day care, in-home care, and respite care have been shown to reduce some of the burden, stress, and strain associated with caring for elderly patients with Alzheimer's dementia. However, a multisystem approach should be used in the outreach and education processes. Finally, the Medicaid application process should be streamlined to make it less cumbersome. More financial and support services are needed by African American caregivers of Alzheimer's care recipients.

  15. Respite care services for children with special healthcare needs: Parental perceptions.

    PubMed

    Whitmore, Kim E; Snethen, Julia

    2018-04-26

    Parents of children with special healthcare needs may become overwhelmed with the ongoing caregiving needs of their children. Caring for a child with special healthcare needs is often challenging, requiring specialized training in many cases. As a result, parents can struggle to find qualified caregivers capable of providing them a break from the 24/7 care of their child. Respite care programs are designed to provide caregivers with a much-needed temporary break. The purpose of this study was to examine parental perceptions of utilizing a respite care program. Twenty-two parents who had a child with special healthcare needs who attended a Midwestern respite care program completed a Participant Characteristic Form addressing their experiences caring for their child with special healthcare needs and using respite care services. Parents participated in a focus group (N = 4) to explore their perceptions and experiences of respite care participation. Multistage thematic analysis and descriptive statistics were used to analyze the data. Themes emerging from the data included: Constant care demands; It is just so stressful; Respite is a gift, we get a break; Respite program "fit"; and Respite is their special time too. Parents emphasized the benefits of respite care for their marital relationship, as well as the benefits to the children with special healthcare needs and their siblings. Parents also described the importance of tailoring respite care to the unique needs of their family. Nurses and other healthcare professionals play a critical role in addressing the unmet respite care needs of parents of children with special healthcare needs by identifying unmet needs and making appropriate referrals to services that will meet the unique needs of the family. Healthcare professionals can also volunteer with existing programs to help expand access to respite care services and increase the availability of adequately trained respite care providers whom parents can trust to provide for the complex healthcare needs of their children. © 2018 Wiley Periodicals, Inc.

  16. 42 CFR 418.25 - Admission to hospice care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Admission to hospice care. 418.25 Section 418.25... (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Eligibility, Election and Duration of Benefits § 418.25 Admission to hospice care. (a) The hospice admits a patient only on the recommendation of the medical director...

  17. Child Care Is Good Business: A Manual on Employer Supported Child Care.

    ERIC Educational Resources Information Center

    Haas, Karen S.

    Many companies today consider employer-sponsored child care a viable solution to problems facing employees who are also parents. Companies can choose from many program options, each with particular benefits for employer and employees. This manual highlights what is presently happening in employer-supported child care, particularly the cost…

  18. Employer-Supported Child Care: Investing in Human Resources.

    ERIC Educational Resources Information Center

    Burud, Sandra L.; And Others

    This book for employers interested in establishing child care programs is organized into five major topic areas. Part One provides an overview of employer-supported child care. Part Two discusses the processes of identifying and estimating benefits of child care to companies, and tax considerations. Part Three presents practical guidelines and a…

  19. Complementary health care: a welcome addition to an employee benefits program.

    PubMed

    DeVries, George

    2003-09-01

    One up-and-coming approach to controlling health care costs is complementary health care, which does not rely on advances in high-tech, invasive technology or expensive new pharmaceuticals, but rather focuses much more on the high-touch, direct practitioner care. It often offers lower cost alternatives to traditional medicine.

  20. Benefits for Children with Disabilities

    MedlinePlus

    ... with disabilities 10 Medicaid and Medicare 12 Children’ s Health Insurance Program 12 Other health care services 13 Introduction ... a child is in a medical facility, and health insurance pays for his or her care. SSI rules ...

  1. Safety and cost benefit of an ambulatory program for patients with low-risk neutropenic fever at an Australian centre.

    PubMed

    Teh, Benjamin W; Brown, Christine; Joyce, Trish; Worth, Leon J; Slavin, Monica A; Thursky, Karin A

    2018-03-01

    Neutropenic fever (NF) is a common complication of cancer chemotherapy. Patients at low risk of medical complications from NF can be identified using a validated risk assessment and managed in an outpatient setting. This is a new model of care for Australia. This study described the implementation of a sustainable ambulatory program for NF at a tertiary cancer centre over a 12-month period. Peter MacCallum Cancer Centre introduced an ambulatory care program in 2014, which identified low-risk NF patients, promoted early de-escalation to oral antibiotics, and early discharge to a nurse-led ambulatory program. Patients prospectively enrolled in the ambulatory program were compared with a historical-matched cohort of patients from 2011 for analysis. Patient demographics, clinical variables (cancer type, recent chemotherapy, treatment intent, site of presentation) and outcomes were collected and compared. Total cost of inpatient admissions was determined from diagnosis-related group (DRG) codes and applied to both the prospective and historical cohorts to allow comparisons. Twenty-five patients were managed in the first year of this program with a reduction in hospital median length of stay from 4.0 to 1.1 days and admission cost from Australian dollars ($AUD) 8580 to $AUD2360 compared to the historical cohort. Offsetting salary costs, the ambulatory program had a net cost benefit of $AUD 71895. Readmission for fever was infrequent (8.0%), and no deaths were reported. Of relevance to hospitals providing cancer care, feasibility, safety, and cost benefits of an ambulatory program for low-risk NF patients have been demonstrated.

  2. Incentives for healthy behaviors: experience from Florida Medicaid's Enhanced Benefit Rewards program.

    PubMed

    Hall, Allyson G; Lemak, Christy Harris; Landry, Amy Yarbrough; Duncan, R Paul

    2013-04-01

    Engaging individuals in their own health care proves challenging for policy makers, health plans, and providers. Florida Medicaid introduced the Enhanced Benefits Rewards (EBR) program in 2006, providing financial incentives as rewards to beneficiaries who engage in health care seeking and healthy behaviors. This study analyzed beneficiary survey data from 2009 to determine predictors associated with awareness of and participation in the EBR program. Non-English speakers, those in a racial and ethnic minority group, those with less than a high school education, and those with limited or no connection to a health care provider were associated with lower awareness of the program. Among those aware of the program, these factors were also associated with reduced likelihood of engaging in the program. Individuals in fair or poor health were also less likely to engage in an approved behavior. Individuals who speak Spanish at home and those without a high school diploma were more likely than other groups to spend their earned program credits. Findings underscore the fact that initial engagement in such a program can prove challenging as different groups are not equally likely to be aware of or participate in an approved activity or redeem a credit. Physicians may play important roles in encouraging participation in programs to incentivize healthy behaviors.

  3. Stakeholder benefit from depression disease management: differences by rurality?

    PubMed

    Xu, Stanley; Rost, Kathryn; Dong, Fran; Dickinson, L Miriam

    2011-01-01

    Despite increasing consensus about the value of depression disease management programs, the field has not identified which stakeholders should absorb the relatively small additional costs associated with these programs. This paper investigates whether two proposed stakeholders (health plans and employer purchasers) economically benefit from depression care management (reduced outpatient utilization and work costs, respectively) in two delivery systems (rural and urban). This study examined the main and differential effects of depression care management on outpatient utilization and work costs over 24 months in a preplanned secondary analysis of 479 depressed patients from rural and urban primary care practices in a randomized controlled trial. Over 24 months, the intervention did not significantly reduce outpatient utilization costs in the entire cohort (-$191, 95% confidence interval (CI)=-$2,083 to $1,647), but it did decrease work costs (-$1,970, 95% CI=-$3,934 to -$92). While not statistically significant, rural-urban differences in work costs were in the same direction, while rural-urban differences in utilization costs differed in direction. These findings provide preliminary evidence that employers who elect to cover depression care management costs should receive comparable economic benefits in the rural and urban employees they insure. Given the limited sample size, further research may be needed to determine whether health plans who elect to cover depression care management costs will receive comparable economic benefits in the rural and urban enrollees they insure.

  4. An Analysis Of The Benefits And Application Of Earned Value Management (EVM) Project Management Techniques For Dod Programs That Do Not Meet Dod Policy Thresholds

    DTIC Science & Technology

    2017-12-01

    carefully to ensure only minimum information needed for effective management control is requested.  Requires cost-benefit analysis and PM...baseline offers metrics that highlights performance treads and program variances. This information provides Program Managers and higher levels of...The existing training philosophy is effective only if the managers using the information have well trained and experienced personnel that can

  5. An evaluative study of the benefits of participating in intergenerational playgroups in aged care for older people.

    PubMed

    Skropeta, C Margaret; Colvin, Alf; Sladen, Shannon

    2014-10-08

    Intergenerational playgroups in aged care are limited and little is known about the perceptions of individuals who have participated in such programs. Most research is focused on intergenerational programs that involved two generations of people--young people and older people or young people and people with dementia reported the significant outcomes for each group of participants. In this study a number of generations participated in the intergenerational playgroup intervention that included older people, child carers who were parents, grandparents or nannies and children aged 0-4 years old. The objective of this study was to explore the benefits of participating in an intergenerational playgroup program IPP in an aged care facility. This mixed methods quantitative and qualitative design explored the benefits of participating in an intergenerational playgroup program IPP in aged care settings. The intervention is an intergenerational playgroup program (IPP) offered in the aged care facility where intergenerational socialisation and interaction occurred between different generations. The SF36 and Geriatric Depression Scale (GDS) were used to collect pre-test post test data. The qualitative interpretive research approach used semi-structured interviews to develop the descriptive interpretation of the intergenerational playgroup experience. Interviews were conducted with aged care residents and child carers. The pre-test post-test results for the SF36 revealed a declining trend in one scale only energy/fatigue and no significant differences on the Geriatric Depression Scale GDS. The interview analyses revealed the following themes (1) intergenerational experiences, (2) two-way contributions, (3) friendships work, (4) personal growth, and (5) environmental considerations and nineteen subthemes were extracted to provide meanings. The IPP provided a successful innovative intergenerational program intervention where older people and people with dementia interacted and connected with a number of people from different generations. The IPP provided meaningful engagement for all participants considered important for self-esteem and the ability to participate fully in society. This allowed people to develop a sense of connectedness and friendships in a safe and secure environment. This increased the dignity of older people and people with dementia within the community and increased public awareness about the existing care and support services available to them.

  6. 77 FR 42185 - Rural Health Care Support Mechanism

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-18

    ... FEDERAL COMMUNICATIONS COMMISSION 47 CFR Part 54 [WC Docket No. 02-60; FCC 12-74] Rural Health... responsible basis for specific Rural Health Care Pilot Program participants that have exhausted their funding... participants' connectivity and the resulting health care benefits that patients receive from those investments...

  7. Psychosocial stress and cardiovascular disease. Part 3: Clinical and policy implications of research on the transcendental meditation program.

    PubMed

    Walton, Kenneth G; Schneider, Robert H; Salerno, John W; Nidich, Sanford I

    2005-01-01

    Cardiovascular disease (CVD) remains the leading cause of death in the United States today and a major contributor to total health care costs. Psychosocial stress has been implicated in CVD, and psychosocial approaches to primary and secondary prevention are gaining research support. This third article in the series on psychosocial stress and CVD continues the evaluation of one such approach, the Maharishi Transcendental Meditation program, a psychophysiological approach from the Vedic tradition that is systematically taught by qualified teachers throughout the world. Evidence suggests not only that this program can provide benefits in prevention but also that it may reduce CVD-related and other health care expenses. On the basis of data from the studies available to date, the Transcendental Meditation program may be responsible for reductions of 80% or greater in medical insurance claims and payments to physicians. This article evaluates the implications of research on the Transcendental Meditation program for health care policy and for large-scale clinical implementation of the program. The Transcendental Meditation program can be used by individuals of any ethnic or cultural background, and compliance with the practice regimen is generally high. The main steps necessary for wider adoption appear to be: (1) educating health care providers and patients about the nature and expected benefits of the program, and (2) adjustments in public policies at the state and national levels to allow this program to be included in private and public health insurance plans.

  8. 42 CFR 422.320 - Special rules for hospice care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... (CONTINUED) MEDICARE PROGRAM MEDICARE ADVANTAGE PROGRAM Payments to Medicare Advantage Organizations § 422... her enrollment in the MA plan and is entitled to receive, through the MA plan, any benefits other than...

  9. A web-based nutrition program reduces health care costs in employees with cardiac risk factors: before and after cost analysis.

    PubMed

    Sacks, Naomi; Cabral, Howard; Kazis, Lewis E; Jarrett, Kelli M; Vetter, Delia; Richmond, Russell; Moore, Thomas J

    2009-10-23

    Rising health insurance premiums represent a rapidly increasing burden on employer-sponsors of health insurance and their employees. Some employers have become proactive in managing health care costs by providing tools to encourage employees to directly manage their health and prevent disease. One example of such a tool is DASH for Health, an Internet-based nutrition and exercise behavior modification program. This program was offered as a free, opt-in benefit to US-based employees of the EMC Corporation. The aim was to determine whether an employer-sponsored, Internet-based diet and exercise program has an effect on health care costs. There were 15,237 total employees and spouses who were included in our analyses, of whom 1967 enrolled in the DASH for Health program (DASH participants). Using a retrospective, quasi-experimental design, study year health care costs among DASH participants and non-participants were compared, controlling for baseline year costs, risk, and demographic variables. The relationship between how often a subject visited the DASH website and health care costs also was examined. These relationships were examined among all study subjects and among a subgroup of 735 subjects with cardiovascular conditions (diabetes, hypertension, hyperlipidemia). Multiple linear regression analysis examined the relationship of program use to health care costs, comparing study year costs among DASH participants and non-participants and then examining the effects of increased website use on health care costs. Analyses were repeated among the cardiovascular condition subgroups. Overall, program use was not associated with changes in health care costs. However, among the cardiovascular risk study subjects, health care costs were US$827 lower, on average, during the study year (P= .05; t(729) = 1.95). Among 1028 program users, increased website use was significantly associated with lower health care costs among those who visited the website at least nine times during the study year (US$14 decrease per visit; P = .04; t(1022) = 2.05), with annual savings highest among 80 program users with targeted conditions (US$55 decrease per visit; P < .001; t(74) = 2.71). An employer-sponsored, Internet-based diet and exercise program shows promise as a low-cost benefit that contributes to lower health care costs among persons at higher risk for above-average health care costs and utilization.

  10. A Web-Based Nutrition Program Reduces Health Care Costs in Employees With Cardiac Risk Factors: Before and After Cost Analysis

    PubMed Central

    Cabral, Howard; Kazis, Lewis E; Jarrett, Kelli M; Vetter, Delia; Richmond, Russell; Moore, Thomas J

    2009-01-01

    Background Rising health insurance premiums represent a rapidly increasing burden on employer-sponsors of health insurance and their employees. Some employers have become proactive in managing health care costs by providing tools to encourage employees to directly manage their health and prevent disease. One example of such a tool is DASH for Health, an Internet-based nutrition and exercise behavior modification program. This program was offered as a free, opt-in benefit to US-based employees of the EMC Corporation. Objective The aim was to determine whether an employer-sponsored, Internet-based diet and exercise program has an effect on health care costs. Methods There were 15,237 total employees and spouses who were included in our analyses, of whom 1967 enrolled in the DASH for Health program (DASH participants). Using a retrospective, quasi-experimental design, study year health care costs among DASH participants and non-participants were compared, controlling for baseline year costs, risk, and demographic variables. The relationship between how often a subject visited the DASH website and health care costs also was examined. These relationships were examined among all study subjects and among a subgroup of 735 subjects with cardiovascular conditions (diabetes, hypertension, hyperlipidemia). Multiple linear regression analysis examined the relationship of program use to health care costs, comparing study year costs among DASH participants and non-participants and then examining the effects of increased website use on health care costs. Analyses were repeated among the cardiovascular condition subgroups. Results Overall, program use was not associated with changes in health care costs. However, among the cardiovascular risk study subjects, health care costs were US$827 lower, on average, during the study year (P = .05; t 729 = 1.95). Among 1028 program users, increased website use was significantly associated with lower health care costs among those who visited the website at least nine times during the study year (US$14 decrease per visit; P = .04; t 1022 = 2.05), with annual savings highest among 80 program users with targeted conditions (US$55 decrease per visit; P < .001; t 74 = 2.71). Conclusions An employer-sponsored, Internet-based diet and exercise program shows promise as a low-cost benefit that contributes to lower health care costs among persons at higher risk for above-average health care costs and utilization. PMID:19861297

  11. 32 CFR 161.16 - Benefits for transitional health care members and dependents.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... members and dependents. This section shows the benefits for THC members and their eligible dependents. THC... Defense Authorization Act of for Fiscal Year 2005” made the THC program permanent and made the medical... years' commissary and exchange benefits to THC members. Section 734 of Public Law 110-417, “National...

  12. Long-term care legislation: an issue of concern for nurse practitioners.

    PubMed

    Jennings, J P

    1989-01-01

    Comprehensive long-term care policy has many hurdles to overcome before it becomes a reality. The biggest hurdle is the price tag! Estimates range from $6 billion (Pepper's home-care bill) to $46 billion (Stark's long-term care coverage bill). Congressional insiders predict that federal long-term care coverage must contain "pay-as-you-go" financing to win congressional passage. The medicare catastrophic health care act is cited by many in the Congress as establishing the precedent for self-financing of new federal benefits. In a pay-as-you-go era in public spending, any new program can only come from trimming existing programs and shifting those funds to new programs or from generating new revenues. The latter could result from increased beneficiary cost-sharing, an increase in the medicare payroll tax, or by eliminating the $45,000 cap on income exposed to the current 1.45% medicare payroll tax. Federal proposals to date build on existing medicare and medicaid programs. In them, quality assurance measures have been strengthened, consumer input encouraged, and a new layer of bureaucracy established to screen potential clients and provide case-management services. The scope of services is broad in most of the current proposals, and reimbursement is provided for respite care to allow family care givers relief and assistance. Access to nurse practitioners' services is an important feature of Kennedy's Lifecare proposal and is the focus of lobbying efforts for all public and private proposals. It is time for nurse practitioners to become involved in long-term care legislation. This may be initiated by reviewing current proposals and long-term care packages offered by major insurance companies. Any future long-term care benefit should bear the imprint of the nurse practitioner's professional perspective and the profession's commitment to humane, caring health policy.

  13. A Faculty Development Program Integrating Cross-Cultural Care into a Gastrointestinal Pathophysiology Tutorial Benefits Students, Tutors, and the Course

    ERIC Educational Resources Information Center

    Shields, Helen M.; Leffler, Daniel A.; Peters, Antoinette S.; Llerena-Quinn, Roxana; Nambudiri, Vinod E.; White, Augustus A., III; Hayward, Jane N.; Pelletier, Stephen R.

    2015-01-01

    A specific faculty development program for tutors to teach cross-cultural care in a preclinical gastrointestinal pathophysiology course with weekly longitudinal followup sessions was designed in 2007 and conducted in the same manner over a 6-yr period. Anonymous student evaluations of how "frequently" the course and the tutor were…

  14. [Potentials and limitations of the planned compulsory quality assurance program for cataract surgery (Qesü)].

    PubMed

    Hahn, U; Bertram, B; Krummenauer, F; Reuscher, A; Fabian, E; Neuhann, T; Schmickler, S; Neuhann, I

    2013-04-01

    Cataract surgery is scheduled for a federal program for quality improvement across the different sectors of care (outpatient care and hospitals). In case of implementation not only ophthalmic surgeons but all ophthalmologists would have to contribute to the documentation. Urgency, potential benefits and limitations of a compulsory compared to a voluntary quality assessment system are analyzed.

  15. 7 CFR 246.4 - State plan.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... CHILD NUTRITION PROGRAMS SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN State... year by category of women, infants and children. (4) The State agency staffing pattern. (5) An... program benefits to unserved infants and children under the care of foster parents, protective services...

  16. 7 CFR 246.4 - State plan.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... CHILD NUTRITION PROGRAMS SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN State... year by category of women, infants and children. (4) The State agency staffing pattern. (5) An... program benefits to unserved infants and children under the care of foster parents, protective services...

  17. 7 CFR 246.4 - State plan.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... CHILD NUTRITION PROGRAMS SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN State... year by category of women, infants and children. (4) The State agency staffing pattern. (5) An... program benefits to unserved infants and children under the care of foster parents, protective services...

  18. Active Learning Crosses Generations.

    ERIC Educational Resources Information Center

    Woodard, Diane K.

    2002-01-01

    Describes the benefits of intergenerational programs, highlighting a child care program that offers age-appropriate and mutually beneficial activities for children and elders within a nearby retirement community. The program has adopted High/Scope's active learning approach to planning and implementing activities that involve both generations. The…

  19. Innovating in Health Care Management Education: Development of an Accelerated MBA and MPH Degree Program at Yale

    PubMed Central

    Forman, Howard P.; Pistell, Anne F.; Nembhard, Ingrid M.

    2015-01-01

    Increasingly, there is recognition of the need for individuals with expertise in both management and public health to help health care organizations deliver high-quality and cost-effective care. The Yale School of Public Health and Yale School of Management began offering an accelerated Master of Business Administration (MBA) and Master of Public Health (MPH) joint degree program in the summer of 2014. This new program enables students to earn MBA and MPH degrees simultaneously from 2 fully accredited schools in 22 months. Students will graduate with the knowledge and skills needed to become innovative leaders of health care organizations. We discuss the rationale for the program, the developmental process, the curriculum, benefits of the program, and potential challenges. PMID:25706023

  20. Innovating in health care management education: development of an accelerated MBA and MPH degree program at Yale.

    PubMed

    Pettigrew, Melinda M; Forman, Howard P; Pistell, Anne F; Nembhard, Ingrid M

    2015-03-01

    Increasingly, there is recognition of the need for individuals with expertise in both management and public health to help health care organizations deliver high-quality and cost-effective care. The Yale School of Public Health and Yale School of Management began offering an accelerated Master of Business Administration (MBA) and Master of Public Health (MPH) joint degree program in the summer of 2014. This new program enables students to earn MBA and MPH degrees simultaneously from 2 fully accredited schools in 22 months. Students will graduate with the knowledge and skills needed to become innovative leaders of health care organizations. We discuss the rationale for the program, the developmental process, the curriculum, benefits of the program, and potential challenges.

  1. 7 CFR 273.11 - Action on households with special circumstances.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... from day care, use the current reimbursement amounts used in the Child and Adult Care Food Program or a..., dependent care, child support, and excess shelter deductions shall continue to apply to the remaining... disqualifications, child support disqualifications, and ineligible ABAWDs. The eligibility and benefit level of any...

  2. 42 CFR 409.43 - Plan of care requirements.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Plan of care requirements. 409.43 Section 409.43 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM HOSPITAL INSURANCE BENEFITS Home Health Services Under Hospital Insurance § 409.43 Plan of care...

  3. 77 FR 10663 - Due Date of Initial Application Requirements for State Home Construction Grants

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-23

    ... professions; Health records; Homeless; Mental health programs; Nursing homes; Philippines, Reporting and... constructing, remodeling, altering, or expanding State home facilities that will furnish specified types of..., Veterans Medical Care Benefits; 64.010, Veterans Nursing Home Care; 64.014, Veterans State Domiciliary Care...

  4. 5 CFR 890.1003 - Definitions.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers General... operating a health benefits plan described by 5 U.S.C. 8903 or 8903a. Community means a geographically... employment as a general manager, business manager, administrator, or other position exercising, either...

  5. Economic Costs and Benefits of a Community-Based Lymphedema Management Program for Lymphatic Filariasis in Odisha State, India

    PubMed Central

    Stillwaggon, Eileen; Sawers, Larry; Rout, Jonathan; Addiss, David; Fox, LeAnne

    2016-01-01

    Lymphatic filariasis afflicts 68 million people in 73 countries, including 17 million persons living with chronic lymphedema. The Global Programme to Eliminate Lymphatic Filariasis aims to stop new infections and to provide care for persons already affected, but morbidity management programs have been initiated in only 24 endemic countries. We examine the economic costs and benefits of alleviating chronic lymphedema and its effects through a simple limb-care program. For Khurda District, Odisha State, India, we estimated lifetime medical costs and earnings losses due to chronic lymphedema and acute dermatolymphangioadenitis (ADLA) with and without a community-based limb-care program. The program would reduce economic costs of lymphedema and ADLA over 60 years by 55%. Savings of US$1,648 for each affected person in the workforce are equivalent to 1,258 days of labor. Per-person savings are more than 130 times the per-person cost of the program. Chronic lymphedema and ADLA impose a substantial physical and economic burden on the population in filariasis-endemic areas. Low-cost programs for lymphedema management based on limb washing and topical medication for infection are effective in reducing the number of ADLA episodes and stopping progression of disabling and disfiguring lymphedema. With reduced disability, people are able to work longer hours, more days per year, and in more strenuous, higher-paying jobs, resulting in an important economic benefit to themselves, their families, and their communities. Mitigating the severity of lymphedema and ADLA also reduces out-of-pocket medical expense. PMID:27573626

  6. Perceived benefits and challenges of interprofessional education based on a multidisciplinary faculty member survey.

    PubMed

    Lash, David Benjamin; Barnett, Mitchell J; Parekh, Nirali; Shieh, Anita; Louie, Maggie C; Tang, Terrill T-L

    2014-12-15

    To identify differences among faculty members in various health professional training programs in perceived benefits and challenges of implementing interprofessional education (IPE). A 19-item survey using a 5-point Likert scale was administered to faculty members across different health disciplines at a west coast, multicollege university with osteopathic medicine, pharmacy, and physician assistant programs. Sixty-two of 103 surveys (60.2%) were included in the study. Faculty members generally agreed that there were benefits of IPE on patient outcomes and that implementing IPE was feasible. However, group differences existed in belief that IPE improves care efficiency (p=0.001) and promotes team-based learning (p=0.001). Program divergence was also seen in frequency of stressing importance of IPE (p=0.009), preference for more IPE opportunities (p=0.041), and support (p=0.002) within respective college for IPE. Despite consensus among faculty members from 3 disciplines that IPE is invaluable to their curricula and training of health care students, important program level differences existed that would likely need to be addressed in advance IPE initiatives.

  7. Impact of patient navigation on timely cancer care: the Patient Navigation Research Program.

    PubMed

    Freund, Karen M; Battaglia, Tracy A; Calhoun, Elizabeth; Darnell, Julie S; Dudley, Donald J; Fiscella, Kevin; Hare, Martha L; LaVerda, Nancy; Lee, Ji-Hyun; Levine, Paul; Murray, David M; Patierno, Steven R; Raich, Peter C; Roetzheim, Richard G; Simon, Melissa; Snyder, Frederick R; Warren-Mears, Victoria; Whitley, Elizabeth M; Winters, Paul; Young, Gregory S; Paskett, Electra D

    2014-06-01

    Patient navigation is a promising intervention to address cancer disparities but requires a multisite controlled trial to assess its effectiveness. The Patient Navigation Research Program compared patient navigation with usual care on time to diagnosis or treatment for participants with breast, cervical, colorectal, or prostate screening abnormalities and/or cancers between 2007 and 2010. Patient navigators developed individualized strategies to address barriers to care, with the focus on preventing delays in care. To assess timeliness of diagnostic resolution, we conducted a meta-analysis of center- and cancer-specific adjusted hazard ratios (aHRs) comparing patient navigation vs usual care. To assess initiation of cancer therapy, we calculated a single aHR, pooling data across all centers and cancer types. We conducted a metaregression to evaluate variability across centers. All statistical tests were two-sided. The 10521 participants with abnormal screening tests and 2105 with a cancer or precancer diagnosis were predominantly from racial/ethnic minority groups (73%) and publically insured (40%) or uninsured (31%). There was no benefit during the first 90 days of care, but a benefit of navigation was seen from 91 to 365 days for both diagnostic resolution (aHR = 1.51; 95% confidence interval [CI] = 1.23 to 1.84; P < .001)) and treatment initiation (aHR = 1.43; 95% CI = 1.10 to 1.86; P < .007). Metaregression revealed that navigation had its greatest benefits within centers with the greatest delays in follow-up under usual care. Patient navigation demonstrated a moderate benefit in improving timely cancer care. These results support adoption of patient navigation in settings that serve populations at risk of being lost to follow-up. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  8. Impact of Patient Navigation on Timely Cancer Care: The Patient Navigation Research Program

    PubMed Central

    Battaglia, Tracy A.; Calhoun, Elizabeth; Darnell, Julie S.; Dudley, Donald J.; Fiscella, Kevin; Hare, Martha L.; LaVerda, Nancy; Lee, Ji-Hyun; Levine, Paul; Murray, David M.; Patierno, Steven R.; Raich, Peter C.; Roetzheim, Richard G.; Simon, Melissa; Snyder, Frederick R.; Warren-Mears, Victoria; Whitley, Elizabeth M.; Winters, Paul; Young, Gregory S.; Paskett, Electra D.

    2014-01-01

    Background Patient navigation is a promising intervention to address cancer disparities but requires a multisite controlled trial to assess its effectiveness. Methods The Patient Navigation Research Program compared patient navigation with usual care on time to diagnosis or treatment for participants with breast, cervical, colorectal, or prostate screening abnormalities and/or cancers between 2007 and 2010. Patient navigators developed individualized strategies to address barriers to care, with the focus on preventing delays in care. To assess timeliness of diagnostic resolution, we conducted a meta-analysis of center- and cancer-specific adjusted hazard ratios (aHRs) comparing patient navigation vs usual care. To assess initiation of cancer therapy, we calculated a single aHR, pooling data across all centers and cancer types. We conducted a metaregression to evaluate variability across centers. All statistical tests were two-sided. Results The 10521 participants with abnormal screening tests and 2105 with a cancer or precancer diagnosis were predominantly from racial/ethnic minority groups (73%) and publically insured (40%) or uninsured (31%). There was no benefit during the first 90 days of care, but a benefit of navigation was seen from 91 to 365 days for both diagnostic resolution (aHR = 1.51; 95% confidence interval [CI] = 1.23 to 1.84; P < .001)) and treatment initiation (aHR = 1.43; 95% CI = 1.10 to 1.86; P < .007). Metaregression revealed that navigation had its greatest benefits within centers with the greatest delays in follow-up under usual care. Conclusions Patient navigation demonstrated a moderate benefit in improving timely cancer care. These results support adoption of patient navigation in settings that serve populations at risk of being lost to follow-up. PMID:24938303

  9. 76 FR 41261 - Notice of Intent To Award Affordable Care Act (ACA) Funding, EH10-1003

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-13

    ... activities including prevention research and health screenings, such as the Community Transformation Grant Program, the Education and Outreach Campaign for Preventative Benefits, and Immunization Programs. The ACA...

  10. 76 FR 54773 - Notice of Intent To Award Affordable Care Act Funding, Funding Opportunity Announcement CDC-RFA...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-02

    ... activities including prevention research and health screenings, such as the Community Transformation Grant Program, the Education and Outreach Campaign for Preventative Benefits, and Immunization Programs. REACH...

  11. Patient Protection and Affordable Care Act; program integrity: exchange, premium stabilization programs, and market standards; amendments to the HHS notice of benefit and payment parameters for 2014. Final rule.

    PubMed

    2013-10-30

    This final rule implements provisions of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the Affordable Care Act). Specifically, this final rule outlines financial integrity and oversight standards with respect to Affordable Insurance Exchanges, qualified health plan (QHP) issuers in Federally-facilitated Exchanges (FFEs), and States with regard to the operation of risk adjustment and reinsurance programs. It also establishes additional standards for special enrollment periods, survey vendors that may conduct enrollee satisfaction surveys on behalf of QHP issuers, and issuer participation in an FFE, and makes certain amendments to definitions and standards related to the market reform rules. These standards, which include financial integrity provisions and protections against fraud and abuse, are consistent with Title I of the Affordable Care Act. This final rule also amends and adopts as final interim provisions set forth in the Amendments to the HHS Notice of Benefit and Payment Parameters for 2014 interim final rule, published in the Federal Register on March 11, 2013, related to risk corridors and cost-sharing reduction reconciliation.

  12. Cost considerations for long-term ecological monitoring

    USGS Publications Warehouse

    Caughlan, L.; Oakley, K.L.

    2001-01-01

    For an ecological monitoring program to be successful over the long-term, the perceived benefits of the information must justify the cost. Financial limitations will always restrict the scope of a monitoring program, hence the program’s focus must be carefully prioritized. Clearly identifying the costs and benefits of a program will assist in this prioritization process, but this is easier said than done. Frequently, the true costs of monitoring are not recognized and are, therefore, underestimated. Benefits are rarely evaluated, because they are difficult to quantify. The intent of this review is to assist the designers and managers of long-term ecological monitoring programs by providing a general framework for building and operating a cost-effective program. Previous considerations of monitoring costs have focused on sampling design optimization. We present cost considerations of monitoring in a broader context. We explore monitoring costs, including both budgetary costs, what dollars are spent on, and economic costs, which include opportunity costs. Often, the largest portion of a monitoring program budget is spent on data collection, and other, critical aspects of the program, such as scientific oversight, training, data management, quality assurance, and reporting, are neglected. Recognizing and budgeting for all program costs is therefore a key factor in a program’s longevity. The close relationship between statistical issues and cost is discussed, highlighting the importance of sampling design, replication and power, and comparing the costs of alternative designs through pilot studies and simulation modeling. A monitoring program development process that includes explicit checkpoints for considering costs is presented. The first checkpoint occurs during the setting of objectives and during sampling design optimization. The last checkpoint occurs once the basic shape of the program is known, and the costs and benefits, or alternatively the cost-effectiveness, of each program element can be evaluated. Moving into the implementation phase without careful evaluation of costs and benefits is risky because if costs are later found to exceed benefits, the program will fail. The costs of development, which can be quite high, will have been largely wasted. Realistic expectations of costs and benefits will help ensure that monitoring programs survive the early, turbulent stages of development and the challenges posed by fluctuating budgets during implementation.

  13. Improving Access to Hospice Care: Informing the Debate

    PubMed Central

    CARLSON, MELISSA D.A.; MORRISON, R. SEAN; BRADLEY, ELIZABETH H.

    2015-01-01

    The most frequently cited policy solution for improving access to hospice care for patients and families is to expand hospice eligibility criteria under the Medicare Hospice Benefit. However, the substantial implications of such a policy change have not been fully articulated or evaluated. This paper seeks to identify and describe the implications of expanding Medicare Hospice Benefit eligibility on the nature of hospice care, the cost of hospice care to the Medicare program, and the very structure of hospice and palliative care delivery in the United States. The growth in hospice has been dramatic and the central issue facing policymakers and the hospice industry is defining the appropriate target population for hospice care. As policymakers and the hospice industry discuss the future of hospice and potential changes to the Medicare Hospice Benefit, it is critical to clearly delineate the options—and the implications and challenges of each option—for improving access to hospice care for patients and families. PMID:18363486

  14. Outcomes and provider perspectives on geriatric care by a nurse practitioner-led community paramedicine program.

    PubMed

    Kant, Rebecca E; Vejar, Maria; Parnes, Bennett; Mulder, Joy; Daddato, Andrea; Matlock, Daniel D; Lum, Hillary D

    2018-05-03

    This study explores the use of a nurse practitioner-led paramedicine program for acute, home-based care of geriatric patients. This case series describes patients, outcomes, and geriatric primary care provider perspectives related to use of this independent paramedicine program. There were 40 patient visits from August 2016-May 2017. We reviewed patient demographics, medical conditions, healthcare utilization, and communication processes and used semi-structured interviews and content analysis to explore staff perspectives. The most commonly treated diagnoses were respiratory conditions, urinary tract infections, and gastrointestinal concerns. Two patients required an immediate transfer to a higher level of care. Six patients had emergency department visits and five patients were hospitalized within two weeks. Geriatric providers identified three themes including: potential benefits to geriatric patients, importance of enhanced care coordination and communication, and considerations for the specific role of nurse practitioner-led community paramedicine programs for geriatric patient care. Published by Elsevier Inc.

  15. 5 CFR 890.103 - Correction of errors.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administration and General Provisions § 890.103... States Code, and permit the individual to enroll in another health benefits plan for purposes of this... health care providers. (e) Retroactive corrections are subject to withholdings and contributions under...

  16. The costs and benefits of enhanced depression care to employers.

    PubMed

    Wang, Philip S; Patrick, Amanda; Avorn, Jerry; Azocar, Francisca; Ludman, Evette; McCulloch, Joyce; Simon, Gregory; Kessler, Ronald

    2006-12-01

    Although outreach and enhanced treatment interventions improve depression outcomes, uptake has been poor in part because purchasers lack information on their return on investment. To estimate the costs and benefits of enhanced depression care for workers from the societal and employer-purchaser perspectives. Cost-effectiveness and cost-benefit analyses using state-transition Markov models. Simulated movements between health states were based on probabilities drawn from the clinical literature. Hypothetical cohort of 40-year-old workers. Intervention Enhanced depression care consisting of a depression screen and care management for those depressed vs usual care. Our base-case cost-effectiveness analysis was from the societal perspective; costs and quality-adjusted life-years were used to compute the incremental cost-effectiveness of the intervention relative to usual care. A secondary cost-benefit analysis from the employer's perspective tracked monetary costs and monetary benefits accruing to employers during a 5-year time horizon. From the societal perspective, screening and depression care management for workers result in an incremental cost-effectiveness ratio of $19 976 per quality-adjusted life-year relative to usual care. These results are consistent with recent primary care effectiveness trials and within the range for medical interventions usually covered by employer-sponsored insurance. From the employer's perspective, enhanced depression care yields a net cumulative benefit of $2895 after 5 years. In 1-way and probabilistic sensitivity analyses, these findings were robust to a variety of assumptions. If these results can be replicated in effectiveness trials directly assessing effects on work outcomes, they suggest that enhanced treatment quality programs for depression are cost-beneficial to purchasers.

  17. 76 FR 26731 - Medicare Program; Hospice Wage Index for Fiscal Year 2012

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-09

    ... care under Part A. See Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA), Public Law 97-248, Sec. 122, 96 Stat. 356, 364 (1982). The hospice benefit was designed to provide patients who are terminally... also 48 FR 56,008, 56,008 (Dec. 16, 1983) (describing hospice benefit). The Medicare hospice benefit...

  18. Disease management programs: barriers and benefits.

    PubMed

    Magnezi, Racheli; Kaufman, Galit; Ziv, Arnona; Kalter-Leibovici, Ofra; Reuveni, Haim

    2013-04-01

    The healthcare system in Israel faces difficulties similar to those of most industrialized countries, including limited resources, a growing chronically ill population, and demand for high quality care. Disease management programs (DMPs) for patients with a chronic illness aim to alleviate some of these problems, primarily by improving patient self-management skills and quality of care. This study surveyed the opinions of senior healthcare administrators regarding barriers, benefits, and support for implementing DMPs. Cross-sectional survey. A 21-item questionnaire was self-completed by 87 of 105 (83%) healthcare administrators included in the study. Participants were 65.5% male and 47% physicians, 25.3% nurses, 17.3% administrators, and 10.3% other healthcare professionals. The main perceived benefit of DMPs among all respondents was improving quality of care. Other benefits noted were better contact with patients (81.6%) and better compliance with treatment (75.9%). Efficient long-term utilization of system resources was perceived as a benefit by only 58.6%. The main perceived barriers to implementing DMPs were lack of budgetary resources (69%) and increased time required versus financial compensation received (63.2%). The benefits of DMPs were patient oriented; barriers were perceived as financial and limiting professional autonomy. Information regarding long-term benefits (better patient outcomes) that ultimately provide better value for the system versus short-term barriers (increased costs and expenditures of time without compensation) might encourage the implementation of DMPs in countries faced with a growing population of patients with at least 1 chronic illness.

  19. Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2017. Final rule.

    PubMed

    2016-03-08

    This final rule sets forth payment parameters and provisions related to the risk adjustment, reinsurance, and risk corridors programs; cost-sharing parameters and cost-sharing reductions; and user fees for Federally-facilitated Exchanges. It also provides additional amendments regarding the annual open enrollment period for the individual market for the 2017 and 2018 benefit years; essential health benefits; cost sharing; qualified health plans; Exchange consumer assistance programs; network adequacy; patient safety; the Small Business Health Options Program; stand-alone dental plans; third-party payments to qualified health plans; the definitions of large employer and small employer; fair health insurance premiums; student health insurance coverage; the rate review program; the medical loss ratio program; eligibility and enrollment; exemptions and appeals; and other related topics.

  20. Sandia National Laboratories: Careers: Benefits and Perks

    Science.gov Websites

    Medical Leave Act and the California Family Rights Act Extended leave of absence for child, family, or medical care; military duty; and personal reasons Health programs Health programs Medical, dental, and

  1. Health Care Crossroads: What's the Right Solution? Putting Consumer-Driven Ideas to Work at Louisiana State University

    ERIC Educational Resources Information Center

    Benedict, Forest; Guinn, Shayla

    2006-01-01

    Idling at the crossroads and faced with ever-increasing health care costs, the Louisiana State University System chose the road less traveled and instituted a consumer-driven benefits plan. In this article, the authors provide an overview of the consumer-driven programs LSU has adopted and how these programs have helped curb costs and improve the…

  2. Cost assessment of a new oral care program in the intensive care unit to prevent ventilator-associated pneumonia.

    PubMed

    Ory, Jérôme; Mourgues, Charline; Raybaud, Evelyne; Chabanne, Russell; Jourdy, Jean Christophe; Belard, Fabien; Guérin, Renaud; Cosserant, Bernard; Faure, Jean Sébastien; Calvet, Laure; Pereira, Bruno; Guelon, Dominique; Traore, Ousmane; Gerbaud, Laurent

    2018-06-01

    Ventilator-associated pneumonia (VAP) is the most frequent hospital-acquired infections in intensive care units (ICU). In the bundle of care to prevent the VAP, the oral care is very important strategies, to decrease the oropharyngeal bacterial colonization and presence of causative bacteria of VAP. In view of the paucity of medical economics studies, our objective was to determine the cost of implementing this oral care program for preventing VAP. In five ICUs, during period 1, caregivers used a foam stick for oral care and, during period 2, a stick and tooth brushing with aspiration. Budgetary effect of the new program from the hospital's point of view was analyzed for both periods. The costs avoided were calculated from the incidence density of VAP (cases per 1000 days of intubation). The cost study included device cost, benefit lost, and ICU cost (medication, employer and employee contributions, blood sample analysis…). A total of 2030 intubated patients admitted to the ICUs benefited from oral care. The cost of implementing the study protocol was estimated to be €11,500 per year. VAP rates decreased significantly between the two periods (p1 = 12.8% and p2 = 8.5%, p = 0.002). The VAP revenue was ranged from €28,000 to €45,000 and the average cost from €39,906 to €42,332. The total cost assessment calculated was thus around €1.9 million in favor of the new oral care program. Our study showed that the implementation of a simple strategy improved the quality of patient care is economically viable. NCT02400294.

  3. Economic Evaluation of Combined Diet and Physical Activity Promotion Programs to Prevent Type 2 Diabetes Among Persons at Increased Risk: A Systematic Review for the Community Preventive Services Task Force

    PubMed Central

    Li, Rui; Qu, Shuli; Zhang, Ping; Chattopadhyay, Sajal; Gregg, Edward W.; Albright, Ann; Hopkins, David; Pronk, Nicolaas P.

    2016-01-01

    Background Diabetes is a highly prevalent and costly disease. Studies indicate that combined diet and physical activity promotion programs can prevent type 2 diabetes among persons at increased risk. Purpose To systematically evaluate the evidence on cost, cost-effectiveness, and cost-benefit estimates of diet and physical activity promotion programs. Data Sources Cochrane Library, EMBASE, MEDLINE, PsycINFO, Sociological Abstracts, Web of Science, EconLit, and CINAHL through 7 April 2015. Study Selection English-language studies from high-income countries that provided data on cost, cost-effectiveness, or cost-benefit ratios of diet and physical activity promotion programs with at least 2 sessions over at least 3 months delivered to persons at increased risk for type 2 diabetes. Data Extraction Dual abstraction and assessment of relevant study details. Data Synthesis Twenty-eight studies were included. Costs were expressed in 2013 U.S. dollars. The median program cost per participant was $653. Costs were lower for group-based programs (median, $417) and programs implemented in community or primary care settings (median, $424) than for the U.S. DPP (Diabetes Prevention Program) trial and the DPP Outcomes Study ($5881). Twenty-two studies assessed the incremental cost-effectiveness ratios (ICERs) of the programs. From a health system perspective, 16 studies reported a median ICER of $13 761 per quality-adjusted life-year (QALY) saved. Group-based programs were more cost-effective (median, $1819 per QALY) than those that used individual sessions (median, $15 846 per QALY). No cost-benefit studies were identified. Limitation Information on recruitment costs and cost-effectiveness of translational programs implemented in community and primary care settings was limited. Conclusion Diet and physical activity promotion programs to prevent type 2 diabetes are cost-effective among persons at increased risk. Costs are lower when programs are delivered to groups in community or primary care settings. Primary Funding Source None. PMID:26167962

  4. 77 FR 1872 - Vocational Rehabilitation and Employment Program-Changes to Subsistence Allowance

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-01-12

    ... agencies prepare an assessment of anticipated costs and benefits before issuing any rule that may result in... Office of Management and Budget (OMB), as ``any regulatory action that is likely to result in a rule that..., Health care, Loan programs--education, Loan programs--veterans, Manpower training programs, Reporting and...

  5. 20 CFR 638.510 - Health care and services.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 20 Employees' Benefits 3 2012-04-01 2012-04-01 false Health care and services. 638.510 Section 638... UNDER TITLE IV-B OF THE JOB TRAINING PARTNERSHIP ACT Center Operations § 638.510 Health care and services. The center operator shall provide a health program, including basic medical, dental, and mental...

  6. 20 CFR 638.510 - Health care and services.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Health care and services. 638.510 Section 638... UNDER TITLE IV-B OF THE JOB TRAINING PARTNERSHIP ACT Center Operations § 638.510 Health care and services. The center operator shall provide a health program, including basic medical, dental, and mental...

  7. 20 CFR 638.510 - Health care and services.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 3 2011-04-01 2011-04-01 false Health care and services. 638.510 Section 638... UNDER TITLE IV-B OF THE JOB TRAINING PARTNERSHIP ACT Center Operations § 638.510 Health care and services. The center operator shall provide a health program, including basic medical, dental, and mental...

  8. A Behavioral Approach to Improving Self-Care Skills in OBS Patients.

    ERIC Educational Resources Information Center

    McEvoy, Cathy L.; Patterson, Roger L.

    Traditionally, the treatment of geriatric patients suffering from Organic Brain Syndrome (OBS) has been characterized by non-therapeutic custodial care. To determine whether elderly clients with dementia can benefit from self-care skill training, and to compare their progress with clients without OBS, 30 clients of the Residential Aging Program in…

  9. 77 FR 22071 - Medicare Program; Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-12

    ... care facility conditions of participation pertaining to pharmacy services. DATES: Effective dates... of Health Care Prepayment Plans (Sec. 417.801) 2. Plan Performance Ratings as a Measure of... Information AHRQ Agency for Health Care Research and Quality ALJ Administrative Law Judge ANOC Annual Notice...

  10. 20 CFR 670.550 - What responsibilities do Job Corps centers have in assisting students with child care needs?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... for their dependent children. (b) Job Corps centers may operate on center child development programs... have in assisting students with child care needs? 670.550 Section 670.550 Employees' Benefits... have in assisting students with child care needs? (a) Job Corps centers are responsible for...

  11. 20 CFR 670.550 - What responsibilities do Job Corps centers have in assisting students with child care needs?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... for their dependent children. (b) Job Corps centers may operate on center child development programs... have in assisting students with child care needs? 670.550 Section 670.550 Employees' Benefits... have in assisting students with child care needs? (a) Job Corps centers are responsible for...

  12. 78 FR 9890 - DoD Medicare-Eligible Retiree Health Care Board of Actuaries; Notice of Federal Advisory...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-12

    ... DEPARTMENT OF DEFENSE Office of the Secretary DoD Medicare-Eligible Retiree Health Care Board of... Retiree Health Care Board of Actuaries will take place. DATES: Friday, August 2, 2013, from 10:00 a.m. to... assumptions to be used in the valuation of benefits under DoD retiree health care programs for Medicare...

  13. From coverage to care: addressing the issue of churn.

    PubMed

    Milligan, Charles

    2015-02-01

    In any given year, a significant number of individuals will move between Medicaid and qualified health plans (QHP). Known as "churn," this movement could disrupt continuity of health care services, even when no gap in insurance coverage exists. The number of people who churn in any given year is significant, and they often are significant utilizers of health care services. They could experience disruption in care in several ways: (1) changing carrier; (2) changing provider because of network differences; (3) a disruption in ongoing services, even when the benefit is covered in both programs (e.g., surgery that has been authorized but not yet performed; ongoing prescription medications for chronic illness; or some but not all therapy or counseling sessions have been completed); and (4) the loss of coverage for a service that is not a covered benefit in the new program. Many strategies are available to states to reduce the disruption caused by churn. The specific option, intervention, and set of policies in a given state will depend on its context. Policy makers would benefit from an examination and discussion of these issues. Copyright © 2015 by Duke University Press.

  14. Comprehensive care improves health outcomes among elderly Taiwanese patients with hip fracture.

    PubMed

    Shyu, Yea-Ing L; Liang, Jersey; Tseng, Ming-Yueh; Li, Hsiao-Juan; Wu, Chi-Chuan; Cheng, Huey-Shinn; Yang, Ching-Tzu; Chou, Shih-Wei; Chen, Ching-Yen

    2013-02-01

    Few studies have investigated the effects of care models that combine interdisciplinary care with nutrition consultation, depression management, and fall prevention in older persons with hip fracture. The purpose of this study was to compare the effects of a comprehensive care program with those of interdisciplinary care and usual care for elderly patients with hip fracture. A randomized experimental trial was used to explore outcomes for 299 elderly patients with hip fracture receiving three treatment care models: interdisciplinary care (n = 101), comprehensive care (n = 99), and usual care (n = 99). Interdisciplinary care included geriatric consultation, continuous rehabilitation, and discharge planning with post-hospital services. Comprehensive care consisted of interdisciplinary care plus nutrition consultation, depression management, and fall prevention. Usual care included only in-hospital rehabilitation without geriatric consultation, in-home rehabilitation, and home environmental assessment. Participants in the comprehensive care group had better self-care ability (odds ratio, OR = 3.19, p < .01) and less risk of depression (OR = 0.48, p < .01) than those who received usual care. The comprehensive care group had less risk of depression (OR = 0.51, p < .05) and of malnutrition (OR = 0.48, p < .05) than the interdisciplinary care group during the first year following discharge. Older persons with hip fracture benefitted more from the comprehensive care program than from interdisciplinary care and usual care. Older persons with hip fracture benefitted more from comprehensive care including interdisciplinary care and nutrition consultation, depression management, and fall prevention than simply interdisciplinary care.

  15. Hospice Value-Based Purchasing Program: A Model Design.

    PubMed

    Nowak, Bryan P

    2016-12-01

    With the implementation of the Affordable Care Act, the U.S. government committed to a transition in payment policy for health care services linking reimbursement to improved health outcomes rather than the volume of services provided. To accomplish this goal, the Department of Health and Human Services is designing and implementing new payment models intended to improve the quality of health care while reducing its cost. Collectively, these novel payment models and programs have been characterized under the moniker of value-based purchasing (VBP), and although many of these models retain a fundamental fee-for-service (FFS) structure, they are seen as essential tools in the evolution away from volume-based health care financing toward a health system that provides "better care, smarter spending, and healthier people." In 2014, approximately 20% of Medicare provider FFS payments were linked to a VBP program. The Department of Health and Human Services has committed to a four-year plan to link 90% of Medicare provider FFS payments to value-based purchasing by 2018. To achieve this goal, all items and services currently reimbursed under Medicare FFS programs will need to be evaluated in the context of VBP. To this end, the Medicare Hospice benefit appears to be appropriate for inclusion in a model of VBP. This policy analysis proposes an adaptable model for a VBP program for the Medicare Hospice benefit linking payment to quality and efficiency in a manner consistent with statutory requirements established in the Affordable Care Act. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  16. Social work in dentistry: the CARES model for improving patient retention and access to care.

    PubMed

    Doris, Joan M; Davis, Elaine; Du Pont, Cynthia; Holdaway, Britt

    2009-07-01

    Social work programs in dental schools and dental clinics have been operated successfully since the 1940s, and have been documented as contributing to patients' access to care and to dental education. However, unlike medical social work, with which it has much in common, social work in dentistry has failed to become a standard feature of dental schools and clinics. Few of the social work initiatives that have been implemented in dental schools have survived after initial grant funding ran out, or the institutional supporters of the program moved on. The authors hope that the CARES program serves as a model for the successful development of other programs at the intersection of social work and dentistry to the benefit of both dental patients and providers.

  17. A cost-benefit analysis of music therapy in a home hospice.

    PubMed

    Romo, Rafael; Gifford, Lisa

    2007-01-01

    Medicare's fixed daily rates create an absolute cost constraint on hospices; consequently, the growth in hospice brings financial pressures. The patient efficacy of music therapy has been demonstrated in the literature and includes improving pain, agitation, disruptive behaviors, communication, depression, and quality of life. Music therapy is well suited to hospice as it addresses the four domains of palliative care (physiological, emotional, social, and spiritual care). In this small study, the total cost of patients in music therapy was $10,659 and $13,643 for standard care patients, resulting in a cost savings of $2984. The music therapy program cost $3615, yielding a cost benefit ratio of 0.83. When using cost per patient day, the cost benefit ratio is 0.95.

  18. Review and analysis of the Mental Health Nurse Incentive Program.

    PubMed

    Happell, Brenda; Platania-Phung, Chris

    2017-09-04

    Objective The aim of the present study was to review and synthesise research on the Mental Health Nurse Incentive Program (MHNIP) to ascertain the benefits and limitations of this initiative for people with mental illness, general practitioners, mental health nurses and the wider community. Methods An electronic and manual search was made of the research literature for MHNIP in May 2017. Features of studies, including cohorts and findings, were tabulated and cross-study patterns in program processes and outcomes were closely compared. Results Seventeen reports of primary research data have been released. Triangulation of data from different cohorts, regions and design show that the program has been successful on the primary objectives of increased access to primary mental health care, and has received positive feedback from all major stakeholders. Although the program has been broadly beneficial to consumer health, there are inequities in access for people with mental illness. Conclusions The MHNIP greatly benefits the health of people with mental illness. Larger and more representative sampling of consumers is needed, as well as intensive case studies to provide a more comprehensive and effective understanding of the benefits and limitations of the program as it evolves with the establishment of primary health networks. What is known about the topic? The MHNIP is designed to increase access to mental health care in primary care settings such as general practice clinics. Studies have reported favourable views about the program. However, research is limited and further investigation is required to demonstrate the strengths and limitations of the program. What does this paper add? All studies reviewed reported that the MHNIP had positive implications for people with severe and persistent mental illness. Qualitative research has been most prevalent for mental health nurse views and research on Health of the Nation Outcome Scale scores for recipients of the program. There is more research on system dimensions than on person-centred care. Mental health consumers, carers and families have been neglected in the establishment, engagement and evaluation of the MHNIP. What are the implications for practitioners? A more systematic, national-level research program into the MHNIP is required that is centred more on the experiences of people with mental illness.

  19. What do practitioners think? A qualitative study of a shared care mental health and nutrition primary care program

    PubMed Central

    Paquette-Warren, Jann; Vingilis, Evelyn; Greenslade, Jaimi; Newnam, Sharon

    2006-01-01

    Abstract Objective To develop an in-depth understanding of a shared care model from primary mental health and nutrition care practitioners with a focus on program goals, strengths, challenges and target population benefits. Design Qualitative method of focus groups. Setting/Participants The study involved fifty-three practitioners from the Hamilton Health Service Organization Mental Health and Nutrition Program located in Hamilton, Ontario, Canada. Method Six focus groups were conducted to obtain the perspective of practitioners belonging to various disciplines or health care teams. A qualitative approach using both an editing and template organization styles was taken followed by a basic content analysis. Main findings Themes revealed accessibility, interdisciplinary care, and complex care as the main goals of the program. Major program strengths included flexibility, communication/collaboration, educational opportunities, access to patient information, continuity of care, and maintenance of practitioner and patient satisfaction. Shared care was described as highly dependent on communication style, skill and expertise, availability, and attitudes toward shared care. Time constraint with respect to collaboration was noted as the main challenge. Conclusion Despite some challenges and variability among practices, the program was perceived as providing better patient care by the most appropriate practitioner in an accessible and comfortable setting. PMID:17041680

  20. Community pediatric hospitalists providing care in the emergency department: an analysis of physician productivity and financial performance.

    PubMed

    Dudas, Robert A; Monroe, David; McColligan Borger, Melissa

    2011-11-01

    Community hospital pediatric inpatient programs are being threatened by current financial and demographic trends. We describe a model of care and report on the financial implications associated with combining emergency department (ED) and inpatient care of pediatric patients. We determine whether this type of model could generate sufficient revenue to support physician salaries for continuous in-house coverage in community hospitals. Financial productivity and selected performance indicators were obtained from a retrospective review of registration and billing records. Data were obtained from 2 community-based pediatric hospitalist programs, which are part of a single health system and included care delivered in the ED and inpatient settings during a 1-year period from July 1, 2008, to July 1, 2009. Together, the combined programs were able to generate 6079 total relative value units and collections of $244,828 annually per full-time equivalent (FTE). Salary, benefits, and practice expenses totaled $235,674 per FTE. Thus, combined daily revenues exceeded expenses and provided 104% of physician salary, benefits, and practice expenses. However, 1 program generated a net profit of $329,715 ($40,706 per FTE), whereas the other recorded a loss of $207,969 ($39,994 per FTE). Emergency department throughput times and left-without-being-seen rates at both programs were comparable to national benchmarks. Incorporating ED care into a pediatric hospitalist program can be an effective strategy to maintain the financial viability of pediatric services at community hospitals with low inpatient volumes that seek to provide 24-hour pediatric staffing.

  1. Rural health care support mechanism. Final rule; denial of petition for reconsideration.

    PubMed

    2003-12-24

    In this document, the Commission modifies its rules to improve the effectiveness of the rural health care support mechanism, which provides discounts to rural health care providers to access modern telecommunications for medical and health maintenance purposes. Because participation in the rural health care support mechanism has not met the Commission's initial projections, the Commission amends its rules to improve the program, increase participation by rural health care providers, and ensure that the benefits of the program continue to be distributed in a fair and equitable manner. In addition, the Commission denies Mobile Satellite Ventures Subsidiary's petition for reconsideration of the 1997 Universal Service Order.

  2. "People don't understand what goes on in here": A consensual qualitative research analysis of inmate-caregiver perspectives on prison-based end-of-life care.

    PubMed

    Depner, Rachel M; Grant, Pei C; Byrwa, David J; Breier, Jennifer M; Lodi-Smith, Jennifer; Luczkiewicz, Debra L; Kerr, Christopher W

    2018-05-01

    The age demographic of the incarcerated is quickly shifting from young to old. Correctional facilities are responsible for navigating inmate access to healthcare; currently, there is no standardization for access to end-of-life care. There is growing research support for prison-based end-of-life care programs that incorporate inmate peer caregivers as a way to meet the needs of the elderly and dying who are incarcerated. This project aims to (a) describe a prison-based end-of-life program utilizing inmate peer caregivers, (b) identify inmate-caregiver motivations for participation, and (c) analyze the role of building trust and meaningful relationships within the correctional end-of-life care setting. A total of 22 semi-structured interviews were conducted with inmate-caregivers. Data were analyzed using Consensual Qualitative Research methodology. All inmate-caregivers currently participating in the end-of-life peer care program at Briarcliff Correctional Facility were given the opportunity to participate. All participants were male, over the age of 18, and also incarcerated at Briarcliff Correctional Facility, a maximum security, state-level correctional facility. In total, five over-arching and distinct domains emerged; this manuscript focuses on the following three: (a) program description, (b) motivation, and (c) connections with others. Findings suggest that inmate-caregivers believe they provide a unique and necessary adaptation to prison-based end-of-life care resulting in multilevel benefits. These additional perceived benefits go beyond a marginalized group gaining access to patient-centered end-of-life care and include potential inmate-caregiver rehabilitation, correctional medical staff feeling supported, and correctional facilities meeting end-of-life care mandates. Additional research is imperative to work toward greater standardization of and access to end-of-life care for the incarcerated.

  3. Corporate smoking cessation on Long Island.

    PubMed

    Mulligan, Peter

    2010-03-01

    Tobacco addiction is a treatable health care problem. Employers are experiencing major annual increases in the cost of providing health insurance benefits. The expenditures due to smoking-related diseases are a major contributor to the escalating cost of employer-sponsored health and life benefit plans. An initiative that employers have adopted to help control increases in health care costs as well as improve the lifestyle of employees is the establishment of corporate wellness programs. Programs that promote healthy lifestyles and wellness are connected to the principle that a happy and healthy worker will be more effective and productive. Another dividend of corporate wellness programs is higher employee retention and better employee morale. An earlier study investigated the impact of wellness programs for Long Island employers. One of the major findings of that research was the confirmation of the prevalence of smoking cessation initiatives as components of the successful wellness programs. This article, through analysis of a follow-up survey, confirms that corporate smoking cessation programs have a significant return on investment. Further, the analysis identifies the components of the cessation programs and measures the relative impact of each element.

  4. Perceived benefits of study abroad programs for nursing students: an integrative review.

    PubMed

    Kelleher, Seán

    2013-12-01

    Study abroad programs that off er health care experiences in another country have become an important method in nursing education to increase students' understanding of cultural competence and intercultural sensitivity and to present them with new ideas and opportunities for personal and career development. Despite the many alleged positive attributes associated with such programs, a gap exists in the overall understanding of the benefits obtained by undergraduate nursing students who study abroad. Using Cooper's framework, 13 studies that explored the benefits of study abroad programs for undergraduate nursing students were reviewed. Findings suggest that participation in a study abroad experience is associated with many benefits for nursing students, including various forms of personal and professional growth, cultural sensitivity and competence, and cognitive development. Although research outcomes are encouraging, the nursing literature regarding this topic is limited, and more rigorous research studies are needed to support this educational practice.

  5. The Hospital at Home program: no place like home.

    PubMed

    Lippert, M; Semmens, S; Tacey, L; Rent, T; Defoe, K; Bucsis, M; Shykula, T; Crysdale, J; Lewis, V; Strother, D; Lafay-Cousin, L

    2017-02-01

    The treatment of children with cancer is associated with significant burden for the entire family. Frequent clinic visits and extended hospital stays can negatively affect quality of life for children and their families. Here, we describe the development of a Hospital at Home program (H@H) that delivers therapy to pediatric hematology, oncology, and blood and marrow transplant (bmt) patients in their homes. The services provided include short infusions of chemotherapy, supportive-care interventions, antibiotics, post-chemotherapy hydration, and teaching. From 2013 to 2015, the H@H program served 136 patients, making 1701 home visits, for patients mainly between the ages of 1 and 4 years. Referrals came from oncology in 82% of cases, from hematology in 11%, and from bmt in 7%. Since inception of the program, no adverse events have been reported. Family surveys suggested less disruption in daily routines and appreciation of specialized care by hematology and oncology nurses. Staff surveys highlighted a perceived benefit of H@H in contributing to early discharge of patients by supporting out-of-hospital monitoring and teaching. The development of a H@H program dedicated to the pediatric hematology, oncology, or bmt patient appears feasible. Our pilot program offers a potential contribution to improvement in patient quality of life and in cost-benefit for parents and the health care system.

  6. Feasibility of Training Early Childhood Educators in a Community Child Care Setting Using a Caregiver-Mediated Intervention for Toddlers with Autism Spectrum Disorder

    ERIC Educational Resources Information Center

    Brian, Jessica; Bernardi, Kate; Dowds, Erin; Easterbrook, Rachel; MacWilliam, Stacey; Bryson, Susan

    2017-01-01

    Parent-mediated intervention programs have demonstrated benefits for toddlers with autism spectrum disorder (ASD). Interest is emerging in other community-level models, such as those that can be integrated into child care settings. These programs have the potential to reach a wide range of high-risk toddlers who spend the majority of their day in…

  7. 43 CFR 41.440 - Health and insurance benefits and services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 43 Public Lands: Interior 1 2011-10-01 2011-10-01 false Health and insurance benefits and services... Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 41.440 Health and insurance... provides full coverage health service shall provide gynecological care. ...

  8. 20 CFR 702.409 - Evaluation of medical questions; results disputed.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 20 Employees' Benefits 4 2014-04-01 2014-04-01 false Evaluation of medical questions; results disputed. 702.409 Section 702.409 Employees' Benefits OFFICE OF WORKERS' COMPENSATION PROGRAMS, DEPARTMENT... PROCEDURE Medical Care and Supervision § 702.409 Evaluation of medical questions; results disputed. Any...

  9. 20 CFR 702.409 - Evaluation of medical questions; results disputed.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 20 Employees' Benefits 4 2012-04-01 2012-04-01 false Evaluation of medical questions; results disputed. 702.409 Section 702.409 Employees' Benefits OFFICE OF WORKERS' COMPENSATION PROGRAMS, DEPARTMENT... PROCEDURE Medical Care and Supervision § 702.409 Evaluation of medical questions; results disputed. Any...

  10. 20 CFR 702.409 - Evaluation of medical questions; results disputed.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 3 2011-04-01 2011-04-01 false Evaluation of medical questions; results disputed. 702.409 Section 702.409 Employees' Benefits OFFICE OF WORKERS' COMPENSATION PROGRAMS, DEPARTMENT... PROCEDURE Medical Care and Supervision § 702.409 Evaluation of medical questions; results disputed. Any...

  11. Comprehensive care plus creative architecture.

    PubMed

    Easter, James G

    2005-01-01

    The delivery of high-quality, comprehensive cancer care and the treatment environment go hand in hand with the patient's recovery. When the planning and design of a comprehensive cancer care program runs parallel to the operational expectations and functional standards, the building users (patients, staff, and physicians) benefit significantly. This behavioral response requires a sensitive interface during the campus master planning, architectural programming, and design phases. Each building component and user functioning along the "continuum of care" will have different expectations, programmatic needs, and design responses. This article addresses the community- and hospital-based elements of this continuum. The environment does affect the patient care and the care-giving team members. It may be a positive or, unfortunately, a negative response.

  12. The reform of home care services in Ontario: opportunity lost or lesson learned?

    PubMed

    Randall, Glen

    2007-06-01

    With the release of the Romanow Commission report, Canadian governments are poised to consider the creation of a national home care program. If occupational and physical therapists are to have input in shaping such a program, they will need to learn from lost opportunities of the past. This paper provides an overview of recent reforms to home care in Ontario with an emphasis on rehabilitation services. Data were collected from documents and 28 key informant interviews with rehabilitation professionals. Home care in Ontario has evolved in a piecemeal manner without rehabilitation professionals playing a prominent role in program design. Rehabilitation services play a critical role in facilitating hospital discharges, minimizing readmissions, and improving the quality of peoples' lives. Canadians will benefit if occupational and physical therapists seize the unique opportunity before them to provide meaningful input into creating a national home care program.

  13. Evaluating the Impact of Dental Care on Housing Intervention Program Outcomes Among Homeless Veterans

    PubMed Central

    Nunez, Elizabeth; Gibson, Gretchen; Jones, Judith A.; Schinka, John A.

    2013-01-01

    Objectives. In this retrospective longitudinal cohort study, we examined the impact of dental care on outcomes among homeless veterans discharged from a Department of Veterans Affairs (VA) transitional housing intervention program. Methods. Our sample consisted of 9870 veterans who were admitted into a VA homeless intervention program during 2008 and 2009, 4482 of whom received dental care during treatment and 5388 of whom did not. Primary outcomes of interest were program completion, employment or stable financial status on discharge, and transition to permanent housing. We calculated descriptive statistics and compared the 2 study groups with respect to demographic characteristics, medical and psychiatric history (including alcohol and substance use), work and financial support, and treatment outcomes. Results. Veterans who received dental care were 30% more likely than those who did not to complete the program, 14% more likely to be employed or financially stable, and 15% more likely to have obtained residential housing. Conclusions. Provision of dental care has a substantial positive impact on outcomes among homeless veterans participating in housing intervention programs. This suggests that homeless programs need to weigh the benefits and cost of dental care in program planning and implementation. PMID:23678921

  14. Usefulness of Palliative Care to Complement the Management of Patients on Left Ventricular Assist Devices

    PubMed Central

    Luo, Nancy; Rogers, Joseph G.; Dodson, Gwen C.; Patel, Chetan B.; Galanos, Anthony N.; Milano, Carmelo A.; O’Connor, Christopher M.; Mentz, Robert J.

    2016-01-01

    Within the last decade, advancements in left ventricular assist device (LVAD) therapy have allowed end-stage heart failure patients to live longer and with better quality of life. Like other life-saving interventions, however, there remains the risk of complications including infections, bleeding episodes, and stroke. The candidate for LVAD therapy faces complex challenges going forward, both physical and psychological, many of which may benefit from the application of palliative care principles by trained specialists. Despite these advantages, palliative care remains underused in many advanced heart failure programs. Here, we describe the benefits of palliative care, barriers to use within heart failure, and specific applications to the integrated care of patients on mechanical circulatory support. PMID:27474339

  15. Germany's Disease Management Program: Improving Outcomes in Congestive Heart Failure

    PubMed Central

    Kottmair, Stefan; Frye, Christian; Ziegenhagen, Dieter J.

    2005-01-01

    Hospital admissions among patients with congestive heart failure (CHF) are a major contributor to health care costs. A comprehensive disease management program for CHF was developed for private and statutory health insurance companies in order to improve health outcomes and reduce rehospitalization rates and costs. The program comprises care calls, written training material, telemetric monitoring, and health reports. Currently, 909 members from six insurance companies are enrolled. Routine evaluation, based on medical data warehouse software, demonstrates benefits in terms of improved health outcomes and processes of care. Economical evaluation of claims data indicates significant cost savings in a pre/post study design. PMID:17288080

  16. Continuing Care in High Schools: A Descriptive Study of Recovery High School Programs

    PubMed Central

    Finch, Andrew J.; Moberg, D. Paul; Krupp, Amanda Lawton

    2014-01-01

    Data from 17 recovery high schools suggest programs are dynamic and vary in enrollment, fiscal stability, governance, staffing, and organizational structure. Schools struggle with enrollment, funding, lack of primary treatment accessibility, academic rigor, and institutional support. Still, for adolescents having received treatment for substance abuse, recovery schools appear to successfully function as continuing care providers reinforcing and sustaining therapeutic benefits gained from treatment. Small size and therapeutic programming allow for a potentially broader continuum of services than currently exists in most of the schools. Recovery schools thus provide a useful design for continuing care warranting further study and policy support. PMID:24591808

  17. 78 FR 27823 - Medicare Program; FY 2014 Hospice Wage Index and Payment Rate Update; Hospice Quality Reporting...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-10

    ... Care Act, and requires, effective January 1, 2011, that a hospice physician or nurse practitioner have... care survey. Robin Dowell, (410) 786-0060 for questions regarding quality reporting for hospices and... of Costs, Benefits, and Transfers II. Background A. Hospice Care B. History of the Medicare Hospice...

  18. Defined contribution: a part of our future.

    PubMed Central

    Baugh, Reginald F.

    2003-01-01

    Rising employer health care costs and consumer backlash against managed care are trends fostering the development of defined contribution plans. Defined contribution plans limit employer responsibility to a fixed financial contribution rather than a benefit program and dramatically increase consumer responsibility for health care decision making. Possible outcomes of widespread adoption of defined contribution plans are presented. PMID:12934869

  19. Medicare program; prohibition of midyear benefit enhancements for Medicare Advantage organizations. Final rule.

    PubMed

    2008-07-28

    This final rule prohibits Medicare Advantage (MA) organizations, including organizations offering MA plans to employer and union group health plan sponsors, from making midyear changes to nonprescription drug benefits, premiums, and cost-sharing submitted in their approved bids for a given contract year. This final rule also clarifies that MA organizations offering certain kinds of plans restricted to employer and union group health plan sponsors and not open to general enrollment may continue to offer benefit enhancements as they do currently, through means other than midyear benefit enhancements (MYBEs). Programs of all-inclusive care for elderly (PACE) are not subject to the provisions of this final rule and may continue to offer enhanced benefits as specified in our guidance for PACE plans.

  20. Point-of-care testing.

    PubMed

    O'Brien, J A

    2000-12-01

    Is POCT worth integrating into a facility? Despite its promise of speed and convenience, this technology requires careful evaluation of potential benefits, disadvantages, and challenges to the existing system. If the pros outweigh the cons, a step-by-step approach can ease the process of implementing a POCT program.

  1. The Business Case for Palliative Care: Translating Research Into Program Development in the U.S.

    PubMed

    Cassel, J Brian; Kerr, Kathleen M; Kalman, Noah S; Smith, Thomas J

    2015-12-01

    Specialist palliative care (PC) often embraces a "less is more" philosophy that runs counter to the revenue-centric nature of most health care financing in the U.S. A special business case is needed in which the financial benefits for organizations such as hospitals and payers are aligned with the demonstrable clinical benefits for patients. Based on published studies and our work with PC programs over the past 15 years, we identified 10 principles that together form a business model for specialist PC. These principles are relatively well established for inpatient PC but are only now emerging for community-based PC. Three developments that are key for the latter are the increasing penalties from payers for overutilization of hospital stays, the variety of alternative payment models such as accountable care organizations, which foster a population health management perspective, and payer-provider partnerships that allow for greater access to and funding of community-based PC. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

  2. Heart failure and diabetes: collateral benefit of chronic disease management.

    PubMed

    Ware, Molly G; Flavell, Carol M; Lewis, Eldrin F; Nohria, Anju; Warner-Stevenson, Lynne; Givertz, Michael M

    2006-01-01

    To test the hypothesis that a focus on heart failure (HF) care may be associated with inadequate diabetes care, the authors screened 78 patients (aged 64+/-11 years; 69% male) with diabetes enrolled in an HF disease management program for diabetes care as recommended by the American Diabetes Association (ADA). Ninety-five percent of patients had hemoglobin A1c levels measured within 12 months, and 71% monitored their glucose at least once daily. Most patients received counseling regarding diabetic diet and exercise, and approximately 80% reported receiving regular eye and foot examinations. Mean hemoglobin A1c level was 7.8+/-1.9%. There was no relationship between hemoglobin A1c levels and New York Heart Association class or history of HF hospitalizations. Contrary to the authors' hypothesis, patients in an HF disease management program demonstrated levels of diabetic care close to ADA goals. "Collateral benefit" of HF disease management may contribute to improved patient outcomes in diabetic patients with HF.

  3. TRICARE program; clarification of benefit coverage of durable equipment and ordering or prescribing durable equipment; clarification of benefit coverage of assistive technology devises under the Extended Care Health Option Program. Final rule.

    PubMed

    2014-12-31

    This final rule modifies the TRICARE regulation to add a definition of assistive technology (AT) devices for purposes of benefit coverage under the TRICARE Extended Care Health Option (ECHO) Program and to amend the definitions of durable equipment (DE) and durable medical equipment (DME) to better conform the language in the regulation to the statute. The final rule amends the language that specifically limits ordering or prescribing of DME to only a physician under the Basic Program, as this amendment will allow certain other TRICARE authorized individual professional providers, acting within the scope of their licensure, to order or prescribe DME. This final rule also incorporates a policy clarification relating to luxury, deluxe, or immaterial features of equipment or devices. That is, TRICARE cannot reimburse for the luxury, deluxe, or immaterial features of equipment or devices, but can reimburse for the base or basic equipment or device that meet the beneficiary's needs. Beneficiaries may choose to pay the provider for the luxury, deluxe, or immaterial features if they desire their equipment or device to have these "extra features."

  4. Education in care and technology, a facilitator of interdisciplinary research and development.

    PubMed

    Willems, Charles G; Sponselee, Anne-Mie; Verkerke, Margreet Michel; Sirkka, Andrew; Saarni, Lea; Castello Branco, Miguel; de Witte, Luc

    2015-01-01

    Application of technology in care is hindered by two factors; a critical attitude of care professionals towards the use of technology as part of care delivery and a lack of knowledge of care practice by technology developers. Technological developments may provide adequate solutions to support care provision. The principles of user centred design and development, traditionally used in the development of assistive technology, may provide powerful tools to support care provision. Interdisciplinary research will be needed to take full benefit. Educational programs to support this development are lacking. Main content of this paper: Six organisations of higher education have taken the initiative to organize a training program to support professionals active in the care or in the technology domain that enables them to become involved in interdisciplinary research and development. a European program to educate a professional master in Care and Technology has been developed and is described in this paper. Accreditation of the program is initiated. Alumni of such a program may form a European network of professionals that are active in developing new solutions to support people with special needs and contribute to the generation of new business.

  5. Why Providers Participate in Clinical Trials: Considering the National Cancer Institute’s Community Clinical Oncology Program

    PubMed Central

    McAlearney, Ann Scheck; Song, Paula H.; Reiter, Kristin L.

    2012-01-01

    Background The translation of research evidence into practice is facilitated by clinical trials such as those sponsored by the National Cancer Institute’s Community Clinical Oncology Program (CCOP) that help disseminate cancer care innovations to community-based physicians and provider organizations. However, CCOP participation involves unsubsidized costs and organizational challenges that raise concerns about sustained provider participation in clinical trials. Objectives This study was designed to improve our understanding of why providers participate in the CCOP in order to inform the decision-making process of administrators, clinicians, organizations, and policy-makers considering CCOP participation. Research Methods We conducted a multi-site qualitative study of five provider organizations engaged with the CCOP. We interviewed 41 administrative and clinician key informants, asking about what motivated CCOP participation, and what benefits they associated with involvement. We deductively and inductively analyzed verbatim interview transcripts, and explored themes that emerged. Results Interviewees expressed both “altruistic” and “self-interested” motives for CCOP participation. Altruistic reasons included a desire to increase access to clinical trials and feeling an obligation to patients. Self-interested reasons included the desire to enhance reputation, and a need to integrate disparate cancer care activities. Perceived benefits largely matched expressed motives for CCOP participation, and included internal and external benefits to the organization, and quality of care benefits for both patients and participating physicians. Conclusion The motives and benefits providers attributed to CCOP participation are consistent with translational research goals, offering evidence that participation can contribute value to providers by expanding access to innovative medical care for patients in need. PMID:22925970

  6. Why providers participate in clinical trials: considering the National Cancer Institute's Community Clinical Oncology Program.

    PubMed

    McAlearney, Ann Scheck; Song, Paula H; Reiter, Kristin L

    2012-11-01

    The translation of research evidence into practice is facilitated by clinical trials such as those sponsored by the National Cancer Institute's Community Clinical Oncology Program (CCOP) that help disseminate cancer care innovations to community-based physicians and provider organizations. However, CCOP participation involves unsubsidized costs and organizational challenges that raise concerns about sustained provider participation in clinical trials. This study was designed to improve our understanding of why providers participate in the CCOP in order to inform the decision-making process of administrators, clinicians, organizations, and policy-makers considering CCOP participation. We conducted a multi-site qualitative study of five provider organizations engaged with the CCOP. We interviewed 41 administrative and clinician key informants, asking about what motivated CCOP participation, and what benefits they associated with involvement. We deductively and inductively analyzed verbatim interview transcripts, and explored themes that emerged. Interviewees expressed both "altruistic" and "self-interested" motives for CCOP participation. Altruistic reasons included a desire to increase access to clinical trials and feeling an obligation to patients. Self-interested reasons included the desire to enhance reputation, and a need to integrate disparate cancer care activities. Perceived benefits largely matched expressed motives for CCOP participation, and included internal and external benefits to the organization, and quality of care benefits for both patients and participating physicians. The motives and benefits providers attributed to CCOP participation are consistent with translational research goals, offering evidence that participation can contribute value to providers by expanding access to innovative medical care for patients in need. Copyright © 2012 Elsevier Inc. All rights reserved.

  7. Health promotion and disease prevention: a look at demand management programs.

    PubMed

    Fronstin, P

    1996-09-01

    This Issue Brief describes employers' efforts to contain health expenditures through demand management programs. These programs are designed to reduce utilization by focusing on disease prevention and health promotion. Demand management includes work site health promotion, wellness programs, and access management. Work site health promotion is a comprehensive approach to improving health and includes awareness, health education, behavioral change, and organizational health initiatives. Wellness programs usually include stress management, smoking cessation, weight management, back care, health screenings, nutrition education, work place safety, prenatal and well baby care, CPR and first aid classes, and employee assistance programs (EAPs). These programs are often viewed positively by workers and can have long-term benefits for employers above and beyond health care cost containment. Demand management can benefit employers by increasing productivity, employee retention, and employee morale and by reducing turnover, absenteeism, future medical claims, and ultimately expenditures on health care. Even though a growing number of employers are offering wellness programs, only 37 percent of full-time workers employed in medium and large private establishments were eligible for wellness programs by 1993. However, a recent survey found that 88 percent of major employers have introduced some form of health promotion, disease prevention, or early intervention initiative to encourage healthy lifestyles among their salaried employees. Distinctions must be drawn between short- and long-term strategies. Demand management can be thought of as a short-term strategy when the focus of the program is on creating more appropriate and efficient health care utilization. Disease prevention is characterized by longer-term health improvement objectives. Whether the purpose is to reduce utilization in the short term or in the long term, the ultimate goal remains the same: to reduce health care expenditures while improving overall health. This goal can be achieved through the use of health risk appraisals, organizational health risk appraisals, high risk programs, awareness programs, medical call centers, return to work programs, EAPs, and smoking cessation programs. Studies of a health program's cost effectiveness must disentangle the effects of many competing factors on cost effectiveness. For example, a health risk appraisal program may identify health problems of which the patient and the health care provider were unaware, resulting in the treatment of these health problems. At the same time, the employer may have switched from a nonmanaged pharmaceutical program to a managed program with incentives for participants to utilize generic and/or mail order drugs. As a result, when evaluating a health promotion program, the long-run impact on the program's cost effectiveness is most important.

  8. Evaluation of the Program in Medical Education for the Urban Underserved (PRIME-US) at the UC Berkeley-UCSF Joint Medical Program (JMP): The First 4 Years.

    PubMed

    Sokal-Gutierrez, Karen; Ivey, Susan L; Garcia, Roxanna M; Azzam, Amin

    2015-01-01

    Medical educators, clinicians, and health policy experts widely acknowledge the need to increase the diversity of our healthcare workforce and build our capacity to care for medically underserved populations and reduce health disparities. The Program in Medical Education for the Urban Underserved (PRIME-US) is part of a family of programs across the University of California (UC) medical schools aiming to recruit and train physicians to care for underserved populations, expand the healthcare workforce to serve diverse populations, and promote health equity. PRIME-US selects medical students from diverse backgrounds who are committed to caring for underserved populations and provides a 5-year curriculum including a summer orientation, a longitudinal seminar series with community engagement and leadership-development activities, preclerkship clinical immersion in an underserved setting, a master's degree, and a capstone rotation in the final year of medical school. This is a mixed-methods evaluation of the first 4 years of the PRIME-US at the UC Berkeley-UC San Francisco Joint Medical Program (JMP). From 2006 to 2010, focus groups were conducted each year with classes of JMP PRIME-US students, for a total of 11 focus groups; major themes were identified using content analysis. In addition, 4 yearly anonymous, online surveys of all JMP students, faculty and staff were conducted and analyzed. Most PRIME-US students came from socioeconomically disadvantaged backgrounds and ethnic backgrounds underrepresented in medicine, and all were committed to caring for underserved populations. The PRIME-US students experienced many program benefits including peer support, professional role models and mentorship, and curricular enrichment activities that developed their knowledge, skills, and sustained commitment to care for underserved populations. Non-PRIME students, faculty, and staff also benefited from participating in PRIME-sponsored seminars and community-based activities. Challenges noted by PRIME-US students and non-PRIME students, faculty, and staff included the stress of additional workload, perceived inequities in student educational opportunities, and some negative comments from physicians in other specialties regarding primary care careers. Over the first 4 years of the program, PRIME-US students and non-PRIME students, faculty, and staff experienced educational benefits consistent with the intended program goals. Long-term evaluation is needed to examine the participants' medical careers and impacts on California's healthcare workforce and patient outcomes. Attention should also be paid to the challenges of implementing new medical education enrichment programs.

  9. Health insurance systems in five Sub-Saharan African countries: medicine benefits and data for decision making.

    PubMed

    Carapinha, João L; Ross-Degnan, Dennis; Desta, Abayneh Tamer; Wagner, Anita K

    2011-03-01

    Medicine benefits through health insurance programs have the potential to improve access to and promote more effective use of affordable, high quality medicines. Information is lacking about medicine benefits provided by health insurance programs in Sub-Saharan Africa. We describe the structure of medicine benefits and data routinely available for decision-making in 33 health insurance programs in Ghana, Kenya, Nigeria, Tanzania and Uganda. Most programs surveyed were private, for profit schemes covering voluntary enrollees, mostly in urban areas. Almost all provide both inpatient and outpatient medicine benefits, with members sharing the cost of medicines in all programs. Some programs use strategies that are common in high-income countries to manage the medicine benefits, such as formularies, generics policies, reimbursement limits, or price negotiation. Basic data to monitor performance in delivering medicine benefits are available in most programs, but key data elements and the resources needed to generate useful management information from the available data are typically missing. Many questions remain unanswered about the design, implementation, and effects of specific medicines policies in the emerging and expanding health insurance programs in Sub-Saharan Africa. These include questions about the most effective medicines policy choices, given different corporate and organizational structures and resources; impacts of specific benefit designs on quality and affordability of care and health outcomes; and ways to facilitate use of routine data for monitoring. Technical capacity building, strong government commitment, and international donor support will be needed to realize the benefits of medicines coverage in emerging and expanding health insurance programs in Sub-Saharan Africa. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  10. MediCaring: development and test marketing of a supportive care benefit for older people.

    PubMed

    Lynn, J; O'Connor, M A; Dulac, J D; Roach, M J; Ross, C S; Wasson, J H

    1999-09-01

    To develop an alternative healthcare benefit (called MediCaring) and to assess the preferences of older Medicare beneficiaries concerning this benefit, which emphasizes more home-based and supportive health care and discourages use of hospitalization and aggressive treatment. To evaluate the beneficiaries' ability to understand and make a choice regarding health insurance benefits; to measure their likelihood to change from traditional Medicare to the new MediCaring benefit; and to determine the short-term stability of that choice. Focus groups of persons aged 65+ and family members shaped the potential MediCaring benefit. A panel of 50 national experts critiqued three iterations of the benefit. The final version was test marketed by discussing it with 382 older people (men > or = 75 years and women > or = 80 years) in their homes. Telephone surveys a few days later, and again 1 month after the home interview, assessed the potential beneficiaries' understanding and preferences concerning MediCaring and the stability of their responses. Focus groups were held in community settings in New Hampshire, Washington, DC, Cleveland, OH, and Columbia, SC. Test marketing occurred in New Hampshire, Cleveland, OH; Columbia, SC, and Los Angeles, CA. Focus group participants were persons more than 65 years old (11 focus groups), healthcare providers (9 focus groups), and family decision-makers (3 focus groups). Participants in the in-home informing (test marketing group) were persons older than 75 years who were identified through contact with a variety of services. Demographics, health characteristics, understanding, and preferences. Focus group beneficiaries between the ages of 65 and 74 generally wanted access to all possible medical treatment and saw MediCaring as a need of persons older than themselves. Those older than age 80 were mostly in favor of it. Test marketing participants understood the key points of the new benefit: 74% generally liked it, and 34% said they would take it now. Preferences were generally stable at 1 month. In multivariate regression, those preferring MediCaring were wealthier, more often white, more often living in senior housing, and using more homecare services. However, they were not more often in poor health or needing ADL assistance. Older persons aged more than 80 years can understand a health benefit choice; most liked the aims of a new supportive care benefit, and 34% would change immediately from Medicare to a supportive care benefit such as MediCaring,. These findings encourage further development of special programs of care, such as MediCaring, that prioritize comfort and support for the old old.

  11. A critical care helicopter system in trauma.

    PubMed Central

    Jacobs, L. M.; Bennett, B.

    1989-01-01

    Civilian helicopters and emergency medical services in the United States have been in existence for approximately 15 years. The rapid growth of this type of health care delivery coupled with an increasing number of accidents has prompted professional and lay scrutiny of these programs. Although they have a demonstrated history of benefit to patients, the type and severity of injuries to patients who are eligible for helicopter transportation need further definition. The composition of the medical crews and the benefits that particular crew members bring to the patients require ongoing evaluation. Significant questions regarding the number of pilots in a helicopter and in a program remain to be answered. This article reviews the role of emergency medical air transport services in providing care to trauma patients, staff training and evaluation, and safety criteria and offers recommendations to minimize risks to patients and crews. PMID:2695653

  12. The implementation of Prime Vendor Europe and its successful impact on an overseas naval medical treatment facility.

    PubMed

    Koerner, S D; Anaya, M A

    1996-10-01

    Prime Vendor Europe (PVE) is the commercial pharmaceutical ordering and delivery program that is revolutionizing overseas health care delivery at military health care treatment facilities located in the European theater. Mirroring civilian programs already available and replacing the Federal Supply System, PVE offers many benefits never before realized at overseas military health care treatment facilities, including: diminished order turnaround times with resultant decreased Operating Target requirements; rapid order confirmation after order placement; lower carrying costs and inventory needs; better dating of pharmaceuticals received; redistribution and increased efficiency of the current manhours needed to operate a pharmacy supply system; order tracking capabilities; and enhancement of the present cooperative and constructive dichotomous relationship between medical logistics and pharmacy regarding pharmaceutical purchasing practices. This paper will explore the fundamentals, past performance, continuous quality improvement of logistical functions, frame-work establishment for PVE, implementation of PVE, and subsequent observed command benefits of PVE realization.

  13. Teacher and Principal Survey Results in the National Preventive Dentistry Demonstration Program.

    ERIC Educational Resources Information Center

    Klein, Stephen P.; And Others

    The National Preventive Dentistry Demonstration Program was conducted to assess the costs and benefits of combinations of school-based preventive dental care procedures. The program involved almost 30,000 elementary school children from 10 sites across the country. Classroom procedures, such as weekly fluoride mouthrinse, were administered or…

  14. Healing by Creating: Patient Evaluations of Art-Making Program

    ERIC Educational Resources Information Center

    Heiney, Sue P.; Darr-Hope, Heidi; Meriwether, Marian P.; Adams, Swann Arp

    2017-01-01

    The benefits of using art in health care, especially with cancer patients, have been described anecdotally. However, few manuscripts include a conceptual framework to describe the evaluation of patient programs. This paper describes patients' evaluation of a healing arts program developed within a hospital for cancer patients that used art-making,…

  15. Developing supplemental activities for primary health care maternity services.

    PubMed

    Panitz, E

    1990-12-01

    Supplemental health care activities are described in the context of the augmented product. The potential benefits of supplemental services to recipients and provider are discussed. The author describes a study that was the basis for (re)developing a supplemental maternity service. The implementation of the results in terms of changes in the marketing mix of this supplemental program is discussed. The effects of the marketing mix changes on program participation are presented.

  16. Autos, tires, aluminum, oil--and cost containment.

    PubMed

    Friedman, E

    1978-09-01

    Faced with massive increases in the costs of the health care benefits they provide for their employees, many large U.S. corporations are becoming increasingly involved in efforts to contain health care costs. Often seeing their efforts as posing an alternative to direct federal government intervention, business leaders are implementing a wide range of programs, including specific arrangements with providers, education of hospital trustees who are also employees, and fitness and preventive medicine programs.

  17. Advancing nursing leadership in long-term care.

    PubMed

    O'Brien, Jennifer; Ringland, Margaret; Wilson, Susan

    2010-05-01

    Nurses working in the long-term care (LTC) sector face unique workplace stresses, demands and circumstances. Designing approaches to leadership training and other supportive human-resource strategies that reflect the demands of the LTC setting fosters a positive work life for nurses by providing them with the skills and knowledge necessary to lead the care team and to address resident and family issues. Through the St. Joseph's Health Centre Guelph demonstration site project, funded by the Nursing Secretariat of Ontario's Ministry of Health and Long-Term Care, the Excelling as a Nurse Leader in Long Term Care training program and the Mentor Team program were developed to address these needs. Evaluation results show that not only have individual nurses benefitted from taking part in these programs, but also that the positive effects were felt in other parts of the LTC home (as reported by Directors of Care). By creating a generally healthier work environment, it is anticipated that these programs will also have a positive effect on recruitment and retention.

  18. 32 CFR 199.4 - Basic program benefits.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... its derivatives, including equipment and supplies, and its administration. (x) Radiation therapy... accommodations are occupied; or (4) When a patient is admitted to an acute care hospital (general or special... available; or, in the case of an acute care hospital (general or special) which does not have semiprivate...

  19. 32 CFR 199.4 - Basic program benefits.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... its derivatives, including equipment and supplies, and its administration. (x) Radiation therapy... accommodations are occupied; or (4) When a patient is admitted to an acute care hospital (general or special... available; or, in the case of an acute care hospital (general or special) which does not have semiprivate...

  20. 32 CFR 199.4 - Basic program benefits.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... its derivatives, including equipment and supplies, and its administration. (x) Radiation therapy... accommodations are occupied; or (4) When a patient is admitted to an acute care hospital (general or special... available; or, in the case of an acute care hospital (general or special) which does not have semiprivate...

  1. 32 CFR 199.4 - Basic program benefits.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... its derivatives, including equipment and supplies, and its administration. (x) Radiation therapy... accommodations are occupied; or (4) When a patient is admitted to an acute care hospital (general or special... available; or, in the case of an acute care hospital (general or special) which does not have semiprivate...

  2. 32 CFR 199.4 - Basic program benefits.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... its derivatives, including equipment and supplies, and its administration. (x) Radiation therapy... accommodations are occupied; or (4) When a patient is admitted to an acute care hospital (general or special... available; or, in the case of an acute care hospital (general or special) which does not have semiprivate...

  3. 42 CFR 435.134 - Individuals who would be eligible except for the increase in OASDI benefits under Pub. L. 92-336...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... programs if he were not in a medical institution or intermediate care facility, and the Medicaid plan... institution or intermediate care facility, and the State's Medicaid plan covers this optional group. [43 FR...

  4. 42 CFR 435.134 - Individuals who would be eligible except for the increase in OASDI benefits under Pub. L. 92-336...

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... programs if he were not in a medical institution or intermediate care facility, and the Medicaid plan... institution or intermediate care facility, and the State's Medicaid plan covers this optional group. [43 FR...

  5. 5 CFR 890.1001 - Scope and purpose.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care... administrative sanctions that OPM may, or in some cases, must apply to health care providers who have committed... assessments. (b) Purpose. OPM uses the authorities in this subpart to protect the health and safety of the...

  6. 5 CFR 890.1001 - Scope and purpose.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care... administrative sanctions that OPM may, or in some cases, must apply to health care providers who have committed... assessments. (b) Purpose. OPM uses the authorities in this subpart to protect the health and safety of the...

  7. The value from investments in health information technology at the U.S. Department of Veterans Affairs.

    PubMed

    Byrne, Colene M; Mercincavage, Lauren M; Pan, Eric C; Vincent, Adam G; Johnston, Douglas S; Middleton, Blackford

    2010-04-01

    We compare health information technology (IT) in the Department of Veterans Affairs (VA) to norms in the private sector, and we estimate the costs and benefits of selected VA health IT systems. The VA spent proportionately more on IT than the private health care sector spent, but it achieved higher levels of IT adoption and quality of care. The potential value of the VA's health IT investments is estimated at $3.09 billion in cumulative benefits net of investment costs. This study serves as a framework to inform efforts to measure and calculate the benefits of federal health IT stimulus programs.

  8. Increasing participation in incentive programs for biodiversity conservation.

    PubMed

    Sorice, Michael G; Oh, Chi-Ok; Gartner, Todd; Snieckus, Mary; Johnson, Rhett; Donlan, C Josh

    2013-07-01

    Engaging private landowners in conservation activities for imperiled species is critical to maintaining and enhancing biodiversity. Market-based approaches can incentivize conservation behaviors on private lands by shifting the benefit-cost ratio of engaging in activities that result in net conservation benefits for target species. In the United States and elsewhere, voluntary conservation agreements with financial incentives are becoming an increasingly common strategy. While the influence of program design and delivery of voluntary conservation programs is often overlooked, these aspects are critical to achieving the necessary participation to attain landscape-scale outcomes. Using a sample of family-forest landowners in the southeast United States, we show how preferences for participation in a conservation program to protect an at-risk species, the gopher tortoise (Gopherus polyphemus), are related to program structure, delivery, and perceived efficacy. Landowners were most sensitive to programs that are highly controlling, require permanent conservation easements, and put landowners at risk for future regulation. Programs designed with greater levels of compensation and that support landowners' autonomy to make land management decisions can increase participation and increase landowner acceptance of program components that are generally unfavorable, like long-term contracts and permanent easements. There is an inherent trade-off between maximizing participation and maximizing the conservation benefits when designing a conservation incentive program. For conservation programs targeting private lands to achieve landscape-level benefits, they must attract a critical level of participation that creates a connected mosaic of conservation benefits. Yet, programs with attributes that strive to maximize conservation benefits within a single agreement (and reduce risks of failure) are likely to have lower participation, and thus lower landscape benefits. Achieving levels of landowner participation in conservation agreement programs that deliver lasting, landscape-level benefits requires careful attention not only to how the program structure influences potential conservation benefits, but also how it influences landowners and their potential to participate.

  9. Group cognitive behavioral therapy to improve the quality of care to opioid-treated patients with chronic noncancer pain: a practice improvement project.

    PubMed

    Whitten, Stacey K; Stanik-Hutt, Julie

    2013-07-01

    To enhance outcomes of patients with chronic noncancer pain (CNCP) treated with opioids in a primary care setting by implementing an evidence-based quality improvement project. The project consisted of the implementation of a 6-week cognitive behavioral therapy (CBT) program. Twenty-two patients with CNCP completed the program. Impact of the project was evaluated by comparing pre- and postintervention participant self-reports of mood on the Beck Depression Inventory and functional status on the Brief Pain Inventory and Short Form-36. Patient perception of treatment benefit was also measured using the Patient Global Impression of Change. Qualitative provider perceptions of the program were also collected. Paired t-test statistics were used to analyze the data. Mood (including negative attitude, performance difficulty, and physical complaints), and patient impression of treatment benefit improved significantly after CBT was added. Primary care providers reported that the CBT supported their overall management of these complex patients. The addition of a CBT program improved selected outcomes in this self-selected sample of patients with CNCP treated with opioids. ©2012 The Author(s) ©2012 American Association of Nurse Practitioners.

  10. 5 CFR 890.1052 - Reinstatements without application.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Reinstatement § 890.1052 Reinstatements without application. OPM shall reinstate a...

  11. 5 CFR 890.1022 - Contesting proposed permissive debarments.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Permissive Debarments § 890.1022 Contesting proposed permissive debarments...

  12. Caring for Kids: Bridging Gaps in Pediatric Emergency Care Through Community Education and Outreach.

    PubMed

    Luckstead-Gosdin, Ann; Vinson, Lori; Greenwell, Cynthia; Tweed, Jefferson

    2017-06-01

    The Pediatric Emergency Services Network (PESN) was developed to provide ongoing continuing education on pediatric guidelines and pediatric emergency care to rural and nonpediatric hospitals, physicians, nurses, and emergency personnel. A survey was developed and given to participants attending PESN educational events to determine the perceived benefit and application to practice of the PESN outreach program. Overall, 91% of participants surveyed reported agreement that PESN educational events were beneficial to their clinical practice, provided them with new knowledge, and made them more knowledgeable about pediatric emergency care. Education and outreach programs can be beneficial to health care workers' educational needs. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Challenges for Managed Care from 340B Contract Pharmacies.

    PubMed

    Fein, Adam J

    2016-03-01

    The federal 340B Drug Pricing Program has expanded rapidly, with important yet still unmeasured impact on both managed care practice and policies. Notably, providers increasingly rely on external, contract pharmacies to extend 340B pricing to a broad set of patients. In 2014, 1 in 4 U.S. retail, mail, and specialty pharmacy locations acted as contract pharmacies for 340B-covered entities. This commentary discusses crucial ways in which 340B growth is affecting managed care pharmacy through formulary rebates, profits from managed care paid prescriptions, disruption of retail pharmacy networks, and reduced generic dispensing rates. Managed care should become more engaged in the discussion on how the 340B program should evolve and offer policy proposals to mitigate the challenges being encountered. There is also an urgent need for objective, transparent research on the 340B program's costs, benefits, and implications for managed care pharmacy and practice.

  14. Patient Navigation to Improve Cancer Screening in Underserved Populations: Reported Experiences, Opportunities, and Challenges.

    PubMed

    Neal, Chrishanae D; Weaver, Davis T; Raphel, Tiana J; Lietz, Anna P; Flores, Efren J; Percac-Lima, Sanja; Knudsen, Amy B; Pandharipande, Pari V

    2018-04-20

    Our goal is to define patient navigation for an imaging audience, present a focused selection of published experiences with navigation programs for breast and colorectal cancer screening, and expose principal barriers to the success of such programs. Despite numerous advances in the early detection of cancers, many patients still present with advanced disease. A disproportionate number are low-income minority patients who experience worse health outcomes than their white or more financially stable counterparts. Patient navigation, which aims to assist the medically underserved by overcoming specific barriers to care, may represent one solution to narrowing disparities. Related research suggests that in general, patient navigation programs that have addressed breast or colorectal cancer screening have been successful in improving screening rates and timeliness of follow-up care. However, although beneficial, navigation is expensive and may present an unmanageable financial burden for many health care centers. To overcome this challenge, navigation efforts will likely need to target those patients that are most likely to benefit. Further research to identify such patients will be critically important for improving the sustainability of navigation programs, and, in turn, for realizing the benefits of such programs in reducing cancer disparities. Copyright © 2018. Published by Elsevier Inc.

  15. Medicaid Adult Dental Benefits Increase Use Of Dental Care, But Impact Of Expansion On Dental Services Use Was Mixed.

    PubMed

    Singhal, Astha; Damiano, Peter; Sabik, Lindsay

    2017-04-01

    Dental coverage for adult enrollees is an optional benefit under Medicaid. Thirty-one states and the District of Columbia have expanded eligibility for Medicaid under the Affordable Care Act. Millions of low-income adults have gained health care coverage and, in states offering dental benefits, oral health coverage as well. Using data for 2010 and 2014 from the Behavioral Risk Factor Surveillance System, we examined the impact of Medicaid adult dental coverage and eligibility expansions on low-income adults' use of dental care. We found that low-income adults in states that provided dental benefits beyond emergency-only coverage were more likely to have had a dental visit in the past year, compared to low-income adults in states without such benefits. Among states that provided dental benefits and expanded their Medicaid program, regression-based estimates suggest that childless adults had a significant increase (1.8 percentage points) in the likelihood of having had a dental visit, while parents had a significant decline (8.1 percentage points). One possible explanation for the disparity is that after expansion, newly enrolled childless adults might have exhausted the limited dental provider capacity that was available to parents before expansion. Additional policy-level efforts may be needed to expand the dental care delivery system's capacity. Project HOPE—The People-to-People Health Foundation, Inc.

  16. Financial Implications of Residency Programs for Sponsoring Organizations.

    ERIC Educational Resources Information Center

    Heiberger, Michael H.

    1997-01-01

    Explores cost implications of residency programs within the Veterans Administration health care system, particularly the costs and benefits of residencies in family medicine, osteopathic medicine, and general dentistry, because they resemble optometric residencies most closely. Costs of an existing vision therapy residency are examined, and…

  17. 31 CFR 28.500 - Employment.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... sex to care for children or dependents, or any other leave; (7) Fringe benefits available by virtue of... SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Employment in Education Programs or Activities Prohibited § 28.500 Employment. (a...

  18. 45 CFR 618.500 - Employment.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... sex to care for children or dependents, or any other leave; (7) Fringe benefits available by virtue of... OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Employment in Education Programs or Activities Prohibited § 618.500 Employment. (a...

  19. 45 CFR 618.500 - Employment.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... sex to care for children or dependents, or any other leave; (7) Fringe benefits available by virtue of... OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Employment in Education Programs or Activities Prohibited § 618.500 Employment. (a...

  20. 31 CFR 28.500 - Employment.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... sex to care for children or dependents, or any other leave; (7) Fringe benefits available by virtue of... SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Employment in Education Programs or Activities Prohibited § 28.500 Employment. (a...

  1. 45 CFR 618.500 - Employment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... sex to care for children or dependents, or any other leave; (7) Fringe benefits available by virtue of... OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Employment in Education Programs or Activities Prohibited § 618.500 Employment. (a...

  2. 31 CFR 28.500 - Employment.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... sex to care for children or dependents, or any other leave; (7) Fringe benefits available by virtue of... SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Employment in Education Programs or Activities Prohibited § 28.500 Employment. (a...

  3. 45 CFR 618.500 - Employment.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... sex to care for children or dependents, or any other leave; (7) Fringe benefits available by virtue of... OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Employment in Education Programs or Activities Prohibited § 618.500 Employment. (a...

  4. 31 CFR 28.500 - Employment.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... sex to care for children or dependents, or any other leave; (7) Fringe benefits available by virtue of... SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Employment in Education Programs or Activities Prohibited § 28.500 Employment. (a...

  5. 45 CFR 618.500 - Employment.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... sex to care for children or dependents, or any other leave; (7) Fringe benefits available by virtue of... OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Employment in Education Programs or Activities Prohibited § 618.500 Employment. (a...

  6. 31 CFR 28.500 - Employment.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... sex to care for children or dependents, or any other leave; (7) Fringe benefits available by virtue of... SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Employment in Education Programs or Activities Prohibited § 28.500 Employment. (a...

  7. Medicare Advantage Penetration and Hospital Costs Before and After the Affordable Care Act.

    PubMed

    Henke, Rachel Mosher; Karaca, Zeynal; Gibson, Teresa B; Cutler, Eli; White, Chapin; Wong, Herbert S

    2018-04-01

    Research has suggested that growth in the Medicare Advantage (MA) program indirectly benefits the entire 65+-year-old population by reducing overall expenditures and creating spillover effects of patient care practices. Medicare programs and innovations initiated by the Affordable Care Act (ACA) have encouraged practices to adopt models applying to all patient populations, which may influence the continued benefits of MA program growth. This study investigated the relationship between MA program growth and inpatient hospital costs and utilization before and after the ACA. Primary data sources were 2005-2014 Health Care Cost and Utilization Project hospital data and 2004-2013 Centers for Medicare & Medicaid Services enrollment data. County-year-level regression analysis with fixed effects examined the relationship between Medicare managed care penetration and hospital cost per enrollee. We decomposed results into changes in utilization, severity, and severity-adjusted inpatient resource use. Analyses were stratified by whether the admission was urgent or nonurgent. A 10% increase in MA penetration was associated with a 3-percentage point decrease in inpatient cost per Medicare enrollee before the ACA. This effect was more prominent in nonurgent admissions and diminished after the ACA. Results suggest that MA enrollment growth is associated with diminished spillover reductions in hospital admission costs after the ACA. We did not observe a strong relationship between MA enrollment and inpatient days per enrollee. Future research should examine whether spillover effects still are observed in outpatient settings.

  8. Integrating care coordination home telehealth and home based primary care in rural Oklahoma: a pilot study.

    PubMed

    Sorocco, Kristen H; Bratkovich, Kristi L; Wingo, Rita; Qureshi, Saleem M; Mason, Patrick J

    2013-08-01

    The purpose of this program was to evaluate the benefits of integrating VA Care Coordination Home Telehealth and Telemental health within HBPC. A case study design was used to determine quality assurance and quality improvement of incorporating additional home telehealth equipment within Home Based Primary Care (HBPC). Veterans with complex medical conditions and their caregivers living in rural Oklahoma were enrolled. Veterans received the same care other HBPC patients received with the addition of home telehealth equipment. Members from the interdisciplinary treatment team were certified to use the telehealth equipment. Veterans and their caregivers were trained on use of the equipment in their homes. Standard HBPC program measures were used to assess the program success. Assessments from all disciplines on the HBPC team were at baseline, 3, and 6 months, and participants provided satisfaction and interview data to assess the benefits of integrating technology into standard care delivery within an HBPC program. Six veterans were enrolled (mean age = 72 yrs) with a range of physical health conditions including: chronic obstructive pulmonary disease, cerebrovascular accident, spinal cord injury, diabetes, hypertension, and syncope. Primary mental health conditions included depression, dementia, anxiety, and PTSD. Scores on the Mini-Mental State Examination ranged from 18 to 30. Over a 6-month period, case studies indicated improvements in strength, social functioning, decreased caregiver burden, and compliance with treatment plan. This integration of CCHT and HBPC served previously underserved rural veterans having complex medical conditions and appears both feasible and clinically beneficial to veterans and their caregivers. PsycINFO Database Record (c) 2013 APA, all rights reserved.

  9. 5 CFR 890.1009 - Contesting proposed mandatory debarments.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Mandatory Debarments § 890.1009 Contesting proposed mandatory debarments. (a...

  10. 42 CFR 409.24 - Medical social services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 2 2011-10-01 2011-10-01 false Medical social services. 409.24 Section 409.24... PROGRAM HOSPITAL INSURANCE BENEFITS Posthospital SNF Care § 409.24 Medical social services. Medicare pays for medical social services as posthospital SNF care, including— (a) Assessment of the social and...

  11. Transforming Professionalism: Relational Bureaucracy and Parent-Teacher Partnerships in Child Care Settings

    ERIC Educational Resources Information Center

    Douglass, Anne; Gittell, Jody Hoffer

    2012-01-01

    Dramatic shifts in early childhood policy in the US are increasing the bureaucratic nature of early childhood programs and influencing the field's definition of professionalism. Despite the many benefits of professionalizing the child care field, the current trend toward formalization and standardization may have unintended negative consequences…

  12. 45 CFR 286.275 - What information must Tribes file annually?

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... grantee's locality) center-based child care. (5) A description of any nonrecurring, short-term benefits... (ASSISTANCE PROGRAMS), ADMINISTRATION FOR CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... of payments for child care services made by the Tribal TANF grantee through the use of disregards, by...

  13. 42 CFR 409.24 - Medical social services.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 2 2014-10-01 2014-10-01 false Medical social services. 409.24 Section 409.24... PROGRAM HOSPITAL INSURANCE BENEFITS Posthospital SNF Care § 409.24 Medical social services. Medicare pays for medical social services as posthospital SNF care, including— (a) Assessment of the social and...

  14. 42 CFR 409.24 - Medical social services.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 2 2013-10-01 2013-10-01 false Medical social services. 409.24 Section 409.24... PROGRAM HOSPITAL INSURANCE BENEFITS Posthospital SNF Care § 409.24 Medical social services. Medicare pays for medical social services as posthospital SNF care, including— (a) Assessment of the social and...

  15. 42 CFR 409.24 - Medical social services.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 2 2012-10-01 2012-10-01 false Medical social services. 409.24 Section 409.24... PROGRAM HOSPITAL INSURANCE BENEFITS Posthospital SNF Care § 409.24 Medical social services. Medicare pays for medical social services as posthospital SNF care, including— (a) Assessment of the social and...

  16. 42 CFR 409.24 - Medical social services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Medical social services. 409.24 Section 409.24... PROGRAM HOSPITAL INSURANCE BENEFITS Posthospital SNF Care § 409.24 Medical social services. Medicare pays for medical social services as posthospital SNF care, including— (a) Assessment of the social and...

  17. Redesigning care for patients at increased hospitalization risk: the Comprehensive Care Physician model.

    PubMed

    Meltzer, David O; Ruhnke, Gregory W

    2014-05-01

    Patients who have been hospitalized often experience care coordination problems that worsen outcomes and increase costs. One reason is that hospital care and ambulatory care are often provided by different physicians. However, interventions to improve care coordination for hospitalized patients have not consistently improved outcomes and generally have not reduced costs. We describe the rationale for the Comprehensive Care Physician model, in which physicians focus their practice on patients at increased risk of hospitalization so that they can provide both inpatient and outpatient care to their patients. We also describe the design and implementation of a study supported by the Center for Medicare and Medicaid Innovation to assess the model's effects on costs and outcomes. Evidence concerning the effectiveness of the program is expected by 2016. If the program is found to be effective, the next steps will be to assess the durability of its benefits and the model's potential for dissemination; evidence to the contrary will provide insights into how to alter the program to address sources of failure.

  18. Social justice considerations in neonatal care for nurse managers and executives.

    PubMed

    Yoder, Linda; Walden, Marlene; Verklan, M Terese

    2010-01-01

    This article presents the struggle between social justice and market justice within the current health care system, specifically issues affecting neonatal care. Community benefit is described and discussed as an aspect of social justice demonstrated by hospitals. The federal and state Children's Health Insurance Program also is discussed in relation to social justice and health care costs. Implications for managers and executives overseeing neonatal care are presented in relation to the economic and social issues.

  19. Cost-benefit analysis of childhood asthma management through school-based clinic programs.

    PubMed

    Tai, Teresa; Bame, Sherry I

    2011-04-01

    Asthma is a leading chronic illness among American children. School-based health clinics (SBHCs) reduced expensive ER visits and hospitalizations through better healthcare access and monitoring in select case studies. The purpose of this study was to examine the cost-benefit of SBHC programs in managing childhood asthma nationwide for reduction in medical costs of ER, hospital and outpatient physician care and savings in opportunity social costs of lowing absenteeism and work loss and of future earnings due to premature deaths. Eight public data sources were used to compare costs of delivering primary and preventive care for childhood asthma in the US via SBHC programs, including direct medical and indirect opportunity costs for children and their parents. The costs of nurse staffing for a nationwide SBHC program were estimated at $4.55 billion compared to the estimated medical savings of $1.69 billion, including ER, hospital, and outpatient care. In contrast, estimated total savings for opportunity costs of work loss and premature death were $23.13 billion. Medical savings alone would not offset the expense of implementing a SBHC program for prevention and monitoring childhood asthma. However, even modest estimates of reducing opportunity costs of parents' work loss would be far greater than the expense of this program. Although SBHC programs would not be expected to affect the increasing prevalence of childhood asthma, these programs would be designed to reduce the severity of asthma condition with ongoing monitoring, disease prevention and patient compliance.

  20. Employer approaches to preconception care.

    PubMed

    Phillips, Kathryn E; Flood, Georgette

    2008-01-01

    In recent years, the idea of preconception care-education, counseling, and interventions delivered to women before they become pregnant--has gained traction as a critically important health promotion opportunity for women and their families. Employers, as purchasers of health care and as providers of wellness services, have an important role to play in the promotion of preconception care. Large, self-insured employers can craft their medical benefit plans to include evidence-informed preventive health benefits such as preconception care. Employers can also design and implement worksite health promotion programs that address preconception, pregnancy, and postpartum health. And employers of all sizes can educate women and their partners on pregnancy health through tailored communication. This article provides an overview of the business case for preconception care and concrete steps employers can take to support and incent preconception care among their beneficiaries. The article also includes suggestions on ways providers and health professionals support employers in these efforts.

  1. A scoping review of the literature on benefits and challenges of participating in patient education programs aimed at promoting self-management for people living with chronic illness.

    PubMed

    Stenberg, Una; Haaland-Øverby, Mette; Fredriksen, Kari; Westermann, Karl Fredrik; Kvisvik, Toril

    2016-11-01

    To give a comprehensive overview of benefits and challenges from participating in group based patient education programs that are carried out by health care professionals and lay participants, aimed at promoting self-management for people living with chronic illness. We searched 8 literature databases. Full text articles meeting the inclusion criteria were retrieved and reviewed. Arksey and O'Malley's framework for scoping studies guided the review process and thematic analysis was undertaken to synthesize extracted data. Of the 5935 titles identified, 47 articles were included in this review. The participants experienced the programs as beneficial according to less symptom distress and greater awareness of their own health, improved self-management strategies, peer support, learning and hope. A substantial evidence base supports the conclusion that group based self-management patient education programs in different ways have been experienced as beneficial, but more research is needed. The insights gained from this review can enable researchers, health care professionals, and participants to understand the complexity in evaluating self-management patient education programs, and constitute a basis for a more standardized and systematic evaluation. The results may also encourage health care professionals in planning and carrying out programs in cooperation with lay participants. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  2. Self-Management Education Participation Among US Adults With Arthritis: Who's Attending?

    PubMed

    Murphy, Louise B; Brady, Teresa J; Boring, Michael A; Theis, Kristina A; Barbour, Kamil E; Qin, Jin; Helmick, Charles G

    2017-09-01

    Self-management education (SME) programs teach people with chronic conditions skills to manage their health conditions. We examined patterns in SME program participation among US adults with arthritis ages ≥18 years. Respondents with arthritis were those who reported ever being diagnosed with arthritis by a doctor or health care provider. We analyzed 2014 National Health Interview Survey data to estimate the percentage (unadjusted and age-standardized) who ever attended an SME program overall and for selected subgroups, representativeness of SME participants relative to all adults with arthritis, and trends in SME course participation. In 2014, 1 in 9 US adults with arthritis (11.3% [95% confidence interval (95% CI) 10.4-12.3]; age-standardized 11.4% [95% CI 10.0-12.9]) had ever participated in an SME program. SME participation (age-standardized) was highest among those with ≥8 health care provider visits in the past 12 months (16.0% [95% CI 13.1-19.4]). Since 2002, the number of adults with arthritis who have ever participated in SME has increased by 1.7 million, but the percentage has remained constant. Despite its many benefits, SME participation among US adults with arthritis remains persistently low. By recommending that their patients attend SME programs, health care providers can increase the likelihood that their patients experience SME program benefits. © 2016, American College of Rheumatology.

  3. Clinical Data Warehouse: An Effective Tool to Create Intelligence in Disease Management.

    PubMed

    Karami, Mahtab; Rahimi, Azin; Shahmirzadi, Ali Hosseini

    Clinical business intelligence tools such as clinical data warehouse enable health care organizations to objectively assess the disease management programs that affect the quality of patients' life and well-being in public. The purpose of these programs is to reduce disease occurrence, improve patient care, and decrease health care costs. Therefore, applying clinical data warehouse can be effective in generating useful information about aspects of patient care to facilitate budgeting, planning, research, process improvement, external reporting, benchmarking, and trend analysis, as well as to enable the decisions needed to prevent the progression or appearance of the illness aligning with maintaining the health of the population. The aim of this review article is to describe the benefits of clinical data warehouse applications in creating intelligence for disease management programs.

  4. Casemix and rehabilitation: evaluation of an early discharge scheme.

    PubMed

    Brandis, S

    2000-01-01

    This paper presents a case study of an early discharge scheme funded by casemix incentives and discusses limitations of a casemix model of funding whereby hospital inpatient care is funded separately from care in other settings. The POSITIVE Rehabilitation program received 151 patients discharged early from hospital in a twelve-month period. Program evaluation demonstrates a 40.9% drop in the average length of stay of rehabilitation patients and a 42.6% drop in average length of stay for patients with stroke. Other benefits of the program include a high level of patient satisfaction, improved carer support and increased continuity of care. The challenge under the Australian interpretation of a casemix model of funding is ensuring the viability of services that extend across acute hospital, non-acute care, and community and home settings.

  5. Green Commuting in the Health Care Sector: Obstacles and Best Practices.

    PubMed

    Kaplan, Susan; Ai, Ning; Orris, Peter; Sriraj, P S

    2016-02-01

    Fossil fuel transportation by health care providers contributes to the prevalence of diseases they treat. We conducted an exploratory study to understand obstacles to, and best practices for, greener commuting among health care providers. We surveyed staff of three hospital clinics as to how they commute and why, and interviewed key staff of five hospital leaders in green commuting about their programs. Factors that might change respondents' commuting choices from driving alone included financial incentives, convenience, and solutions to crime and safety concerns. Successful green commuting programs offer benefits including free or reduced transit passes, shuttle buses to transit stations, and free emergency rides home. Exemplary programs throughout the country demonstrate that modifying those factors within reach can impact the amount of fossil fuel energy used for health care provider transportation.

  6. 42 CFR 403.724 - Valid election requirements.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... acceptance of nonexcepted medical treatment is inconsistent with his or her sincere religious beliefs. (iii... GENERAL PROVISIONS SPECIAL PROGRAMS AND PROJECTS Religious Nonmedical Health Care Institutions-Benefits...

  7. 42 CFR 403.724 - Valid election requirements.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... acceptance of nonexcepted medical treatment is inconsistent with his or her sincere religious beliefs. (iii... GENERAL PROVISIONS SPECIAL PROGRAMS AND PROJECTS Religious Nonmedical Health Care Institutions-Benefits...

  8. 42 CFR 403.724 - Valid election requirements.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... acceptance of nonexcepted medical treatment is inconsistent with his or her sincere religious beliefs. (iii... GENERAL PROVISIONS SPECIAL PROGRAMS AND PROJECTS Religious Nonmedical Health Care Institutions-Benefits...

  9. 42 CFR 403.724 - Valid election requirements.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... acceptance of nonexcepted medical treatment is inconsistent with his or her sincere religious beliefs. (iii... GENERAL PROVISIONS SPECIAL PROGRAMS AND PROJECTS Religious Nonmedical Health Care Institutions-Benefits...

  10. 42 CFR 403.724 - Valid election requirements.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... acceptance of nonexcepted medical treatment is inconsistent with his or her sincere religious beliefs. (iii... GENERAL PROVISIONS SPECIAL PROGRAMS AND PROJECTS Religious Nonmedical Health Care Institutions-Benefits...

  11. Analysis of FY 1990 Budget Proposals and Their Impact on Low Income Programs.

    ERIC Educational Resources Information Center

    Center on Budget and Policy Priorities, Washington, DC.

    Despite claims that benefits for the needy have not been reduced, the Reagan Administration's final budget for fiscal year 1990 is marked by substantial reductions in programs for the poor. Actual spending for low-income programs would be sliced $6.75 billion below current levels. Medicaid, which provides health care coverage for poor families…

  12. Department of Veterans Affairs' Implementation of Information Security Education Assistance Program. GAO-10-170R

    ERIC Educational Resources Information Center

    Wilshusen, Gregory C.; Melvin, Valerie C.

    2009-01-01

    The Veterans Benefits, Health Care, and Information Technology Act of 2006 authorizes the Secretary of Veterans Affairs to establish an educational assistance program for information security. The Information Security Education Assistance Program is envisioned as a means for the Department of Veterans Affairs (VA) to attract and retain individuals…

  13. Nurses' perceptions of nurse residency: identifying barriers to implementation.

    PubMed

    Wierzbinski-Cross, Heather; Ward, Kristin; Baumann, Paula

    2015-01-01

    The purpose of this project was to describe the benefits and components of successful nurse residency programs, as well as gain insight into the perceptions of staff nurses, nurse educators, and nurse leaders regarding value, feasibility, and barriers to implementing nurse residency programs in acute care settings. This study has important implications for implementing an effective residency program.

  14. Early Survey Results from the Minnesota Medical Cannabis Program.

    PubMed

    McGriff, Deepa; Anderson, Susan; Arneson, Tom

    2016-06-01

    As part of its legislative mandate, the Minnesota Department of Health's Office of Medical Cannabis (OMC) is required to study and report on the state's medical cannabis program. This article describes preliminary findings from the OMC's research about who is using the program and whether patients and their certifying health care practitioners are noticing benefits and harms.

  15. Insights into managed care--operational, legal and actuarial.

    PubMed

    Melek, S P; Johnson, B A; Schryver, D

    1997-01-01

    Understanding the operational, legal and actuarial dimensions of managed care is essential to developing managed care contracts between managed care organizations and individual health care providers or groups such as provider-sponsored organizations or independent practice associations. Operationally, it is important to understand managed care and its trends, emphasizing business issues, knowing your practice and defining acceptable levels of reimbursement and risk. Legally, there are a number of common themes or issues relevant to all managed care contracts, including primary care vs. specialist contracts, services offered, program policies and procedures, utilization review, physician reimbursement and compensation, payment schedule, terms and conditions, term and termination, continuation of care requirements, indemnification, amendment of contract and program policies, and stop-loss insurance. Actuarial issues include membership, geography, age-gender distribution, degree of health care management, local managed care utilization levels, historical utilization levels, health plan benefit design, among others.

  16. Integrated Payment and Delivery Models Offer Opportunities and Challenges for Residential Care Facilities

    PubMed Central

    Grabowski, David C.; Caudry, Daryl J.; Dean, Katie M.; Stevenson, David G.

    2016-01-01

    Under health care reform, a series of new financing and delivery models are being piloted to integrate health and long-term care services for older adults. To date, these programs have not encompassed residential care facilities, with most programs focusing on long-term care recipients in the community or the nursing home. Our analyses indicate that individuals living in residential care facilities have similarly high rates of chronic illness and Medicare utilization when compared with similar populations in the community and nursing home. These results suggest the residential care facility population could benefit greatly from models that coordinate health and long-term care. However, few providers have invested in integrated delivery models. Several challenges exist toward greater integration including the private payment of residential care facility services and the fact that residential care facilities do not share in any Medicare savings due to improved coordination of care. PMID:26438740

  17. Health care utilization among Medicare-Medicaid dual eligibles: a count data analysis.

    PubMed

    Moon, Sangho; Shin, Jaeun

    2006-04-05

    Medicare-Medicaid dual eligibles are the beneficiaries of both Medicare and Medicaid. Dual eligibles satisfy the eligibility conditions for Medicare benefit. Dual eligibles also qualify for Medicaid because they are aged, blind, or disabled and meet the income and asset requirements for receiving Supplement Security Income (SSI) assistance. The objective of this study is to explore the relationship between dual eligibility and health care utilization among Medicare beneficiaries. The household component of the nationally representative Medical Expenditure Panel Survey (MEPS) 1996-2000 is used for the analysis. Total 8,262 Medicare beneficiaries are selected from the MEPS data. The Medicare beneficiary sample includes individuals who are covered by Medicare and do not have private health insurance during a given year. Zero-inflated negative binomial (ZINB) regression model is used to analyse the count data regarding health care utilization: office-based physician visits, hospital inpatient nights, agency-sponsored home health provider days, and total dental visits. Dual eligibility is positively correlated with the likelihood of using hospital inpatient care and agency-sponsored home health services and the frequency of agency-sponsored home health days. Frequency of dental visits is inversely associated with dual eligibility. With respect to racial differences, dually eligible Afro-Americans use more office-based physician and dental services than white duals. Asian duals use more home health services than white duals at the 5% statistical significance level. The dual eligibility programs seem particularly beneficial to Afro-American duals. Dual eligibility has varied impact on health care utilization across service types. More utilization of home healthcare among dual eligibles appears to be the result of delayed realization of their unmet healthcare needs under the traditional Medicare-only program rather than the result of overutilization in response to the expanded benefits of the dual eligibility program. The dual eligibility program is particularly beneficial to Asian and Afro-American duals in association with the provision of home healthcare and dental benefits.

  18. Integrated health practices: development of a graduate nursing program.

    PubMed

    Jossens, Marilyn O R; Ganley, Barbara J

    2006-01-01

    This article describes pedagogical issues in the development of a graduate nursing program in Integrated Health Practices (IHP), reports early experiences in the program, and asserts the importance of a graduate program in the specialty. The experience is described, and unique pedagogical issues encountered are discussed. While noting the contributions made to health and health care by Western medicine and nursing practice, the authors elaborate on the benefits of integrating western health care with less technological, less invasive, and less expensive holistic approaches. Diverse populations often require attention to specific chronic conditions, rather than to acute conditions, and constitutional requirements for overall health may be influenced by diverse health philosophies and practices. These requirements may be grounded in cultural and religious beliefs that must be incorporated into culturally sensitive plans of care. Clinical nurse specialists in IHP can offer knowledge and leadership to nursing practice, which address these complex, yet subtle health care issues.

  19. Learning from history: the legacy of Title VII in academic family medicine.

    PubMed

    Newton, Warren; Arndt, Jane E

    2008-11-01

    The current renaissance of interest in primary care could benefit from reviewing the history of federal investment in academic family medicine. The authors review 30 years of experience with the Title VII, Section 747 Training in Primary Care Medicine and Dentistry (Title VII) grant program, addressing three questions: (1) What Title VII grant programs were available to family medicine, and what were their goals? (2) How did Title VII change the discipline? and (3) What impact did Title VII family medicine programs have outside the discipline?Title VII grant programs evolved from broad support for the new discipline of family medicine to a sharper focus on specific national workforce objectives such as improving care for underserved and vulnerable populations and increasing diversity in the health professions. Grant programs were instrumental in establishing family medicine in nearly all medical schools and in supporting the educational underpinnings of the field. Title VII grants helped enhance the social capital of the discipline. Outside family medicine, Title VII fostered the development of innovative ambulatory education, institutional initiatives focusing on underserved and vulnerable populations, and primary care research capacity. Adverse effects include relative inattention to clinical and research missions in family medicine academic units and, institutionally, the development of medical education initiatives without core institutional support, which has put innovation and extension of education to communities at risk as grant funding has decreased. Reinvestment in academic family medicine can yield substantial benefits for family medicine and help reorient academic health centers. This article is part of a theme issue of Academic Medicine on the Title VII health professions training programs.

  20. Combined Diet and Physical Activity Promotion Programs for Prevention of Diabetes: Community Preventive Services Task Force Recommendation Statement.

    PubMed

    Pronk, Nicolaas P; Remington, Patrick L

    2015-09-15

    Community Preventive Services Task Force recommendation on the use of combined diet and physical activity promotion programs to reduce progression to type 2 diabetes in persons at increased risk. The Task Force commissioned an evidence review that assessed the benefits and harms of programs to promote and support individual improvements in diet, exercise, and weight and supervised a review on the economic efficiency of these programs in clinical trial, primary care, and primary care-referable settings. Adolescents and adults at increased risk for progression to type 2 diabetes. The Task Force recommends the use of combined diet and physical activity promotion programs by health care systems, communities, and other implementers to provide counseling and support to clients identified as being at increased risk for type 2 diabetes. Economic evidence indicates that these programs are cost-effective.

  1. Geriatric resources in acute care hospitals and trauma centers: a scarce commodity.

    PubMed

    Maxwell, Cathy A; Mion, Lorraine C; Minnick, Ann

    2013-12-01

    The number of older adults admitted to acute care hospitals with traumatic injury is rising. The purpose of this study was to examine the location of five prominent geriatric resource programs in U.S. acute care hospitals and trauma centers (N = 4,865). As of 2010, 5.8% of all U.S. hospitals had at least one of these programs. Only 8.8% of trauma centers were served by at least one program; the majorities were in level I trauma centers. Slow adoption of geriatric resource programs in hospitals may be due to lack of champions who will advocate for these programs, lack of evidence of their impact on outcomes, or lack of a business plan to support adoption. Future studies should focus on the benefits of geriatric resource programs from patients' perspectives, as well as from business case and outcomes perspectives. Copyright 2013, SLACK Incorporated.

  2. Overcoming barriers in care for the dying: Theoretical analysis of an innovative program model.

    PubMed

    Wallace, Cara L

    2016-08-01

    This article explores barriers to end-of-life (EOL) care (including development of a death denying culture, ongoing perceptions about EOL care, poor communication, delayed access, and benefit restrictions) through the theoretical lens of symbolic interactionism (SI), and applies general systems theory (GST) to a promising practice model appropriate for addressing these barriers. The Compassionate Care program is a practice model designed to bridge gaps in care for the dying and is one example of a program offering concurrent care, a recent focus of evaluation though the Affordable Care Act. Concurrent care involves offering curative care alongside palliative or hospice care. Additionally, the program offers comprehensive case management and online resources to enrollees in a national health plan (Spettell et al., 2009).SI and GST are compatible and interrelated theories that provide a relevant picture of barriers to end-of-life care and a practice model that might evoke change among multiple levels of systems. These theories promote insight into current challenges in EOL care, as well as point to areas of needed research and interventions to address them. The article concludes with implications for policy and practice, and discusses the important role of social work in impacting change within EOL care.

  3. Outcomes of Kidney Transplantations Under the Philippine Health Insurance Corporation's Type Z Benefit Package at the National Kidney and Transplant Institute, Philippines.

    PubMed

    Pamugas, G E P; Arakama, M-H I; Danguilan, R A; Ledesma, D

    2016-04-01

    Under the Universal Health Care Program of the Department of Health, the Philippine Health Insurance Corporation (PHIC) launched the Case Type Z benefit package for kidney transplantation, providing the largest amount (USD $13,300.00) for any single medical procedure. The objective of this study was to describe under the PHIC Case Type Z Benefit Package for kidney transplantation at the National Kidney and Transplant Institute and kidney transplantation outcomes under this package. Included in the benefit were standard risk recipients between 10 and 70 years of age with at least 1 human leukocyte antigen (HLA) DR match with the donor, panel-reactive antibody (PRA) less than 20%, and absence of donor-specific antibody (DSA). Previous transplantations, malignancy, hepatitis B and C, human immunodeficiency virus (HIV) positivity, cytomegalovirus (CMV) R-/D+, congestive heart failure, and liver cirrhosis were exclusion criteria. Patients were evaluated by a medical social worker according to their family's financial status. Since June 2012, a total of 261 patients have received the benefit, with 44 under service, 37 with fixed co-pay and 180 with variable co-pay. Of the living donor kidney transplants, 98% had immediate graft function, with 2.3% (6/261) acute rejection rates at 1 year. The total cost of hospitalization was within the benefit for living donor kidney transplants (less than USD 8000.00) but exceeded it in all cases of deceased donor kidney transplants. The successful use of and excellent outcomes under the Case Type Z benefit demonstrated how collaboration among government agencies, health care providers, and pharmaceutical companies could result in a program that improved the access to health care for Filipino patients with end-stage renal disease. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. GATEWAY Demonstrations: Tuning the Light in Senior Care: Evaluating a Trial LED Lighting System at the ACC Care Center in Sacramento, CA

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

    Davis, Robert G.; Wilkerson, Andrea M.; Samla, Connie

    The GATEWAY program documented the performance of tunable-white LED lighting systems installed in several spaces within the ACC Care Center, a senior-care facility in Sacramento, CA. The project results included energy savings and improved lighting quality, as well as other possible health-related benefits that may have been attributable, at least in part, to the lighting changes.

  5. Health plan switching among members of the Federal Employees Health Benefits Program.

    PubMed

    Atherly, Adam; Florence, Curtis; Thorpe, Kenneth E

    2005-01-01

    This paper examines factors associated with switching health plans in the Federal Employees Health Benefits Program. Switching plans is not uncommon, with 12% of members switching plans annually. Individuals switch out of plans with premium increases and benefit decreases relative to other plans in the market. Switching is negatively associated with age due to increasing switching costs associated with age rather than decreasing premium sensitivity. Individuals in preferred provider organizations are less likely to switch, but are more responsive to premium increases than those in the managed care sector. Those who do switch plans are likely to switch to a different plan in the same sector.

  6. Twenty years of Medicare and Medicaid: Covered populations, use of benefits, and program expenditures

    PubMed Central

    Gornick, Marian; Greenberg, Jay N.; Eggers, Paul W.; Dobson, Allen

    1985-01-01

    Marian Gornick is Director, Division of Beneficiary Studies, in the Office of Research, Health Care Financing Administration. She has been involved in research studies relating to Medicare and Medicaid since the programs were first implemented. Jay N. Greenberg is on the faculty of the Heller Graduate School, Brandeis University. Dr. Greenberg serves as the Associate Director for Research of the school's Health Policy Center. Paul W. Eggers is Chief, Program Evaluation Branch, in the Office of Research, Health Care Financing Administration (HCFA). Dr. Eggers’ research activities involve the evaluation of the impact of HCFA programs on the beneficiaries. Allen Dobson is Director, Office of Research, Health Care Financing Administration. Dr. Dobson is responsible for directing the planning and development of the Agency's research agenda. PMID:10311371

  7. 5 CFR 890.1010 - Debarring official's decision of contest.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Mandatory Debarments § 890.1010 Debarring official's decision of contest. (a...

  8. 5 CFR 890.1007 - Minimum length of mandatory debarments.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Mandatory Debarments § 890.1007 Minimum length of mandatory debarments. (a...

  9. 5 CFR 890.1023 - Information considered in deciding a contest.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ...) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Permissive Debarments § 890.1023 Information considered in deciding...

  10. Telemedicine in the Intensive Care Unit: Improved Access to Care at What Cost?

    PubMed

    Binder, William J; Cook, Jennifer L; Gramze, Nickalaus; Airhart, Sophia

    2018-06-01

    Health systems across the United States are adopting intensive care unit telemedicine programs to improve patient outcomes. Research demonstrates the potential for decreased mortality and length of stay for patients of these remotely monitored units. Financial models and studies point to cost-effectiveness and the possibility of cost savings in the face of abundant startup costs. Questions remain as to the true financial implications of these programs and targeted populations that may see the greatest benefit. Despite recent growth, widespread adoption may be limited until these unknowns are answered. Copyright © 2018 Elsevier Inc. All rights reserved.

  11. A framework for designing and implementing community benefit standards.

    PubMed

    Longo, D R; Kruse, R L; Kiely, R G

    1997-01-01

    Increasingly, health care professionals and the public are asking questions about the role of the hospital in meeting community need including its not-for-profit tax status. This article reviews the community benefit literature, provides a framework for understanding how a hospital community benefit program was developed, and delineates through a structured case study the lessons learned from this experience. It provides the practitioner with a context in which other hospitals may replicate the program and gives researchers a substantive case study that may be used as the basis for the empirical testing of community benefit models. The authors also outline the many difficult issues faced by a typical community hospital as it attempted to examine and develop additional responses to community need.

  12. Chronic disease management in rural and underserved populations: innovation and system improvement help lead to success.

    PubMed

    Bolin, Jane; Gamm, Larry; Kash, Bita; Peck, Mitchell

    2005-03-01

    Successful implementation of disease management (DM) is based on the ability of an organization to overcome a variety of barriers to deliver timely, appropriate care of chronic illnesses. Such programs initiate DM services to patient populations while initiating self-management education among medication-resistant patients who are chronically ill. Despite formidable challenges, rural health care providers have been successful in initiating DM programs and have discovered several ways in which these programs benefit their organizations. This research reports on six DM programs that serve large rural and underserved populations and have demonstrated that DM can be successfully implemented in such areas.

  13. 5 CFR 890.1048 - Waiver of debarment for a provider that is the sole source of health care services in a community.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Waiver of debarment for a provider that... HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Exceptions to the Effect of Debarments § 890.1048 Waiver of debarment for a provider that is the sole source of health care...

  14. GATEWAY Report Brief: Tunable-White Lighting at the ACC Care Center

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

    None, None

    Summary of a GATEWAY program report that documented the performance of tunable-white LED lighting systems installed in several spaces within the ACC Care Center, a senior-care facility in Sacramento, CA. The project results included energy savings and improved lighting quality, as well as other possible health-related benefits that may have been attributable, at least in part, to the lighting changes.

  15. Footing the bill: the introduction of Medicare Benefits Schedule rebates for podiatry services in Australia.

    PubMed

    Short, Anthony J

    2009-12-07

    The introduction of Medicare Benefits Schedule items for allied health professionals in 2004 was a pivotal event in the public funding of non-medical primary care services. This commentary seeks to provide supplementary discussion of the article by Menz (Utilisation of podiatry services in Australia under the Medicare Enhanced Primary Care program, 2004-2008 Journal of Foot and Ankle Research 2009, 2:30), by placing these findings within the context of the podiatry profession, clinical decision making and the broader health workforce and government policy.

  16. The affordable care ACT on loyalty programs for federal beneficiaries.

    PubMed

    Piacentino, Justin J; Williams, Karl G

    2014-02-01

    To discuss changes in the law that allow community pharmacy loyalty programs to include and offer incentives to Medicare and Medicaid beneficiaries. The retailer rewards exception of the Patient Protection and Affordable Care Act of 2010 and its change to the definition of remuneration in the civil monetary penalties of the Anti-Kickback Statute now allow incentives to be earned on federal benefit tied prescription out-of-pocket costs. The criteria required to design a compliant loyalty program are discussed. Community pharmacies can now include Medicare and Medicaid beneficiaries in compliant customer loyalty programs, where allowed by state law. There is a need for research directly on the influence of loyalty programs and nominal incentives on adherence.

  17. Understanding Effects of Flexible Spending Accounts on People with Disabilities: The Case of a Consumer-Directed Care Program.

    PubMed

    Lombe, Margaret; Inoue, Megumi; Mahoney, Kevin; Chu, Yoosun; Putnam, Michelle

    2016-01-01

    This study set out to explore the saving behavior, barriers, and facilitators along with effects of participating in a consumer-directed care program among people with disabilities in the state of West Virginia (N = 29). Results suggest that respondents were able to save money through the program to enable them to purchase goods and services they needed to enhance their welfare and quality of life. Generally, items saved for fell into 3 broad categories: household equipment, individual functioning, and home modification. Facilitators and barriers to saving were also indicated and so were the benefits of program participation. Program and policy implications are presented.

  18. Case histories of six consumers and their families in Cash and Counseling.

    PubMed

    San Antonio, Patricia M; Simon-Rusinowitz, Lori; Loughlin, Dawn; Eckert, J Kevin; Mahoney, Kevin J

    2007-02-01

    To examine how the lives of consumers and their caregivers were affected by making choices and controlling their own resources with the cash option, this paper focuses on six case studies from the Cash and Counseling Demonstration Program. Twenty-one consumers, caregivers, and state consultants were interviewed about their experiences in the program. The data come from a larger study of over 200 interviews conducted from June 2000 to August 2004. Interview data were analyzed for themes about caregiving and program satisfaction. Cash and Counseling benefited consumers and caregivers by allowing consumers increased continuity and reliability of care, increased ability to set hours of care, more satisfaction with how caregiving is offered and more satisfaction with the quality of care. The cash option allowed consumers to create, schedule, and manage their own model of care. Some consumers faced challenges in the program with paperwork, accounting, worries about receiving care, and some ineffective state consultants who could have been more helpful.

  19. Case Histories of Six Consumers and Their Families in Cash and Counseling

    PubMed Central

    San Antonio, Patricia M; Simon-Rusinowitz, Lori; Loughlin, Dawn; Eckert, J Kevin; Mahoney, Kevin J

    2007-01-01

    Objective To examine how the lives of consumers and their caregivers were affected by making choices and controlling their own resources with the cash option, this paper focuses on six case studies from the Cash and Counseling Demonstration Program. Data Sources Twenty-one consumers, caregivers, and state consultants were interviewed about their experiences in the program. Study Design The data come from a larger study of over 200 interviews conducted from June 2000 to August 2004. Interview data were analyzed for themes about caregiving and program satisfaction. Principal Findings Cash and Counseling benefited consumers and caregivers by allowing consumers increased continuity and reliability of care, increased ability to set hours of care, more satisfaction with how caregiving is offered and more satisfaction with the quality of care. Conclusions The cash option allowed consumers to create, schedule, and manage their own model of care. Some consumers faced challenges in the program with paperwork, accounting, worries about receiving care, and some ineffective state consultants who could have been more helpful. PMID:17244296

  20. The Role of Consumer-Controlled Personal Health Management Systems in the Evolution of Employer-Based Health Care Benefits.

    PubMed

    Jones, Spencer S; Caloyeras, John; Mattke, Soeren

    2011-01-01

    The passage of the Patient Protection and Affordable Care Act has piqued employers' interest in new benefit designs because it includes numerous provisions that favor cost-reducing strategies, such as workplace wellness programs, value-based insurance design (VBID), and consumer-directed health plans (CDHPs). Consumer-controlled personal health management systems (HMSs) are a class of tools that provide encouragement, data, and decision support to individuals. Their functionalities fall into the following three categories: health information management, promotion of wellness and healthy lifestyles, and decision support. In this study, we review the evidence for many of the possible components of an HMS, including personal health records, web-based health risk assessments, integrated remote monitoring data, personalized health education and messaging, nutrition solutions and physical activity monitoring, diabetes-management solutions, medication reminders, vaccination and preventive-care applications, integrated incentive programs, social-networking tools, comparative data on price and value of providers, telehealth consultations, virtual coaching, and an integrated nurse hotline. The value of the HMS will be borne out as employers begin to adopt and implement these emerging technologies, enabling further assessment as their benefits and costs become better understood.

  1. Using the ecological framework to identify barriers and enablers to implementing Namaste Care in Canada's long-term care system.

    PubMed

    Hunter, Paulette V; Kaasalainen, Sharon; Froggatt, Katherine A; Ploeg, Jenny; Dolovich, Lisa; Simard, Joyce; Salsali, Mahvash

    2017-10-01

    Higher acuity of care at the time of admission to long-term care (LTC) is resulting in a shorter period to time of death, yet most LTC homes in Canada do not have formalized approaches to palliative care. Namaste Care is a palliative care approach specifically tailored to persons with advanced cognitive impairment who are living in LTC. The purpose of this study was to employ the ecological framework to identify barriers and enablers to an implementation of Namaste Care. Six group interviews were conducted with families, unlicensed staff, and licensed staff at two Canadian LTC homes that were planning to implement Namaste Care. None of the interviewees had prior experience implementing Namaste Care. The resulting qualitative data were analyzed using a template organizing approach. We found that the strongest implementation enablers were positive perceptions of need for the program, benefits of the program, and fit within a resident-centred or palliative approach to care. Barriers included a generally low resource base for LTC, the need to adjust highly developed routines to accommodate the program, and reliance on a casual work force. We conclude that within the Canadian LTC system, positive perceptions of Namaste Care are tempered by concerns about organizational capacity to support new programming.

  2. High School Athletes' Perceptions of the Motivational Climate in Their Off-Season Training Programs.

    PubMed

    Chamberlin, Jacob M; Fry, Mary D; Iwasaki, Susumu

    2017-03-01

    Chamberlin, JM, Fry, MD, and Iwasaki, S. High school athletes' perceptions of the motivational climate in their off-season training programs. J Strength Cond Res 31(3): 736-742, 2017-Athletes benefit tremendously from working hard in off-season training (OST) because it sets them up to avoid injuries and perform their best during the season. Ironically, many athletes struggle to stay motivated to participate regularly in this training. Research has highlighted the benefits for athletes perceiving a caring and task-involving climate, where they gauge their success based on their personal effort and improvement, and perceive each member of the team is treated with mutual kindness and respect. Athletes who perceive a caring and task-involving climate on their teams are more likely to report greater adaptive motivational responses. Research has not currently examined athletes' perceptions of the climate in OST programs. The purpose of this study was to examine the relationship between athletes' perceptions of the climate in an OST program and their motivational responses. High school athletes (N = 128; 90 males 35 females; mean age = 15.3 years) participating in summer OST programs completed a survey that included measures of intrinsic motivation, commitment, their valuing OST, feeling like it is their decision to participate in OST, their perceptions that their teammates take OST seriously, and attendance. A canonical correlation revealed that athletes, who perceived a highly caring and task-involving climate reported higher intrinsic motivation, value of and commitment to OST; attendance; and perceived teammates take OST seriously. Results suggest that creating a caring and task-involving climate in OST programs may help athletes optimize their motivation to participate in important strength and conditioning programs.

  3. 5 CFR 890.1035 - Provider contests of suspensions.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Suspension § 890.1035 Provider contests of suspensions. (a) Filing a contest of the...

  4. Long-term outcomes and costs of an integrated rehabilitation program for chronic knee pain: a pragmatic, cluster randomized, controlled trial.

    PubMed

    Hurley, M V; Walsh, N E; Mitchell, H; Nicholas, J; Patel, A

    2012-02-01

    Chronic joint pain is a major cause of pain and disability. Exercise and self-management have short-term benefits, but few studies follow participants for more than 6 months. We investigated the long-term (up to 30 months) clinical and cost effectiveness of a rehabilitation program combining self-management and exercise: Enabling Self-Management and Coping of Arthritic Knee Pain Through Exercise (ESCAPE-knee pain). In this pragmatic, cluster randomized, controlled trial, 418 people with chronic knee pain (recruited from 54 primary care surgeries) were randomized to usual care (pragmatic control) or the ESCAPE-knee pain program. The primary outcome was physical function (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] function), with a clinically meaningful improvement in physical function defined as a ≥15% change from baseline. Secondary outcomes included pain, psychosocial and physiologic variables, costs, and cost effectiveness. Compared to usual care, ESCAPE-knee pain participants had large initial improvements in function (mean difference in WOMAC function -5.5; 95% confidence interval [95% CI] -7.8, -3.2). These improvements declined over time, but 30 months after completing the program, ESCAPE-knee pain participants still had better physical function (difference in WOMAC function -2.8; 95% CI -5.3, -0.2); lower community-based health care costs (£-47; 95% CI £-94, £-7), medication costs (£-16; 95% CI £-29, £-3), and total health and social care costs (£-1,118; 95% CI £-2,566, £-221); and a high probability (80-100%) of being cost effective. Clinical and cost benefits of ESCAPE-knee pain were still evident 30 months after completing the program. ESCAPE-knee pain is a more effective and efficient model of care that could substantially improve the health, well-being, and independence of many people, while reducing health care costs. Copyright © 2012 by the American College of Rheumatology.

  5. 45 CFR 98.83 - Requirements for tribal programs.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ....83 Public Welfare Department of Health and Human Services GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND Indian Tribes § 98.83 Requirements for tribal programs. (a) The grantee shall designate an... reservation for the benefit of Indian children. (c) In the case of a tribal grantee that is a consortium: (1...

  6. 45 CFR 98.83 - Requirements for tribal programs.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ....83 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND Indian Tribes § 98.83 Requirements for tribal programs. (a) The grantee shall designate an... reservation for the benefit of Indian children. (c) In the case of a tribal grantee that is a consortium: (1...

  7. 45 CFR 98.83 - Requirements for tribal programs.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ....83 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND Indian Tribes § 98.83 Requirements for tribal programs. (a) The grantee shall designate an... reservation for the benefit of Indian children. (c) In the case of a tribal grantee that is a consortium: (1...

  8. 45 CFR 98.83 - Requirements for tribal programs.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ....83 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND Indian Tribes § 98.83 Requirements for tribal programs. (a) The grantee shall designate an... reservation for the benefit of Indian children. (c) In the case of a tribal grantee that is a consortium: (1...

  9. 45 CFR 98.83 - Requirements for tribal programs.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ....83 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND Indian Tribes § 98.83 Requirements for tribal programs. (a) The grantee shall designate an... reservation for the benefit of Indian children. (c) In the case of a tribal grantee that is a consortium: (1...

  10. A Short Stay, a Long-Lasting Lesson.

    ERIC Educational Resources Information Center

    Benham, Dianne C.

    1991-01-01

    Presents an integrated schoolwide program in which students learn about pet care and the behaviors of 14 unusual animals. Each participating teacher sets up one animal center describing the animal and the animal's habitat. Centers change at the end of each month. Discusses costs and learning benefits of the program. (MDH)

  11. Mentoring new nurse practitioners to accelerate their development as primary care providers: a literature review.

    PubMed

    Harrington, Susan

    2011-04-01

    To provide a review of the literature regarding programs for mentoring new nurse practitioners (NPs) to accelerate their development as primary care providers. A search was conducted in PubMed, Ovid, CINAHL, and Cochrane Database of Systematic Reviews. There is currently a critical shortage of primary care providers and an aging population requiring management of chronic medical conditions. Although NPs are trained in health promotion, disease prevention, and medical management and are well equipped to treat patients in primary care, the work can be overwhelming to the novice NP. A mentoring program could help the new NP further develop competencies and capabilities as a provider. However, there is a gap in the literature concerning any mentoring programs for novice NPs. Nonetheless, the literature review has provided a mentoring definition, program models, desired characteristics of nurse mentors, and barriers to mentoring programs. It has also described the benefits, goals and outcomes of a mentoring relationship. These insights from the literature provide a foundation for future mentoring program development. A mentoring program for new NPs working in primary care could accelerate productivity, increase job satisfaction, and provide longevity in the primary care setting. ©2011 The Author(s) Journal compilation ©2011 American Academy of Nurse Practitioners.

  12. Clinical orientation program for new medical registrars--a qualitative evaluation.

    PubMed

    Rosemergy, Ian; Bell, Damon A; Jayathissa, Sisira K

    2009-02-01

    We present a qualitative evaluation of a clinical orientation program for medical registrars within the Wellington region in New Zealand, designed and implemented by current advanced registrars. This program was intended to improve the transition from house officer to medical registrar. The program was qualitatively evaluated using focus groups comprising participants, presenters and senior nursing staff. Purposive samples were drawn from each of these groups. The most significant finding was the perception of enhanced professional collegiality among medical staff. There were benefits to participants and presenters with improved communication between medical registrars. We believe there are individual, institutional and patient care benefits with a region-specific, clinical orientation for new medical registrars.

  13. Workplace injuries and the take-up of Social Security disability benefits.

    PubMed

    O'Leary, Paul; Boden, Leslie I; Seabury, Seth A; Ozonoff, Al; Scherer, Ethan

    2012-01-01

    Workplace injuries and illnesses are an important cause of disability. State workers' compensation programs provide almost $60 billion per year in cash and medical-care benefits for those injuries and illnesses. Social Security Disability Insurance (DI) is the largest disability insurance program in the United States, with annual cash payments to disabled workers of $95 billion in 2008. Because injured workers may also receive DI benefits, it is important to understand how those two systems interact to provide benefits. This article uses matched state workers' compensation and Social Security data to study the relationship between workplace injuries and illnesses and DI benefit receipt. We find that having a lost-time injury substantially increases the probability of DI receipt, and, for people who become DI beneficiaries, those with injuries receive DI benefits at younger ages. This relationship remains robust even after we account for important personal and work characteristics.

  14. Variation of employee benefit costs by age.

    PubMed

    Rappaport, A

    2000-01-01

    Health care, pension, and disability plans account for the bulk of employers' benefit costs, as defined in this article. Because those costs tend to rise as employees get older, the age structure of the workforce affects not only employers' costs but ultimately their competitiveness in global markets. How much costs vary depends in large part on the structure of the benefits package provided. The method a company chooses to finance benefits generally varies with its size. This article focuses primarily on the benefit practices of large, private employers. In the long run, such employers pay the costs associated with the demographics of their workers, whereas small employers can often pool costs with other companies in the community. In addition, small employers often offer fewer benefits, and the costs and financing of those benefits are subject to the insurance markets and state regulations. The discussion of benefit packages is illustrated by case studies based on benefits that are typical for three types of organizations--a large traditional company such as steel, automobile, and manufacturing; a large financial services company such as a bank or health care organization; and a medium-sized retail organization. The case studies demonstrate the extent to which the costs of typical packages vary and reveal that employers differ radically in the incentives they offer employees to retire at a specific time. An employer can shift the variation in cost by age by changing the structure of the benefit program. The major forces that drive age differences in benefit costs are the time value of money (the period of time available to earn investment income and the operation of compound interest) and rates of health care use, disability, and death. Those forces apply universally, in the United States and elsewhere, and they have not changed in recent years. However, the marketplace and the prevalence of various types of benefit programs have changed, and those changes have generally resulted in less cost variation by age and more frequent employer selection of benefit packages that exhibit less variation by age.

  15. A Preliminary Qualitative Evaluation of the Virginia Gold Quality Improvement Program

    ERIC Educational Resources Information Center

    Craver, Gerald A.; Burkett, Amy K.

    2012-01-01

    Certified nursing assistants (CNAs) perform an important role in the long-term care system because they provide the majority of paid care to nursing facility residents. Unfortunately, annual CNA turnover often exceeds 100 percent nationally. Many factors account for this, including stressful working conditions, low pay, and limited benefits. The…

  16. Adding Value to the Health Care System: Identifying Value-Added Systems Roles for Medical Students.

    PubMed

    Gonzalo, Jed D; Graaf, Deanna; Johannes, Bobbie; Blatt, Barbara; Wolpaw, Daniel R

    To catalyze learning in Health Systems Science and add value to health systems, education programs are seeking to incorporate students into systems roles, which are not well described. The authors sought to identify authentic roles for students within a range of clinical sites and explore site leaders' perceptions of the value of students performing these roles. From 2013 to 2015, site visits and interviews with leadership from an array of clinical sites (n = 30) were conducted. Thematic analysis was used to identify tasks and benefits of integrating students into interprofessional care teams. Types of systems roles included direct patient benefit activities, including monitoring patient progress with care plans and facilitating access to resources, and clinic benefit activities, including facilitating coordination and improving clinical processes. Perceived benefits included improved value of the clinical mission and enhanced student education. These results elucidate a framework for student roles that enhance learning and add value to health systems.

  17. Transition support for new graduate and novice nurses in critical care settings: An integrative review of the literature.

    PubMed

    Innes, Tiana; Calleja, Pauline

    2018-05-01

    Transition into critical care areas for new graduate nurses may be more difficult than transitioning into other areas due to the specialised knowledge needed. It is unknown which aspects of transition programs best support new graduate nurses improve competence and confidence to transition into critical care nursing specialties. Identifying these aspects would assist to design and implement best practice transition programs for new graduates in critical care areas. Themes identified in the literature include; having a designated resource person, workplace culture, socialisation, knowledge and skill acquisition, orientation, and rotation. Allocation of a quality resource person/s, supportive workplace culture, positive socialisation experiences, knowledge and skill acquisition and structured orientation based on new graduates' learning needs all positively supported increased confidence, competence and transition into nursing practice. Rotations between areas within graduate programs can potentially have both positive and negative impacts on the transition process. Negative impacts of including a rotation component in a transition program should be carefully considered alongside perceived benefits when designing new graduate nurse transition programs. Copyright © 2018. Published by Elsevier Ltd.

  18. Defining the road ahead: thinking strategically in the new era of health care reform.

    PubMed

    Pudlowski, Edward M

    2011-01-01

    Understanding the implications of the new health care reform legislation, including those provisions that do not take effect for several years, will be critical in developing a successful strategic plan under the new environment of health care reform and avoiding unintended consequences of decisions made without the benefit of long-term thinking. Although this article is not a comprehensive assessment of the challenges and opportunities that exist under health care reform, nor a layout of all of the issues, it looks at some of the key areas in order to demonstrate why employers need to identify critical pathways and the associated risks and benefits of each decision. Key health care reform areas include insurance market reforms, grandfather rules, provisions that have the potential to influence the underlying cost of health care, the individual mandate, the employer mandate (including the free-choice voucher program) and the excise tax on high-cost plans.

  19. Insights from a pilot program to integrate medical and social services.

    PubMed

    Meiners, Mark R; Mokler, Pamela M; Kasunic, Mary Lynn; Hawthornthwaite, Scott; Foster, Susan; Scheer, David; Maldonado, Anna Maria

    2014-01-01

    This study examines lessons learned from the design, implementation, and early results of an integrated managed care pilot program linking member benefits of a Medicare-Medicaid health care plan with community services and supports. The health plan's average monthly costs for members receiving an assessment and services declined by an economically meaningful, statistically significant amount in the postintervention period relative to the preintervention period compared with those who did not accept an assessment or services. The results along with the lesson learned from the pilot are viewed by the parties as supportive of further program development.

  20. 78 FR 15559 - Patient Protection and Affordable Care Act; Establishment of the Multi-State Plan Program for the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-11

    .... Based on initial comparative research, it appears that the proposed OPM-selected EHB-benchmark plans are... include any discriminatory benefit design elements as defined under 45 CFR 156.125. Response: In response... OPM-selected benchmarks and substitutions not be allowed in States having standard benefit designs...

  1. Access to High Quality Early Care and Education: Readiness and Opportunity Gaps in America. CEELO Policy Report

    ERIC Educational Resources Information Center

    Nores, Milagros; Barnett, W. Steven

    2014-01-01

    A substantial body of research establishes that high quality preschool education can enhance cognitive and social development with long-term benefits for later success in school, the economy, and society more broadly. Such programs have been found to have particularly large benefits for children who are economically disadvantaged. Such children…

  2. Titrating versus targeting home care services to frail elderly clients: an application of agency theory and cost-benefit analysis to home care policy.

    PubMed

    Weissert, William; Chernew, Michael; Hirth, Richard

    2003-02-01

    The article summarizes the shortcomings of current home care targeting policy, provides a conceptual framework for understanding the sources of its problems, and proposes an alternative resource allocation method. Methods required for different aspects of the study included synthesis of the published literature, regression analysis of risk predictors, and comparison of actual resource allocations with simulated budgets. Problems of imperfect agency ranging from unclear goals and inappropriate incentives to lack of information about the marginal effectiveness of home care could be mitigated with an improved budgeting method that combines client selection and resource allocation. No program can produce its best outcome performance when its goals are unclear and its technology is unstandardized. Titration of care would reallocate resources to maximize marginal benefit for marginal cost.

  3. Model citizens. Outsourcing helps start-up Medicare HMO.

    PubMed

    Slavic, B; Adami, S

    1999-04-01

    Health Plans of Pennsylvania (HPP), the managed care arm of Crozer-Keystone Health System, in Media, Pa. Selecting the information systems and building the infrastructure to support the start-up of a new Medicare HMO product. HPP chose to outsource the information systems needed to integrate all the components of managed care administration into a cost-effective and cohesive program. Because of its aggressive programming and start-up of the MedCarePlus product offering, HPP became the first plan in the country to submit Medicare claims data electronically for encounter reporting to the Health Care Financing Administration (HCFA). "Through an integrated team approach, an organization truly can benefit from the economies of scale gained through outsourcing."

  4. Healthcare cost differences with participation in a community-based group physical activity benefit for medicare managed care health plan members.

    PubMed

    Ackermann, Ronald T; Williams, Barbara; Nguyen, Huong Q; Berke, Ethan M; Maciejewski, Matthew L; LoGerfo, James P

    2008-08-01

    To determine whether participation in a physical activity benefit by Medicare managed care enrollees is associated with lower healthcare utilization and costs. Retrospective cohort study. Medicare managed care. A cohort of 1,188 older adult health maintenance organization enrollees who participated at least once in the EnhanceFitness (EF) physical activity benefit and a matched group of enrollees who never used the program. Healthcare costs and utilization were estimated. Ordinary least squares regression was used, adjusting for demographics, comorbidity, indicators of preventive service use, and baseline utilization or cost. Robustness of findings was tested in sensitivity analyses involving continuous propensity score adjustment and generalized linear models with nonconstant variance assumptions. EF participants had similar total healthcare costs during Year 1 of the program, but during Year 2, adjusted total costs were $1,186 lower (P=.005) than for non-EF users. Differences were partially attributable to lower inpatient costs (-$3,384; P=.02), which did not result from high-cost outliers. Enrollees who attended EF an average of one visit or more per week had lower adjusted total healthcare costs in Year 1 (-$1,929; P<.001) and Year 2 (-$1,784; P<.001) than nonusers. Health plan coverage of a preventive physical activity benefit for seniors is a promising strategy to avoid significant healthcare costs in the short term.

  5. Can smallpox response teams use the experience of disease management programs?

    PubMed

    Kozma, Chris M

    2003-02-01

    Any attempt to widely disperse smallpox vaccinations will necessitate educating people about the risks and benefits of vaccination. Most disease management programs have extensive experience in distributing educational materials and programs to health care workers and patients as well as in tracking response to interventions. Can this experience lend a hand in the event of widespread vaccination?

  6. 5 CFR 890.1015 - Minimum and maximum length of permissive debarments.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ...) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Permissive Debarments § 890.1015 Minimum and maximum length of...

  7. 5 CFR 890.1008 - Mandatory debarment for longer than the minimum length.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Mandatory Debarments § 890.1008 Mandatory debarment for...

  8. 5 CFR 890.1051 - Applying for reinstatement when period of debarment expires.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Reinstatement § 890.1051 Applying for reinstatement when...

  9. 5 CFR 890.1038 - Deciding a contest without additional fact-finding.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Suspension § 890.1038 Deciding a contest without additional...

  10. 5 CFR 890.1039 - Cases where additional fact-finding is required.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ...) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Suspension § 890.1039 Cases where additional fact-finding is...

  11. Effect of lifestyle improvement program on the biomarkers of adiposity, inflammation and gut hormones in overweight/obese Asian Indians with prediabetes.

    PubMed

    Gokulakrishnan, Kuppan; Ranjani, Harish; Weber, Mary Beth; Pandey, Gautam Kumar; Anjana, Ranjit Mohan; Balasubramanyam, Muthuswamy; Prabhakaran, Dorairaj; Tandon, Nikhil; Narayan, K M; Mohan, Viswanathan

    2017-09-01

    While lifestyle modification is known to offer several metabolic benefits, there is paucity of comprehensive data on changes in biomarkers of adiposity, inflammation as well as gut hormones. We investigated these biomarkers in overweight/obese individuals with prediabetes randomized to either 4 months of a lifestyle improvement program or standard care and followed them up for a year. Participants [standard care and intervention arm (n = 75 each)] were randomly selected from the Diabetes Community Lifestyle Improvement Program trial. Glycemic and lipid control and anthropometric measurements were assessed by standard protocols. Adipokines, inflammatory markers and gut hormones were measured using multiplex and standard ELISA kits. Along with modest benefits in primary outcomes (glycemic and lipid control and weight reduction), participants in the intervention group showed significant reductions (p < 0.001) in plasma levels of leptin (17.6%), TNF-α (35%), IL-6 (33.3%), MCP-1 (22.3%) and PYY (28.3%) and increased levels of adiponectin (33.1%) and ghrelin (23.6%) at the end of 4 months of lifestyle intervention. The changes were independent of weight and persisted even at 1 year of follow-up. In contrast, participants from the standard care arm did not show any statistically significant improvements on the above parameters. Participants who underwent an intensive lifestyle improvement program showed metabolic benefits as well as favorable beneficial changes in systemic levels of adipokines, cytokines and gut hormones, not only during the intervention period, but also during 12-month follow-up period.

  12. Economic effect of an expansion of pharmacy benefits on total health care expenditures by a state Medicaid program.

    PubMed

    Jenkins, Tara L; Harrison, Donald L; Jacobs, Elgene W; Neas, Barbara R; Hagemann, Tracy M

    2009-01-01

    To evaluate the economic effect of a pharmacy benefit expansion on a population of Oklahoma Medicaid recipients and to determine whether recipients who routinely maximized their monthly prescription limit (cap) before the benefit expansion benefited more from the expansion than the remainder of the study population. Retrospective study. Oklahoma Medicaid claims data from January 1, 2003, to December 31, 2004. Data from 15,936 Oklahoma Medicaid recipients. Retrospective administrative analysis using the Oklahoma Health Care Authority pharmacy and medical claims databases. Total health care expenditures per recipient per year, total medical expenditures per recipient per year, and total pharmacy expenditures per recipient per year. Total health care expenditures increased 17% after the benefit expansion (P < 0.0001). Of this increase, 65% was attributed to pharmacy expenditures and 35% to medical expenditures. However, a subpopulation of recipients who routinely reached their prescription limit before the expansion had a statistically significant increase in total and pharmacy expenditures; a statistically significant increase in medical expenditures was not observed. Although total health care expenditures increased after a monthly pharmacy benefit in a Medicaid population was expanded, a subpopulation of recipients identified as high pharmacy users before the expansion did not have a statistically significant increase in medical expenditures, whereas those who were non-high users experienced a significant increase. Additionally, this subpopulation experienced a nonsignificant decrease in hospital expenditures. These results could suggest that this subpopulation was affected differently than the overall population by the expansion of the Medicaid pharmacy benefit.

  13. Innovation in survivor care: group visits.

    PubMed

    Trotter, Kathryn; Frazier, Alana; Hendricks, Colleen K; Scarsella, Heidi

    2011-04-01

    The Centering Cancer Survivorship (CCS) follow-up care program is an innovation in healthcare delivery that meets the needs of cancer survivors and cancer centers. Piloted in a breast cancer clinic, the program provides an avenue for provision of psychological support and health-promotion activities, as well as surveillance for recurrence or late effects. The program empowers each survivor by enlisting her to produce a written breast cancer survivorship care plan for personal use and to share with her primary care provider. Concurrently, this innovation should enhance the viability of the primary cancer center by freeing appointment slots for oncologists who provide expensive therapies to newly diagnosed patients. The CCS program's central feature is the implementation of a multidisciplinary clinic designated specifically for breast cancer survivors in which follow-up care is provided through a group visit medical model. This model of care provides opportunities for health assessment, patient empowerment, and patient education within a framework of social support from peers with similar issues. The group visit model may be well suited to addressing the unique chronic healthcare needs of breast cancer survivors. Further evaluation is needed to verify cost-benefit analysis.

  14. Integrated employee assistance program/managed behavioral health care benefits: relationship with access and client characteristics.

    PubMed

    Levy Merrick, Elizabeth S; Hodgkin, Dominic; Horgan, Constance M; Hiatt, Deirdre; McCann, Bernard; Azzone, Vanessa; Zolotusky, Galina; Ritter, Grant; Reif, Sharon; McGuire, Thomas G

    2009-11-01

    This study examined service user characteristics and determinants of access for enrollees in integrated EAP/behavioral health versus standard managed behavioral health care plans. A national managed behavioral health care organization's claims data from 2004 were used. Integrated plan service users were more likely to be employees rather than dependents, and to be diagnosed with adjustment disorder. Logistic regression analyses found greater likelihood in integrated plans of accessing behavioral health services (OR 1.20, CI 1.17-1.24), and substance abuse services specifically (OR 1.23, CI 1.06-1.43). Results are consistent with the concept that EAP benefits may increase access and address problems earlier.

  15. Determinants of Private Long-Term Care Insurance Purchase in Response to the Partnership Program.

    PubMed

    Lin, Haizhen; Prince, Jeffrey T

    2016-04-01

    To assess three possible determinants of individuals' response in their private insurance purchases to the availability of the Partnership for Long-Term Care (PLTC) insurance program: bequest motives, financial literacy, and program awareness. The health and retirement study (HRS) merged with data on states' implementation of the PLTC program. Individual-level decision on private long-term care insurance is regressed on whether the PLTC program is being implemented for a given state-year, asset dummies, policy determinant variable, two-way and three-way interactions of these variables, and other controls, using fixed effects panel regression. Analysis used a sample between 50 and 69 years of age from 2002 to 2010, resulting in 12,695 unique individuals with a total of 39,151 observations. We find mild evidence that intent to bequest influences individual purchase of insurance. We also find that program awareness is necessary for response, while financial literacy notably increases responsiveness. Increasing response to the PLTC program among the middle class (the stated target group) requires increased efforts to create awareness of the program's existence and increased education about the program's benefits, and more generally, about long-term care risks and needs. © Health Research and Educational Trust.

  16. Recovering Servicemembers and Veterans: Sustained Leadership Attention and Systematic Oversight Needed to Resolve Persistent Problems Affecting Care and Benefits

    DTIC Science & Technology

    2012-11-01

    Freedom OND Operation New Dawn PTSD posttraumatic stress disorder RCP Recovery Coordination Program Recovering Warrior...Hotel Aftermath,” Washington Post (Washington, D.C.: Feb. 19, 2007); and “ Hospital Investigates Former Aid Chief,” Washington Post (Washington, D.C...the Federal Recovery Coordination Program (FRCP), the Recovery Coordination Program ( RCP ), and the Interagency Program Office. (See fig. 1.) Figure 1

  17. The efficacy of a multifactorial memory training in older adults living in residential care settings.

    PubMed

    Vranić, Andrea; Španić, Ana Marija; Carretti, Barbara; Borella, Erika

    2013-11-01

    Several studies have shown an increase in memory performance after teaching mnemonic techniques to older participants. However, transfer effects to non-trained tasks are generally either very small, or not found. The present study investigates the efficacy of a multifactorial memory training program for older adults living in a residential care center. The program combines teaching of memory strategies with activities based on metacognitive (metamemory) and motivational aspects. Specific training-related gains in the Immediate list recall task (criterion task), as well as transfer effects on measures of short-term memory, long-term memory, working memory, motivational (need for cognition), and metacognitive aspects (subjective measure of one's memory) were examined. Maintenance of training benefits was assessed after seven months. Fifty-one older adults living in a residential care center, with no cognitive impairments, participated in the study. Participants were randomly assigned to two programs: the experimental group attended the training program, while the active control group was involved in a program in which different psychological issues were discussed. A benefit in the criterion task and substantial general transfer effects were found for the trained group, but not for the active control, and they were maintained at the seven months follow-up. Our results suggest that training procedures, which combine teaching of strategies with metacognitive-motivational aspects, can improve cognitive functioning and attitude toward cognitive activities in older adults.

  18. The Impact of a Primary Care Education Program Regarding Cancer Survivorship Care Plans: Results from an Engineering, Primary Care, and Oncology Collaborative for Survivorship Health.

    PubMed

    Donohue, SarahMaria; Haine, James E; Li, Zhanhai; Trowbridge, Elizabeth R; Kamnetz, Sandra A; Feldstein, David A; Sosman, James M; Wilke, Lee G; Sesto, Mary E; Tevaarwerk, Amye J

    2017-09-20

    Survivorship care plans (SCPs) have been recommended as tools to improve care coordination and outcomes for cancer survivors. SCPs are increasingly being provided to survivors and their primary care providers. However, most primary care providers remain unaware of SCPs, limiting their potential benefit. Best practices for educating primary care providers regarding SCP existence and content are needed. We developed an education program to inform primary care providers of the existence, content, and potential uses for SCPs. The education program consisted of a 15-min presentation highlighting SCP basics presented at mandatory primary care faculty meetings. An anonymous survey was electronically administered via email (n = 287 addresses) to evaluate experience with and basic knowledge of SCPs pre- and post-education. A total of 101 primary care advanced practice providers (APPs) and physicians (35% response rate) completed the baseline survey with only 23% reporting prior receipt of a SCP. Only 9% could identify the SCP location within the electronic health record (EHR). Following the education program, primary care physicians and APPs demonstrated a significant improvement in SCP knowledge, including improvement in their ability to locate one within the EHR (9 vs 59%, p < 0.0001). A brief educational program containing information about SCP existence, content, and location in the EHR increased primary care physician and APP knowledge in these areas, which are prerequisites for using SCP in clinical practice.

  19. The impact of patient navigation on the delivery of diagnostic breast cancer care in the National Patient Navigation Research Program: a prospective meta-analysis

    PubMed Central

    Darnell, Julie S.; Ko, Naomi; Snyder, Fred; Paskett, Electra D.; Wells, Kristen J.; Whitley, Elizabeth M.; Griggs, Jennifer J.; Karnad, Anand; Young, Heather; Warren-Mears, Victoria; Simon, Melissa A.; Calhoun, Elizabeth

    2016-01-01

    Patient navigation is emerging as a standard in breast cancer care delivery, yet multi-site data on the impact of navigation at reducing delays along the continuum of care are lacking. The purpose of this study was to determine the effect of navigation on reaching diagnostic resolution at specific time points after an abnormal breast cancer screening test among a national sample. A prospective meta-analysis estimated the adjusted odds of achieving timely diagnostic resolution at 60, 180, and 365 days. Exploratory analyses were conducted on the pooled sample to identify which groups had the most benefit from navigation. Clinics from six medical centers serving vulnerable populations participated in the Patient Navigation Research Program. Women with an abnormal breast cancer screening test between 2007 and 2009 were included and received the patient navigation intervention or usual care. Patient navigators worked with patients and their care providers to address patient-specific barriers to care to prevent delays in diagnosis. A total of 4675 participants included predominantly racial/ethnic minorities (74 %) with public insurance (40 %) or no insurance (31 %). At 60 days and 180 days, there was no statistically significant effect of navigation on achieving timely diagnostic care, but a benefit of navigation was seen at 365 days (aOR 2.12, CI 1.36–3.29). We found an equal benefit of navigation across all groups, regardless of race/ethnicity, language, insurance status, and type of screening abnormality. Patient navigation resulted in more timely diagnostic resolution at 365 days among a diverse group of minority, low-income women with breast cancer screening abnormalities. PMID:27432417

  20. The impact of patient navigation on the delivery of diagnostic breast cancer care in the National Patient Navigation Research Program: a prospective meta-analysis.

    PubMed

    Battaglia, Tracy A; Darnell, Julie S; Ko, Naomi; Snyder, Fred; Paskett, Electra D; Wells, Kristen J; Whitley, Elizabeth M; Griggs, Jennifer J; Karnad, Anand; Young, Heather; Warren-Mears, Victoria; Simon, Melissa A; Calhoun, Elizabeth

    2016-08-01

    Patient navigation is emerging as a standard in breast cancer care delivery, yet multi-site data on the impact of navigation at reducing delays along the continuum of care are lacking. The purpose of this study was to determine the effect of navigation on reaching diagnostic resolution at specific time points after an abnormal breast cancer screening test among a national sample. A prospective meta-analysis estimated the adjusted odds of achieving timely diagnostic resolution at 60, 180, and 365 days. Exploratory analyses were conducted on the pooled sample to identify which groups had the most benefit from navigation. Clinics from six medical centers serving vulnerable populations participated in the Patient Navigation Research Program. Women with an abnormal breast cancer screening test between 2007 and 2009 were included and received the patient navigation intervention or usual care. Patient navigators worked with patients and their care providers to address patient-specific barriers to care to prevent delays in diagnosis. A total of 4675 participants included predominantly racial/ethnic minorities (74 %) with public insurance (40 %) or no insurance (31 %). At 60 days and 180 days, there was no statistically significant effect of navigation on achieving timely diagnostic care, but a benefit of navigation was seen at 365 days (aOR 2.12, CI 1.36-3.29). We found an equal benefit of navigation across all groups, regardless of race/ethnicity, language, insurance status, and type of screening abnormality. Patient navigation resulted in more timely diagnostic resolution at 365 days among a diverse group of minority, low-income women with breast cancer screening abnormalities. Trial registrations clinicaltrials.gov Identifiers: NCT00613275, NCT00496678, NCT00375024, NCT01569672.

  1. 5 CFR 890.1053 - Table of procedures and effective dates for reinstatements.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Reinstatement § 890.1053 Table of procedures and effective...

  2. State health care financing strategies for children with intellectual and developmental disabilities.

    PubMed

    Bachman, Sara S; Comeau, Margaret; Tobias, Carol; Allen, Deborah; Epstein, Susan; Jantz, Kathryn; Honberg, Lynda

    2012-06-01

    We provide the first descriptive summary of selected programs developed to help expand the scope of coverage, mitigate family financial hardship, and provide health and support services that children with intellectual and developmental disabilities need to maximize their functional status and quality of life. State financing initiatives were identified through interviews with family advocacy, Title V, and Medicaid organizational representatives. Results showed that states use myriad strategies to pay for care and maximize supports, including benefits counseling, consumer- and family-directed care, flexible funding, mandated benefits, Medicaid buy-in programs, and Tax Equity and Fiscal Responsibility Act of 1982 funding. Although health reform may reduce variation among states, its impact on families of children with intellectual and developmental disabilities is not yet clear. As health reform is implemented, state strategies to ameliorate financial hardship among families of children with intellectual and developmental disabilities show promise for immediate use. However, further analysis and evaluation are required to understand their impact on family and child well-being.

  3. Who wins and who loses? Public transfer accounts for US generations born 1850 to 2090

    PubMed Central

    Bommier, Antoine; Miller, Tim; Zuber, Stéphane

    2010-01-01

    Public transfer programs in industrial nations are thought to benefit the elderly through pension and health care programs at the expense of the young and future generations. However, this intergenerational picture changes if public education is also considered as a transfer program. We calculate the net present value (NPV) of benefits received minus taxes paid for US generations born 1850 to 2090. Surprisingly, all generations 1950 to 2050 are net gainers, while many current elderly are losers. Windfall gains from starting Social Security and Medicare partially offset windfall losses from starting public education, roughly consistent with the Becker-Murphy theory. PMID:20300431

  4. The influence of maternal health literacy and child's age on participation in social welfare programs.

    PubMed

    Pati, Susmita; Siewert, Elizabeth; Wong, Angie T; Bhatt, Suraj K; Calixte, Rose E; Cnaan, Avital

    2014-07-01

    The objective of this study is to determine the influence of maternal health literacy and child's age on participation in social welfare programs benefiting children. In a longitudinal prospective cohort study of 560 Medicaid-eligible mother-infant dyads recruited in Philadelphia, maternal health literacy was assessed using the test of functional health literacy in adults (short version). Participation in social welfare programs [Temporary Assistance to Needy Families (TANF), Supplemental Nutrition Assistance Program (SNAP), Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), child care subsidy, and public housing] was self-reported at child's birth, and at the 6, 12, 18, 24 month follow-up interviews. Generalized estimating equations quantified the strength of maternal health literacy as an estimator of program participation. The mothers were primarily African-Americans (83%), single (87%), with multiple children (62%). Nearly 24% of the mothers had inadequate or marginal health literacy. Children whose mothers had inadequate health literacy were less likely to receive child care subsidy (adjusted OR = 0.54, 95% CI 0.34-0.85) than children whose mothers had adequate health literacy. Health literacy was not a significant predictor for TANF, SNAP, WIC or housing assistance. The predicted probability for participation in all programs decreased from birth to 24 months. Most notably, predicted WIC participation declined rapidly after age one. During the first 24 months, mothers with inadequate health literacy could benefit from simplified or facilitated child care subsidy application processes. Targeted outreach and enrollment efforts conducted by social welfare programs need to take into account the changing needs of families as children age.

  5. Effects of individual and group exercise programs on pain, balance, mobility and perceived benefits in rheumatoid arthritis with pain and foot deformities.

    PubMed

    do Carmo, Carolina Mendes; Almeida da Rocha, Bruna; Tanaka, Clarice

    2017-11-01

    [Purpose] To verify the effects of individual and group exercise programs on pain, balance, mobility and perceived benefits of rheumatoid arthritis patients (RA) with pain and foot deformities. [Subjects and Methods] Thirty patients with RA pain and foot deformity were allocated into two groups: G1: individual exercise program and G2: group exercise program. The variables analyzed were Numerical Rating Scale (NRS) for pain, Berg Balance Scale (BBS) for balance, Timed Up & Go Test (TUG) and Functional Reach (FR) for mobility, and Foot Health Status Questionnaire (FHSQ-Br) for perceived benefits. Both exercise programs consisted of functional rehabilitation exercises and self-care guidance aimed at reducing pain and improving balance and mobility. Intragroup comparisons of variables between A1 (pre-intervention) and A2 (post-intervention) were performed. [Results] Patients in both groups were similar in A1 (pre-intervention) in all the variables analyzed. Comparison between A1 and A2 for each variable showed improvement for G1 in the NRS, BBS, FR, TUG and in four out of ten domains of FHSQ-Br. G2 showed improvement in the NRS, BBS and eight out of ten domains of FHSQ-Br. [Conclusion] Both individual and group programs revealed benefits for patients with RA, however, group exercise programs showed better perception of benefits.

  6. Patterns of use for brand-name versus generic oral bisphosphonate drugs in Ontario over a 13-year period: a descriptive study.

    PubMed

    Fraser, Lisa-Ann; Albaum, Jordan M; Tadrous, Mina; Burden, Andrea M; Shariff, Salimah Z; Cadarette, Suzanne M

    2015-01-01

    Bisphosphonates are the first-line therapy for the treatment of osteoporosis. In the province of Ontario, the Ontario Drug Benefit Program funds medications for patients aged 65 years and older. The Ontario Drug Benefit Program has a generic substitution policy that requires lower-cost generic drugs to be dispensed when they are available. However, there is controversy surrounding the efficacy and tolerability of generic bisphosphonates. The objective of this study was to describe patterns in the use of brand-name versus generic formulations when dispensing oral bisphosphonate over a 13-year period. We identified all osteoporotic preparations for alendronate and risedronate that were dispensed through the Ontario Drug Benefit Program from 2001 to 2014. We stratified our sample into community-dwelling residents and residents in long-term care facilities. The number of prescriptions dispensed per month were plotted to illustrate trends over time. We found a rapid switch from brand-name to generic bisphosphonate equivalents immediately after the generic became available on the Ontario Drug Benefit formulary, with generics accounting for > 88% of dispensed drug within 2 months. We also observed a reduction in the number of generic drugs dispensed each time a new brand-name alternative (e.g., monthly risedronate, weekly alendronate plus vitamin D) was introduced to the formulary. The dispensing trends were similar in the community and long-term care settings. The Ontario Drug Benefit Program generic substitution policy resulted in rapid uptake of generic oral bisphosphonates among seniors in Ontario. However, there was a switch away from generic medications to new brand-name alternatives whenever they were introduced to the formulary. Therefore, some patients continued to use brand-name bisphosphonate despite the availability of generic options.

  7. 5 CFR 890.1020 - Determining length of debarment based on false, wrongful, or deceptive claims.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Permissive Debarments § 890.1020...

  8. 5 CFR 890.1005 - Time limits for OPM to initiate mandatory debarments.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ...) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Mandatory Debarments § 890.1005 Time limits for OPM to initiate...

  9. 5 CFR 890.1020 - Determining length of debarment based on false, wrongful, or deceptive claims.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Permissive Debarments § 890.1020...

  10. 5 CFR 890.1012 - Time limits for OPM to initiate permissive debarments.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Permissive Debarments § 890.1012 Time limits for OPM to...

  11. 5 CFR 890.1054 - Agencies and entities to be notified of reinstatements.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ...) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Reinstatement § 890.1054 Agencies and entities to be notified of...

  12. 5 CFR 890.1020 - Determining length of debarment based on false, wrongful, or deceptive claims.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Permissive Debarments § 890.1020...

  13. 5 CFR 890.1024 - Standard and burden of proof for deciding contests.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ...) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Permissive Debarments § 890.1024 Standard and burden of proof for...

  14. 5 CFR 890.1027 - Cases where an additional fact-finding proceeding is required.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Permissive Debarments § 890.1027 Cases where an additional...

  15. 5 CFR 890.1026 - Procedures if a fact-finding proceeding is not required.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Permissive Debarments § 890.1026 Procedures if a fact...

  16. 5 CFR 890.1037 - Cases where additional fact-finding is not required.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Suspension § 890.1037 Cases where additional fact-finding is...

  17. 5 CFR 890.1020 - Determining length of debarment based on false, wrongful, or deceptive claims.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Permissive Debarments § 890.1020...

  18. Multi-Year Analysis Examines Costs, Benefits, and Impacts of Renewable Portfolio Standards

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

    As states consider revising renewable portfolio standard (RPS) programs or developing new ones, careful assessments of the costs, benefits, and other impacts of existing policies will be critical. RPS programs currently exist in 29 states and Washington, D.C. Many of these policies, which were enacted largely during the late 1990s and 2000s, will reach their terminal targets by the end of this decade. The National Renewable Energy Laboratory (NREL) and Lawrence Berkeley National Laboratory (LBNL) are engaged in a multi-year project to examine the costs, benefits, and other impacts of state RPS polices both retrospectively and prospectively. This fact sheetmore » overviews this work.« less

  19. [Training of institutional research networks as a strategy of improvement].

    PubMed

    Galván-Plata, María Eugenia; Almeida-Gutiérrez, Eduardo; Salamanca-Gómez, Fabio Abdel

    2017-01-01

    The Instituto Mexicano del Seguro Social (IMSS) through the Coordinación de Investigación en Salud (Health Research Council) has promoted a strong link between the generation of scientific knowledge and the clinical care through the program Redes Institucionales de Investigación (Institutional Research Network Program), whose main aim is to promote and generate collaborative research between clinical, basic, epidemiologic, educational, economic and health services researchers, seeking direct benefits for patients, as well as to generate a positive impact on institutional processes. All of these research lines have focused on high-priority health issues in Mexico. The IMSS internal structure, as well as the sufficient health services coverage, allows the integration of researchers at the three levels of health care into these networks. A few years after their creation, these networks have already generated significant results, and these are currently applied in the institutional regulations in diseases that represent a high burden to health care. Two examples are the National Health Care Program for Patients with Acute Myocardial Infarction "Código Infarto", and the Early Detection Program on Chronic Kidney Disease; another result is the generation of multiple scientific publications, and the promotion of training of human resources in research from the same members of our Research Networks. There is no doubt that the Coordinación de Investigación en Salud advances steadily implementing the translational research, which will keep being fruitful to the benefit of our patients, and of our own institution.

  20. Telemedicine delivery of patient education in remote Ontario communities: feasibility of an Advanced Clinician Practitioner in Arthritis Care (ACPAC)-led inflammatory arthritis education program.

    PubMed

    Warmington, Kelly; Flewelling, Carol; Kennedy, Carol A; Shupak, Rachel; Papachristos, Angelo; Jones, Caroline; Linton, Denise; Beaton, Dorcas E; Lineker, Sydney

    2017-01-01

    Telemedicine-based approaches to health care service delivery improve access to care. It was recognized that adults with inflammatory arthritis (IA) living in remote areas had limited access to patient education and could benefit from the 1-day Prescription for Education (RxEd) program. The program was delivered by extended role practitioners with advanced training in arthritis care. Normally offered at one urban center, RxEd was adapted for videoconference delivery through two educator development workshops that addressed telemedicine and adult education best practices. This study explores the feasibility of and participant satisfaction with telemedicine delivery of the RxEd program in remote communities. Participants included adults with IA attending the RxEd program at one of six rural sites. They completed post-course program evaluations and follow-up interviews. Educators provided post-course feedback to identify program improvements that were later implemented. In total, 123 people (36 in-person and 87 remote, across 6 sites) participated, attending one of three RxEd sessions. Remote participants were satisfied with the quality of the video-conference (% agree/strongly agree): could hear the presenter (92.9%) and discussion between sites (82.4%); could see who was speaking at other remote sites (85.7%); could see the slides (95.3%); and interaction between sites adequately facilitated (94.0%). Educator and participant feedback were consistent. Suggested improvements included: use of two screens (speaker and slides); frontal camera angles; equal interaction with remote sites; and slide modifications to improve the readability on screen. Interview data included similar constructive feedback but highlighted the educational and social benefits of the program, which participants noted would have been inaccessible if not offered via telemedicine. Study findings confirm the feasibility of delivering the RxEd program to remote communities by using telemedicine. Future research with a focus on the sustainability of this and other models of technology-supported patient education for adults with IA across Ontario is warranted.

  1. The costs of prevention.

    PubMed

    Weinstein, M C

    1990-01-01

    A prevention program is cost-effective if it yields more health benefits than do alternative uses of health care resources. Some prevention programs meet this standard: either they actually save more health care resources than they utilize, or their net costs per healthy year of life gained are lower than those of alternatives such as curative or palliative medicine. Other prevention programs, however, are less cost-effective than are medical treatments for the same disease. One lesson for public policy is that generalizations about the cost-effectiveness of "prevention" are unwise. Another lesson is that prevention programs should not be subjected to a higher standard than other health programs: they should not be expected to save money, but they should be expected to yield improved health at a reasonable price.

  2. "Doing Good" in Italian through Student Community Engagement: The Benefits of Language Placements

    ERIC Educational Resources Information Center

    Bouvet, Eric; Cosmini, Daniela; Palaktsoglou, Maria; Vanzo, Lynn

    2017-01-01

    This article discusses a community engagement pilot program for language students offered at Flinders University. For a number of years, the "Language in Action" program has provided placement opportunities for language students in a range of community settings such as aged-care agencies and cultural associations. From an educational…

  3. Class Size Reduction: Great Hopes, Great Challenges. Policy Brief.

    ERIC Educational Resources Information Center

    WestEd, San Francisco, CA.

    This policy brief examines the benefits and the challenges that accompany class-size reduction (CSR). It suggests that when designing CSR programs, states should carefully assess specific circumstances in their schools as they adopt or modify CSR efforts to avoid the unintended consequences that some programs have experienced. Some of the…

  4. Wellness for Older Workers and Retirees. WBGH Worksite Wellness Series.

    ERIC Educational Resources Information Center

    Levin, Robert C.

    Company-sponsored wellness programs are particularly important for older employees inasmuch as they are at greater risk of disease and disability than are their younger counterparts and their health care and health insurance costs are generally higher. As the cost of retirement benefits rises, wellness programs for retirees are becoming…

  5. The Federal Employees Health Benefits Program: A Model for Competition in Rural America?

    ERIC Educational Resources Information Center

    Mueller, Keith J.; McBride, Timothy D.; Andrews, Courtney; Fraser, Roslyn; Xu, Liyan

    2005-01-01

    The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) created the Medicare Advantage (MA) program, which promotes the entry of private Preferred Provider Organization (PPO) plans into regions that have not previously had Medicare managed care plans. The assumption that a competitive environment will develop is based on…

  6. Communication Strategies for Promoting Crime Prevention Competence among Elderly Persons.

    ERIC Educational Resources Information Center

    O'Keefe, Garrett J.; Reid, Kathaleen

    Recent research indicates that public information campaigns and promotional programs can have an impact on the extent to which citizens involve themselves in crime prevention. Subgroups such as the elderly may especially benefit from efforts more carefully tailored to their own needs and circumstances. The design of successful programs requires…

  7. Impact of Critical Access Hospital Conversion on Beneficiary Liability

    ERIC Educational Resources Information Center

    Gilman, Boyd H.

    2008-01-01

    Context: While the Medicare Critical Access Hospital (CAH) program has improved the financial viability of small rural hospitals and enhanced access to care in rural communities, the program puts beneficiaries at risk for paying a larger share of the cost of services covered under the Medicare part B benefit. Purpose: This paper examines the…

  8. Evaluation of a clinical medical librarianship program at a university Health Sciences Library.

    PubMed Central

    Schnall, J G; Wilson, J W

    1976-01-01

    An evaluation of the clinical medical librarianship program at the University of Washington Health Sciences Library was undertaken to determine the benefits of the program to patient care and to the education of the recipients of the service. Results of a questionnaire reflected overwhelming acceptance of the clinical medical librarianship program. Guidelines for the establishment of a limited clinical medical librarianship program are described. A statistical cost analysis of the program is included. PMID:938773

  9. Responses to "Intention to Leave, Anticipated Reasons for Leaving, and 12-Month Turnover of Child Care Center Staff."

    ERIC Educational Resources Information Center

    Whitehead, Linda; Russell, Susan

    1997-01-01

    Two practitioners address problem of employee turnover in child care centers. The first plan argues for comprehensive wage raises, increased benefits, and low cost options to workers that increase flexibility. The second strategy advocates continuing education opportunities, special mentoring programs, and bonuses or raises paid early in the…

  10. Dyadic Intervention for Family Caregivers and Care Receivers in Early-Stage Dementia

    ERIC Educational Resources Information Center

    Whitlatch, Carol J.; Judge, Katherine; Zarit, Steven H.; Femia, Elia

    2006-01-01

    Purpose: The Early Diagnosis Dyadic Intervention (EDDI) program provides a structured, time-limited protocol of one-on-one and dyadic counseling for family caregivers and care receivers who are in the early stages of dementia. The goals and procedures of EDDI are based on previous research suggesting that dyads would benefit from an intervention…

  11. An Analysis of Campus Child Care Centers in the State-Supported Colleges and Universities of Florida.

    ERIC Educational Resources Information Center

    Holdnak, Mildred Walden

    Objectives of this master's thesis were to analyze the status of existing day care centers at state supported colleges and universities in Florida in terms of purposes, funding, policies and policy making, staffing, program content for children, training experiences offered to college students and benefits of the center to the sponsoring…

  12. 5 CFR 890.1046 - Effect of debarment or suspension on payments for services furnished in emergency situations.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Exceptions to the Effect of... situations. A debarred or suspended health care provider may receive FEHBP funds paid for items or services... provider's treatment was essential to the health and safety of the covered individual; and (b) No other...

  13. 5 CFR 890.1046 - Effect of debarment or suspension on payments for services furnished in emergency situations.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Exceptions to the Effect of... situations. A debarred or suspended health care provider may receive FEHBP funds paid for items or services... provider's treatment was essential to the health and safety of the covered individual; and (b) No other...

  14. Military Retirement: Background and Recent Developments

    DTIC Science & Technology

    2017-01-06

    nonmonetary benefits including exchange and commissary privileges, medical care through TRICARE, and access to Morale , Welfare and Recreation (MWR...include exchange and commissary privileges, medical care through TRICARE, and access to Morale , Welfare and Recreation facilities and programs...over the past decade. Congress grapples with constituent concerns as well as budgetary constraints in considering military retirement issues . In the

  15. Convergence and dissonance: evolution in private-sector approaches to disease management and care coordination.

    PubMed

    Mays, Glen P; Au, Melanie; Claxton, Gary

    2007-01-01

    Disease management (DM) approaches survived the 1990s backlash against managed care because of their potential for consumer-friendly cost containment, but purchasers have been cautious about investing heavily in them because of uncertainty about return on investment. This study examines how private-sector approaches to DM have evolved over the past two years in the midst of the movement toward consumer-driven health care. Findings indicate that these programs have become standard features of health plan design, despite a thin evidence base concerning their effectiveness. Uncertainties remain regarding how well these programs will function within benefit designs that require higher consumer cost sharing.

  16. The Importance of Place and Time in Translating Knowledge About Canada's Compassionate Care Benefit to Informal Caregivers

    PubMed Central

    Dykeman, Sarah; Williams, Allison

    2013-01-01

    Canada's Compassionate Care Benefit (CCB), an employment insurance program designed to allow Canadian workers time off to care for a dying relative or friend, has had low uptake since its inception. Due to their role in working with family caregivers, social workers are one group of primary health care professionals who have been identified as benefiting from a knowledge translation campaign. Knowledge tools about the CCB have been developed through social worker input in a prior study. This article presents the findings of a qualitative exploratory intervention. Social workers (n = 8) utilized the tools for 6 months and discussed their experiences with them. Data analysis revealed references to time and space constraints in using to the tools, and demonstrated the impact of time geography on knowledge translation about the CCB. The results suggest that knowledge translation about the CCB could be targeted toward caregivers earlier on in the disease progression before the terminal diagnosis, and knowledge tools must be disseminated to more locations. These results may be valuable to policymakers and palliative care providers, as well as theorists interested in ongoing applications of time geography in knowledge translation and the consumption/production of care. PMID:24295098

  17. Implementation of an integrated primary care cardiometabolic risk prevention and management network in Montréal: does greater coordination of care with primary care physicians have an impact on health outcomes?

    PubMed

    Provost, Sylvie; Pineault, Raynald; Grimard, Dominique; Pérez, José; Fournier, Michel; Lévesque, Yves; Desforges, Johanne; Tousignant, Pierre; Borgès Da Silva, Roxane

    2017-04-01

    Chronic disease management requires substantial services integration. A cardiometabolic risk management program inspired by the Chronic Care Model was implemented in Montréal for patients with diabetes or hypertension. One of this study's objectives was to assess the impact of care coordination between the interdisciplinary teams and physicians on patient participation in the program, lifestyle improvements and disease control. We obtained data on health outcomes from a register of clinical data, questionnaires completed by patients upon entry into the program and at the 12-month mark, and we drew information on the program's characteristics from the implementation analysis. We conducted multiple regression analyses, controlling for patient sociodemographic and health characteristics, to measure the association between interdisciplinary team coordination with primary care physicians and various health outcomes. A total of 1689 patients took part in the study (60.1% participation rate). Approximately 40% of patients withdrew from the program during the first year. At the 12-month follow-up (n = 992), we observed a significant increase in the proportion of patients achieving the various clinical targets. The perception by the interdisciplinary team of greater care coordination with primary care physicians was associated with increased participation in the program and the achievement of better clinical results. Greater coordination of patient services between interdisciplinary teams and primary care physicians translates into benefits for patients.

  18. 78 FR 48233 - Medicare Program; FY 2014 Hospice Wage Index and Payment Rate Update; Hospice Quality Reporting...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-07

    ... Contents I. Executive Summary A. Purpose B. Summary of the Major Provisions C. Summary of Costs, Benefits, and Transfers II. Background A. Hospice Care B. History of the Medicare Hospice Benefit C. Services... IV.C.3. We also update the FY 2014 hospice wage index with more current wage data, and the BNAF will...

  19. Beyond the feminisation of poverty: gender-aware poverty reduction.

    PubMed

    Lockwood, M; Baden, S

    1995-09-01

    There must be an awareness of gender issues in poverty reduction programs. For example, program efforts that direct aid to the promotion of labor intensive employment options disregard women's already overburdened work regime. Public expenditures to benefit the poor, such as primary education or reformed agricultural extension, may be based on the assumption that men and women will benefit equally, yet there is often gender bias in the delivery of services. One recommendation is to target female headed households in budget-constrained anti-poverty programs. One of the few examples of such programs provides urban female household heads in Chile with employment training, housing, health care, child care, and legal aid services. Causes of female headship vary, and a simple correlation with poverty is not always the case. Well-intentioned women-in-development credit programs in Ghana and Bangladesh have been "hijacked" by men. Programs to address gender discrimination only among the poor may overlook other oppressed women. In India gender discrimination is often greatest among women in wealthy households. Programs must offer more than economic resources, they must help women stretch traditional gender boundaries and obtain skills such as literacy or financial management. They must help women organize collectively to protest injustices and achieve institutional reforms.

  20. A New Vision for Integrated Breast Care.

    DTIC Science & Technology

    1998-09-01

    Analysis tools to Mapping; and established counseling methods to Debriefing. We are now investigating how Neurolinguistic Programming to may help... programs and services for the benefit of the patient. Our Continuous Quality Improvement, Informatics and Education Cores are working together to help...streamline implementation of programs . This enables us to identify the quality improvements we hope to gain by changing a service and the quality

  1. Examining the Costs and Benefits of Family Rewards 2.0: A Conditional Cash Transfer Program in Two American Cities

    ERIC Educational Resources Information Center

    Rudd, Timothy; Rodriguez, Jonathan; Greenberg, David

    2016-01-01

    Family Rewards was an innovative approach to poverty reduction in the United States that was modelled on the conditional cash transfer (CCT) programs common in lower- and middle-income countries. The program offered cash assistance to poor families to reduce immediate hardship, provided they met certain criteria related to family health care,…

  2. Cost-effectiveness of a multicomponent primary care program targeting frail elderly people.

    PubMed

    Ruikes, Franca G H; Adang, Eddy M; Assendelft, Willem J J; Schers, Henk J; Koopmans, Raymond T C M; Zuidema, Sytse U

    2018-05-16

    Over the last 20 years, integrated care programs for frail elderly people aimed to prevent functional dependence and reduce hospitalization and institutionalization. However, results have been inconsistent and merely modest. To date, evidence on the cost-effectiveness of these programs is scarce. We evaluated the cost-effectiveness of the CareWell program, a multicomponent integrated care program for frail elderly people. Economic evaluation from a healthcare perspective embedded in a cluster controlled trial of 12 months in 12 general practices in (the region of) Nijmegen. Two hundred and four frail elderly from 6 general practices in the intervention group received care according to the CareWell program, consisting of multidisciplinary team meetings, proactive care planning, case management, and medication reviews; 165 frail elderly from 6 general practices in the control group received usual care. In cost-effectiveness analyses, we related costs to daily functioning (Katz-15 change score i.e. follow up score minus baseline score) and quality adjusted life years (EQ-5D-3 L). Adjusted mean costs directly related to the intervention were €456 per person. Adjusted mean total costs, i.e. intervention costs plus healthcare utilization costs, were €1583 (95% CI -4647 to 1481) higher in the intervention group than in the control group. Incremental Net Monetary Benefits did not show significant differences between groups, but on average tended to favour usual care. The CareWell primary program was not cost-effective after 12 months. From a cost-effectiveness perspective, widespread implementation of the program in its current form cannot be recommended. The study was registered in the ClinicalTrials.govProtocol Registration System: ( NCT01499797 ; December 26, 2011). Retrospectively registered.

  3. Meaningful use's benefits and burdens for US family physicians.

    PubMed

    Holman, G Talley; Waldren, Steven E; Beasley, John W; Cohen, Deborah J; Dardick, Lawrence D; Fox, Chester H; Marquard, Jenna; Mullins, Ryan; North, Charles Q; Rafalski, Matt; Rivera, A Joy; Wetterneck, Tosha B

    2018-06-01

    The federal meaningful use (MU) program was aimed at improving adoption and use of electronic health records, but practicing physicians have criticized it. This study was aimed at quantifying the benefits (ie, usefulness) and burdens (ie, workload) of the MU program for practicing family physicians. An interdisciplinary national panel of experts (physicians and engineers) identified the work associated with MU criteria during patient encounters. They conducted a national survey to assess each criterion's level of patient benefit and compliance burden. In 2015, 480 US family physicians responded to the survey. Their demographics were comparable to US norms. Eighteen of 31 MU criteria were perceived as useful for more than half of patient encounters, with 13 of those being useful for more than two-thirds. Thirteen criteria were useful for less than half of patient encounters. Four useful criteria were reported as having a high compliance burden. There was high variability in physicians' perceived benefits and burdens of MU criteria. MU Stage 1 criteria, which are more related to basic/routine care, were perceived as beneficial by most physicians. Stage 2 criteria, which are more related to complex and population care, were perceived as less beneficial and more burdensome to comply with. MU was discontinued, but the merit-based incentive payment system within the Medicare Access and CHIP Reauthorization Act of 2015 adopted its criteria. For many physicians, MU created a significant practice burden without clear benefits to patient care. This study suggests that policymakers should not assess MU in aggregate, but as individual criteria for open discussion.

  4. 5 CFR 890.1019 - Determining length of debarment based on ownership or control of a sanctioned entity.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Permissive Debarments § 890.1019...

  5. 5 CFR 890.1019 - Determining length of debarment based on ownership or control of a sanctioned entity.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Permissive Debarments § 890.1019...

  6. 5 CFR 890.1033 - Notice of suspension.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 890.1033 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care... suspension; and (6) The provider's rights to contest the suspension. ...

  7. 5 CFR 890.1033 - Notice of suspension.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 890.1033 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care... suspension; and (6) The provider's rights to contest the suspension. ...

  8. 5 CFR 890.1019 - Determining length of debarment based on ownership or control of a sanctioned entity.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Permissive Debarments § 890.1019...

  9. 5 CFR 890.1017 - Determining length of debarment based on revocation or suspension of a provider's professional...

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Permissive...

  10. 5 CFR 890.1019 - Determining length of debarment based on ownership or control of a sanctioned entity.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Permissive Debarments § 890.1019...

  11. Medicaid and Children's Health Insurance Programs: Eligibility Notices, Fair Hearing and Appeal Processes for Medicaid and Other Provisions Related to Eligibility and Enrollment for Medicaid and CHIP. Final rule.

    PubMed

    2016-11-30

    This final rule implements provisions of the Affordable Care Act that expand access to health coverage through improvements in Medicaid and coordination between Medicaid, CHIP, and Exchanges. This rule finalizes most of the remaining provisions from the "Medicaid, Children's Health Insurance Programs, and Exchanges: Essential Health Benefits in Alternative Benefit Plans, Eligibility Notices, Fair Hearing and Appeal Processes for Medicaid and Exchange Eligibility Appeals and Other Provisions Related to Eligibility and Enrollment for Exchanges, Medicaid and CHIP, and Medicaid Premiums and Cost Sharing; Proposed Rule" that we published in the January 22, 2013, Federal Register. This final rule continues our efforts to assist states in implementing Medicaid and CHIP eligibility, appeals, and enrollment changes required by the Affordable Care Act.

  12. Impact of the Affordable Care Act on stem cell transplantation.

    PubMed

    Farnia, Stephanie; Gedan, Alicia; Boo, Michael

    2014-03-01

    The Patient Protection and Affordable Care Act, signed into law in 2010, will have a wide-reaching impact on the health care system in the United States when it is fully implemented in 2014. Patients will see increased access to care coupled with new insurance coverage protections as well as a minimum set of benefits mandated in each state known as essential health benefits. Providers are likely to see new forms of payment reform, particularly in the Medicare program, and narrower commercial provider networks. In addition, the composition of the health insurance market will broaden with the introduction of health insurance exchanges and expanded Medicaid populations in many states. Furthermore, the Patient Protection and Affordable Care Act calls for quality initiatives such as comparative effectiveness research to increase effective, appropriate and high-value care. This paper will review the main provisions of the Patient Protection and Affordable Care Act with specific attention to their impact on the field of Stem Cell Transplantation.

  13. Historical evolution of medical quality assurance in the Department of Defense.

    PubMed

    Granger, Elder; Boyer, John; Weiss, Richard; Linton, Andrea; Williams, Thomas V

    2010-08-01

    The Department of Defense (DoD) Military Health System (MHS) embodies decades of health care practice that has evolved in scope and complexity to meet the demands for quality care to which its beneficiaries are entitled. War, Base Realignment and Closure (BRAC), and other dynamic forces require the ongoing review and revision of health care policy and practice in military hospitals as well as the expanded network of civilian providers who care for our nation's soldiers, sailors, airmen, and marines and their families. The result has been an incrementally constructed quality assurance (QA) program with emphasis on organizational structures, programs, and systems, and the use of robust data sources and standard measures to analyze and improve processes, manage disease, assess patient perceptions of care, and ensure that a uniform health care benefit and high quality health care is accessible to all MHS beneficiaries.

  14. Physician involvement in disease management as part of the CCM.

    PubMed

    Wallace, Paul J

    2005-01-01

    Phase I of the voluntary chronic care improvement (CCI-I) under traditional fee-for-service Medicare initiative seeks to extend the benefits of disease management to an elderly population with comorbid chronic medical conditions. Active, sustained involvement of treating physicians, a historical deficit of disease management programs, is a CCI-I program goal. During the last decade, Kaiser Permanente, an integrated health care delivery system with more than 60 years of experience in managing the care of individuals and populations, has applied the chronic care model (CCM) to develop care management strategies for populations of patients with chronic medical conditions. Physician leadership and involvement have been key to successfully incorporating these practices into care. The scope of physician involvement in leading, developing, and delivering chronic illness care management at Kaiser Permanente is described as a basis for identifying opportunities to involve practicing physicians in the CCI-I.

  15. Physician Involvement in Disease Management as Part of the CCM

    PubMed Central

    Wallace, Paul J.

    2005-01-01

    Phase I of the voluntary chronic care improvement (CCI-I) under traditional fee-for-service Medicare initiative seeks to extend the benefits of disease management to an elderly population with comorbid chronic medical conditions. Active, sustained involvement of treating physicians, a historical deficit of disease management programs, is a CCI-I program goal. During the last decade, Kaiser Permanente, an integrated health care delivery system with more than 60 years of experience in managing the care of individuals and populations, has applied the chronic care model (CCM) to develop care management strategies for populations of patients with chronic medical conditions. Physician leadership and involvement have been key to successfully incorporating these practices into care. The scope of physician involvement in leading, developing, and delivering chronic illness care management at Kaiser Permanente is described as a basis for identifying opportunities to involve practicing physicians in the CCI-I. PMID:17288075

  16. A cost-benefit analysis of the outpatient smoking cessation services in Taiwan from a societal viewpoint.

    PubMed

    Chen, Pei-Ching; Lee, Yue-Chune; Tsai, Shih-Tzu; Lai, Chih-Kuan

    2012-05-01

    This study applied a cost-benefit analysis from a societal viewpoint to evaluate the Outpatient Smoking Cessation Services (OSCS) program. The costs measured in this study include the cost to the health sector, non-health sectors, the patients and their family, as well as the loss of productivity as a result of smoking. The benefits measured the medical costs savings and the earnings due to the increased life expectancy of a person that has stopped smoking for 15 years. Data were obtained from the primary data of a telephone survey, the literatures and reports from the Outpatient Smoking Cessation Management Center and government. Sensitivity analyses were conducted to verify the robustness of the results. There were 169,761 cases that participated in the outpatient smoking cessation program in the years 2007 and 2008, of those cases, 8,282 successfully stopped smoking. The total cost of the OSCS program was 18 million USD. The total benefits of the program were 215 million USD with a 3% discount rate; the net benefit to society was 196 million USD. After conducting sensitivity analyses on the different abstinence, relapse, and discount rates, from a societal perspective, the benefits still far exceeded the costs, while from a health care perspective, there was only a net benefit when the respondent's abstinence rate was used. From a societal perspective, the OSCS program in Taiwan is cost-beneficial. This study provides partial support for the policy makers to increase the budget and expand the OSCS program.

  17. Using an ounce of prevention: does it reduce health care expenditures and reap pounds of profits? A study of the financial impact of wellness and health risk screening programs.

    PubMed

    Phillips, Janet F

    2009-01-01

    As we are all well aware, health care expenditures in the United States are out of control and growing at epic proportions. Since private industry shoulders a significant burden of paying these rising health care costs, the huge and ever increasing sum paid by these corporations continues to impact the US economy translating into higher prices of services and manufactured goods and reduced job opportunities when companies outsource jobs or locate manufacturing facilities to avoid paying health care benefits for workers. As a result, health care expenditures have become a centerpiece of an enormous public policy debate as Congress is currently working on several versions of a bill to completely revise health care from the ground up. This research project was accomplished to examine the effectiveness of one approach to control rising health care costs and contain corporate financial responsibility--the establishment of wellness and health risk screening programs to improve the health of employees. Total health care cost per insured individual was gathered through an online survey directly from health care benefit administrators. The survey also asked information about wellness and health risk screening programs and the related responses were used to determine if there were a relationship between health care costs and health prevention programs. While statistical analysis was hampered in the current study because of the small sample size, some valid conclusions were reached. The study was successful in identifying a benchmark of Average Total Health Care Cost per Individual from $5,100 to $5,800 for 2005 through 2007. This is especially interesting in light of the fact that an average of $7,026 was spent on health care per person in 2006 in the United States. The study was also able to contribute an estimate of the increase realized in these expenditures of 6 percent in 2007 over 2006, and 4 percent in 2006 over 2005, which were in fact similar to the national average. The final contribution of the study is to suggest an explanation for the costs which appear to be holding their own in terms of the national average. While this cannot be statistically verified, it does seem that the active participation of these companies in wellness programs could be a factor. Wellness programs were very popular in this sample of companies as 82 percent of the respondents answered "YES" when asked if the company funds their own employee wellness program. This is an impressive number of companies that have recognized wellness programs as a potential means to reduce employee health care costs. In regards to specific programs, at least 50 percent of respondents answered that they have smoking cessation, employee fitness, counseling, health risk screening, and bio-metric screening programs. The existence of health screening variables show an impressive 73 percent of respondents do practice some sort of health care screening, 50 percent offer biometric screening while 18 percent have onsite clinics and 23 percent run annual employee fairs.

  18. Development and validation of an online interactive, multimedia wound care algorithms program.

    PubMed

    Beitz, Janice M; van Rijswijk, Lia

    2012-01-01

    To provide education based on evidence-based and validated wound care algorithms we designed and implemented an interactive, Web-based learning program for teaching wound care. A mixed methods quantitative pilot study design with qualitative components was used to test and ascertain the ease of use, validity, and reliability of the online program. A convenience sample of 56 RN wound experts (formally educated, certified in wound care, or both) participated. The interactive, online program consists of a user introduction, interactive assessment of 15 acute and chronic wound photos, user feedback about the percentage correct, partially correct, or incorrect algorithm and dressing choices and a user survey. After giving consent, participants accessed the online program, provided answers to the demographic survey, and completed the assessment module and photographic test, along with a posttest survey. The construct validity of the online interactive program was strong. Eighty-five percent (85%) of algorithm and 87% of dressing choices were fully correct even though some programming design issues were identified. Online study results were consistently better than previously conducted comparable paper-pencil study results. Using a 5-point Likert-type scale, participants rated the program's value and ease of use as 3.88 (valuable to very valuable) and 3.97 (easy to very easy), respectively. Similarly the research process was described qualitatively as "enjoyable" and "exciting." This digital program was well received indicating its "perceived benefits" for nonexpert users, which may help reduce barriers to implementing safe, evidence-based care. Ongoing research using larger sample sizes may help refine the program or algorithms while identifying clinician educational needs. Initial design imperfections and programming problems identified also underscored the importance of testing all paper and Web-based programs designed to educate health care professionals or guide patient care.

  19. Transfer of financial risk and alternative financing solutions.

    PubMed

    Levitt, Jeffrey C

    2004-01-01

    The high cost of health care in the United States has created a number of alarming economic and social problems. It has contributed to a greater number of underinsured and uninsured individuals living in the United States, and forced people to either ration or not purchase the care they need. Accumulated medical debt is grossly disproportionate to the US median AGI, and accounted for at least 25 percent of all personal bankruptcies. For patients, a guaranteed loan program specifically for medical procedures and treatments with below market interest rates would help alleviate bankruptcies related to medical debt by lowering payments and extending the loan maturities. A guaranteed loan program would also improve the debt charge-off rate for medical providers that carry patient receivables and reduce the risk of their balance sheets. This might hold or reduce the rate at which health care inflation grows. The health care loan program could model the current student loan programs and produce significant economic and societal benefits.

  20. Health programs at risk in wake of '84 election.

    PubMed

    Iglehart, J K

    1985-01-01

    President Ronald Reagan's reelection suggests that government will continue to promote policies that favor marketplace allocation of medical care resources and that it will continue to cut social welfare programs, particularly health programs for the elderly and the poor. Unlike previous administrations, which focused on controlling private and public health care costs, President Reagan has targeted Medicare and Medicaid expenditures--a policy which has caused substantial cost shifting to underwrite hospitals' uncompensated and undercompensated care. Physician payment policies likely will receive the greatest attention in spending reduction efforts. Congress, as it showed in the president's first term, can cut spending sharply. Its task, however, has been complicated by the president's campaign declaration that defense spending and Social Security benefits were off-limits. Expected to lead health care debate on Capitol Hill are Sens. Albert Gore, Jr., D-TN, and Phil Gramm, R-TX, and Rep. James Jones, D-OK.

  1. Policies and procedures in the workplace: how health care organizations compare.

    PubMed

    Loo, R

    1993-01-01

    Many organizations are implementing programs and services to manage the human and economic costs of stress. A mail survey was conducted of 500 randomly selected Canadian organizations having at least 500 employees. The survey tapped four major areas: organizational policies and procedures for managing stress; programs and services offered; perceived benefits and constraints for the organization; and projected future directions in this area. Analyses of returns from 210 organizations-43 health and 167 non-health-revealed various findings. For example, over half of health care organizations have policies and procedures as opposed to less than half of non-health care organizations. Also, health care organizations place greater emphasis on smoking cessation, weight control programs and on stress management training. Although some Canadian organizations are addressing stress, much more could and should be done, especially by organizations that do not yet recognize the impact of stress on employees and their work performance.

  2. Pediatric resident perceptions of family-friendly benefits.

    PubMed

    Berkowitz, Carol D; Frintner, Mary Pat; Cull, William L

    2010-01-01

    The aim of this study was to examine the importance of family-friendly features in residency program selection, benefits offered to and used by residents, and importance of benefits in future job selection. A survey of a random, national sample of 1000 graduating pediatric residents in 2008 was mailed and e-mailed. Survey response rate for graduating resident respondents was 59%. Among the respondents, 76% were women. Thirty-seven percent of men and 32% of women were parents. Residents with children were more likely than residents without children to rate family-friendly characteristics as very important in their residency selection (P < .05). Many residents reported that their programs offered maternity leave (88%), paternity leave (59%), individual flexibility with schedule (63%), and lactation rooms (55%), but fewer reported on-site child care (24%), care for ill children (19%), and part-time residency positions (12%). Among residents reporting availability, 77% of women with children used maternity leave and lactation rooms. Few held part-time residency positions (2%), but many expressed interest (23% of women with children). The majority of residents with and without children reported that flexibility with schedule was important in their future job selection. Most women with children (71%) and many women without children (52%) considered part-time work to be very important in their job selection. Family-friendly benefits are important to residents, particularly those with children. The data provides a benchmark for the availability and use of family-friendly features at pediatric training programs. The data also shows that many residents are unaware if benefits are offered, which suggests a need to make available benefits more transparent to residents. Copyright 2010 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  3. A qualitative study of patient and provider perspectives on using web-based pain coping skills training to treat persistent cancer pain.

    PubMed

    Rini, Christine; Vu, Maihan B; Lerner, Hannah; Bloom, Catherine; Carda-Auten, Jessica; Wood, William A; Basch, Ethan M; Voorhees, Peter M; Reeder-Hayes, Katherine E; Keefe, Francis J

    2018-04-01

    Persistent pain is common and inadequately treated in cancer patients. Behavioral pain interventions are a recommended part of multimodal pain treatments, but they are underused in clinical care due to barriers such as a lack of the resources needed to deliver them in person and difficulties coordinating their use with clinical care. Pain coping skills training (PCST) is an evidence-based behavioral pain intervention traditionally delivered in person. Delivering this training via the web would increase access to it by addressing barriers that currently limit its use. We conducted a patient pilot study of an 8-week web-based PCST program to determine the acceptability of this approach to patients and the program features needed to meet their needs. Focus groups with healthcare providers identified strategies for coordinating the use of web-based PCST in clinical care. Participants included 7 adults with bone pain due to multiple myeloma or metastasized breast or prostate cancer and 12 healthcare providers (4 physicians and 8 advanced practice providers) who treat cancer-related bone pain. Patients completed web-based PCST at home and then took part in an in-depth qualitative interview. Providers attended focus groups led by a trained moderator. Qualitative analyses identified themes in the patient and provider data. Patients reported strongly favorable responses to web-based PCST and described emotional and physical benefits. They offered suggestions for adapting the approach to better fit their needs and to overcome barriers to completion. Focus groups indicated a need to familiarize healthcare providers with PCST and to address concerns about overburdening patients. Providers would recommend the program to patients they felt could benefit. They suggested applying a broad definition of cancer pain and having various types of providers help coordinate program its use with clinical care. Web-based PCST was acceptable to patients and providers. Our findings suggest that patients could benefit from this approach, especially if patient and provider barriers are addressed.

  4. The CLASS Act: is it dead or just sleeping?

    PubMed

    Wiener, Joshua M

    2012-01-01

    The Affordable Care Act (ACA) established a voluntary public insurance program for long-term care: the Community Living Assistance Services and Supports (CLASS) Act. In October 2011, the Obama Administration announced that the program would not be implemented because of the high risk of fiscal insolvency. Under the legislative design, adverse selection was a major risk and premiums would have been very high. This article discusses several CLASS Act design and implementation issues, including the design features that led to the decision not to implement the program: the voluntary enrollment, the weak work requirement, the lifetime and cash benefits, and the premium subsidy for low-income workers and students.

  5. Health care access and health care workforce for immigrant workers in the agriculture, forestry, and fisheries sector in the southeastern US.

    PubMed

    Frank, Arthur L; Liebman, Amy K; Ryder, Bobbi; Weir, Maria; Arcury, Thomas A

    2013-08-01

    The Agriculture, Forestry, and Fishery (AgFF) Sector workforce in the US is comprised primarily of Latino immigrants. Health care access for these workers is limited and increases health disparities. This article addresses health care access for immigrant workers in the AgFF Sector, and the workforce providing care to these workers. Immigrant workers bear a disproportionate burden of poverty and ill health and additionally face significant occupational hazards. AgFF laborers largely are uninsured, ineligible for benefits, and unable to afford health services. The new Affordable Care Act will likely not benefit such individuals. Community and Migrant Health Centers (C/MHCs) are the frontline of health care access for immigrant AgFF workers. C/MHCs offer discounted health services that are tailored to meet the special needs of their underserved clientele. C/MHCs struggle, however, with a shortage of primary care providers and staff prepared to treat occupational illness and injury among AgFF workers. A number of programs across the US aim to increase the number of primary care physicians and care givers trained in occupational health at C/MHCs. While such programs are beneficial, substantial action is needed at the national level to strengthen and expand the C/MHC system and to establish widely Medical Home models and Accountable Care Organizations. System-wide policy changes alone have the potential to reduce and eliminate the rampant health disparities experienced by the immigrant workers who sustain the vital Agricultural, Forestry, and Fishery sector in the US. Copyright © 2013 Wiley Periodicals, Inc.

  6. Enablers and barriers in delivery of a cancer exercise program: the Canadian experience

    PubMed Central

    Mina, D. Santa; Petrella, A.; Currie, K.L.; Bietola, K.; Alibhai, S.M.H.; Trachtenberg, J.; Ritvo, P.; Matthew, A.G.

    2015-01-01

    Background Exercise is an important therapy to improve well-being after a cancer diagnosis. Accordingly, cancer-exercise programs have been developed to enhance clinical care; however, few programs exist in Canada. Expansion of cancer-exercise programming depends on an understanding of the process of program implementation, as well as enablers and barriers to program success. Gaining knowledge from current professionals in cancer-exercise programs could serve to facilitate the necessary understanding. Methods Key personnel from Canadian cancer-exercise programs (n = 14) participated in semistructured interviews about program development and delivery. Results Content analysis revealed 13 categories and 15 subcategories, which were grouped by three organizing domains: Program Implementation, Program Enablers, and Program Barriers. ■ Program Implementation (5 categories, 8 subcategories) included Program Initiation (clinical care extension, research project expansion, program champion), Funding, Participant Intake (avenues of awareness, health and safety assessment), Active Programming (monitoring patient exercise progress, health care practitioner involvement, program composition), and Discharge and Follow-up Plan.■ Program Enablers (4 categories, 4 subcategories) included Patient Participation (personalized care, supportive network, personal control, awareness of benefits), Partnerships, Advocacy and Support, and Program Characteristics.■ Program Barriers (4 categories, 3 subcategories) included Lack of Funding, Lack of Physician Support, Deterrents to Participation (fear and shame, program location, competing interests), and Disease Progression and Treatment. Conclusions Interview results provided insight into the development and delivery of cancer-exercise programs in Canada and could be used to guide future program development and expansion in Canada. PMID:26715869

  7. Utilization and costs of home-based and community-based care within a social HMO: trends over an 18-year period

    PubMed Central

    Leutz, Walter; Nonnenkamp, Lucy; Dickinson, Lynn; Brody, Kathleen

    2005-01-01

    Abstract Purpose Our objective was to describe the utilization and costs of services from 1985 to 2002 of a Social Health Maintenance Organization (SHMO) demonstration project providing a benefit for home-based and community-based as well as short-term institutional (HCB) care at Kaiser Permanente Northwest (KPNW), serving the Portland, Oregon area. The HCB care benefit was offered by KPNW as a supplement to Medicare's acute care medical benefits, which KPNW provides in an HMO model. KPNW receives a monthly per capita payment from Medicare to provide medical benefits, and Medicare beneficiaries who choose to join pay a supplemental premium that covers prescription drugs, HCB care benefits, and other services. A HCB care benefit of up to $12,000 per year in services was available to SHMO members meeting requirement for nursing home certification (NHC). Methods We used aggregate data to track temporal changes in the period 1985 to 2002 on member eligibility, enrollment in HCB care plans, age, service utilization and co-payments. Trends in the overall costs and financing of the HCB care benefit were extracted from quarterly reports, management data, and finance data. Results During the time period, 14,815 members enrolled in the SHMO and membership averaged 4,531. The proportion of SHMO members aged 85 or older grew from 12 to 25%; proportion meeting requirements for NHC rose from 4 to 27%; and proportion with HCB care plans rose from 4 to 18%. Costs for the HCB care benefit rose from $21 per SHMO member per month in 1985 to $95 in 2002. The HCB care costs were equivalent to 12% to 16% of Medicare reimbursement. The HCB program costs were covered by member premiums (which rose from $49 to $180) and co-payments from members with care plans. Over the 18-year period, spending shifted from nursing homes to a range of community services, e.g. personal care, homemaking, member reimbursement, lifeline, equipment, transportation, shift care, home nursing, adult day care, respite care, and dentures. Rising costs per month per SHMO member reflected increasing HCB eligibility rather than costs per member with HCB care, which actually fell from $6,164 in 1989 to $4,328 in 2002. Care management accounted for about one-quarter of community care costs since 1992. Conclusions The Kaiser Permanente Northwest SHMO served an increasingly aged and disabled membership by reducing costs per HCB member care plan and shifting utilization to a broad range of community care services. Supported by a disability-based Medicare payment formula and by SHMO beneficiaries willing to pay increasing premiums, KPNW has been able to offer comprehensive community care. The model could be replicated by other HMOs with the support of favorable federal policies. PMID:16773166

  8. Communicating Value in Simulation: Cost-Benefit Analysis and Return on Investment.

    PubMed

    Asche, Carl V; Kim, Minchul; Brown, Alisha; Golden, Antoinette; Laack, Torrey A; Rosario, Javier; Strother, Christopher; Totten, Vicken Y; Okuda, Yasuharu

    2018-02-01

    Value-based health care requires a balancing of medical outcomes with economic value. Administrators need to understand both the clinical and the economic effects of potentially expensive simulation programs to rationalize the costs. Given the often-disparate priorities of clinical educators relative to health care administrators, justifying the value of simulation requires the use of economic analyses few physicians have been trained to conduct. Clinical educators need to be able to present thorough economic analyses demonstrating returns on investment and cost-effectiveness to effectively communicate with administrators. At the 2017 Academic Emergency Medicine Consensus Conference "Catalyzing System Change through Health Care Simulation: Systems, Competency, and Outcomes," our breakout session critically evaluated the cost-benefit and return on investment of simulation. In this paper we provide an overview of some of the economic tools that a clinician may use to present the value of simulation training to financial officers and other administrators in the economic terms they understand. We also define three themes as a call to action for research related to cost-benefit analysis in simulation as well as four specific research questions that will help guide educators and hospital leadership to make decisions on the value of simulation for their system or program. © 2017 by the Society for Academic Emergency Medicine.

  9. Principles of Child Health Care Financing.

    PubMed

    Hudak, Mark L; Helm, Mark E; White, Patience H

    2017-09-01

    After passage of the Patient Protection and Affordable Care Act, more children and young adults have become insured and have benefited from health care coverage than at any time since the creation of the Medicaid program in 1965. From 2009 to 2015, the uninsurance rate for children younger than 19 years fell from 9.7% to 5.3%, whereas the uninsurance rate for young adults 19 to 25 years of age declined from 31.7% to 14.5%. Nonetheless, much work remains to be done. The American Academy of Pediatrics (AAP) believes that the United States can and should ensure that all children, adolescents, and young adults from birth through the age of 26 years who reside within its borders have affordable access to high-quality and comprehensive health care, regardless of their or their families' incomes. Public and private health insurance should safeguard existing benefits for children and take further steps to cover the full array of essential health care services recommended by the AAP. Each family should be able to afford the premiums, deductibles, and other cost-sharing provisions of the plan. Health plans providing these benefits should ensure, insofar as possible, that families have a choice of professionals and facilities with expertise in the care of children within a reasonable distance of their residence. Traditional and innovative payment methodologies by public and private payers should be structured to guarantee the economic viability of the pediatric medical home and of other pediatric specialty and subspecialty practices to address developing shortages in the pediatric specialty and subspecialty workforce, to promote the use of health information technology, to improve population health and the experience of care, and to encourage the delivery of evidence-based and quality health care in the medical home, as well as in other outpatient, inpatient, and home settings. All current and future health care insurance plans should incorporate the principles for child health financing outlined in this statement. Espousing the core principle to do no harm, the AAP believes that the United States must not sacrifice any of the hard-won gains for our children. Medicaid, as the largest single payer of health care for children and young adults, should remain true to its origins as an entitlement program; in other words, future fiscal or regulatory reforms of Medicaid should not reduce the eligibility and scope of benefits for children and young adults below current levels nor jeopardize children's access to care. Proposed Medicaid funding "reforms" (eg, institution of block grant, capped allotment, or per-capita capitation payments to states) will achieve their goal of securing cost savings but will inevitably compel states to reduce enrollee eligibility, trim existing benefits (such as Early and Periodic Screening, Diagnostic, and Treatment), and/or compromise children's access to necessary and timely care through cuts in payments to providers and delivery systems. In fact, the AAP advocates for increased Medicaid funding to improve access to essential care for existing enrollees, fund care for eligible but uninsured children once they enroll, and accommodate enrollment growth that will occur in states that choose to expand Medicaid eligibility. The AAP also calls for Congress to extend funding for the Children's Health Insurance Program, a plan vital to the 8.9 million children it covered in fiscal year 2016, for a minimum of 5 years. Copyright © 2017 by the American Academy of Pediatrics.

  10. Child health: a legitimate business concern.

    PubMed

    Major, Debra A; Cardenas, Rebekah A; Allard, Carolyn B

    2004-10-01

    This article reviews evidence substantiating the relationship between child health and business outcomes and evaluates literature regarding organizational interventions that benefit child health and reduce associated costs. The review focuses on 4 family-friendly initiatives, including prenatal programs, lactation programs, sick child care, and flexible working arrangements, and considers 4 business outcomes, specifically health care costs, face time, productive time, and employer attractiveness. Limitations of previous research are discussed, and preventive and reactive models of the relationship between child health and business outcomes are developed as guides for future research.

  11. Defined contribution defined: health insurance for the next century.

    PubMed

    Marhula, D C; Shannon, E G

    2001-01-01

    The consumerism movement will dramatically affect the current payer model and present a new series of challenges for managed care organizations. Employers will fuel the changes, as they create health benefit programs that are modeled after retirement programs. In these cases, employers will shift a major portion of financial responsibility to employees, who will be asked to make buying decisions often previously determined by managed care organizations. New business entities known as health navigators will be formed to aid consumers. However, many structural and policy obstacles may slow or transform the consumerism movement.

  12. eHealth in integrated care programs for people with multimorbidity in Europe: Insights from the ICARE4EU project.

    PubMed

    Melchiorre, Maria Gabriella; Papa, Roberta; Rijken, Mieke; van Ginneken, Ewout; Hujala, Anneli; Barbabella, Francesco

    2018-01-01

    Care for people with multimorbidity requires an integrated approach in order to adequately meet their complex needs. In this respect eHealth could be of help. This paper aims to describe the implementation, as well as benefits and barriers of eHealth applications in integrated care programs targeting people with multimorbidity in European countries, including insights on older people 65+. Within the framework of the ICARE4EU project, in 2014, expert organizations in 24 European countries identified 101 integrated care programs based on selected inclusion criteria. Managers of these programs completed a related on-line questionnaire addressing various aspects including the use of eHealth. In this paper we analyze data from this questionnaire, in addition to qualitative information from six programs which were selected as 'high potential' for their innovative approach and studied in depth through site visits. Out of 101 programs, 85 adopted eHealth applications, of which 42 focused explicitly on older people. In most cases Electronic Health Records (EHRs), registration databases with patients' data and tools for communication between care providers were implemented. Percentages were slightly higher for programs addressing older people. eHealth improves care integration and management processes. Inadequate funding mechanisms, interoperability and technical support represent major barriers. Findings seems to suggest that eHealth could support integrated care for (older) people with multimorbidity. Copyright © 2017. Published by Elsevier B.V.

  13. A comparative assessment of major international disasters: the need for exposure assessment, systematic emergency preparedness, and lifetime health care.

    PubMed

    Lucchini, Roberto G; Hashim, Dana; Acquilla, Sushma; Basanets, Angela; Bertazzi, Pier Alberto; Bushmanov, Andrey; Crane, Michael; Harrison, Denise J; Holden, William; Landrigan, Philip J; Luft, Benjamin J; Mocarelli, Paolo; Mazitova, Nailya; Melius, James; Moline, Jacqueline M; Mori, Koji; Prezant, David; Reibman, Joan; Reissman, Dori B; Stazharau, Alexander; Takahashi, Ken; Udasin, Iris G; Todd, Andrew C

    2017-01-07

    The disasters at Seveso, Three Mile Island, Bhopal, Chernobyl, the World Trade Center (WTC) and Fukushima had historic health and economic sequelae for large populations of workers, responders and community members. Comparative data from these events were collected to derive indications for future preparedness. Information from the primary sources and a literature review addressed: i) exposure assessment; ii) exposed populations; iii) health surveillance; iv) follow-up and research outputs; v) observed physical and mental health effects; vi) treatment and benefits; and vii) outreach activities. Exposure assessment was conducted in Seveso, Chernobyl and Fukushima, although none benefited from a timely or systematic strategy, yielding immediate and sequential measurements after the disaster. Identification of exposed subjects was overall underestimated. Health surveillance, treatment and follow-up research were implemented in Seveso, Chernobyl, Fukushima, and at the WTC, mostly focusing on the workers and responders, and to a lesser extent on residents. Exposure-related physical and mental health consequences were identified, indicating the need for a long-term health care of the affected populations. Fukushima has generated the largest scientific output so far, followed by the WTCHP and Chernobyl. Benefits programs and active outreach figured prominently in only the WTC Health Program. The analysis of these programs yielded the following lessons: 1) Know who was there; 2) Have public health input to the disaster response; 3) Collect health and needs data rapidly; 4) Take care of the affected; 5) Emergency preparedness; 6) Data driven, needs assessment, advocacy. Given the long-lasting health consequences of natural and man-made disasters, health surveillance and treatment programs are critical for management of health conditions, and emergency preparedness plans are needed to prevent or minimize the impact of future threats.

  14. Family practice residencies in community health centers--an approach to cost and access concerns.

    PubMed Central

    Zweifler, J

    1995-01-01

    An inadequate number of trained primary care clinicians limits access to care at Community Health Centers. If family practice residents working in these centers can provide care to patients at a cost that is comparable to the center's hiring its own physicians, then expansion of Family Practice Residency Programs into community centers can address both cost and access concerns. A cost-benefit analysis of the Family Practice Residency Program at the Fresno, CA, community center was performed; the community center is affiliated with the University of California at San Francisco. Costs included (a) residents' salaries, (b) supervision of the family practice residents, (c) family practice program costs for educational activities apart from supervision at the community center, and (d) administrative costs attributable to family practice residents in the community center. Benefits were based on the number of patients that residents saw in the community center. Using this approach, a cost of $7,700 per resident per year was calculated. This cost is modest compared with the cost of training residents in inpatient settings. The added costs attributable to training residents in community health centers can be shared with agencies that are concerned with medical education, providing physicians to underserved communities, and increasing the supply of primary care physicians. Redirecting graduate medical education funding from hospitals to selected ambulatory care training centers of excellence would facilitate placing residents in community centers. This change would have the dual advantage of addressing the current imbalance between training in ambulatory care and hospital sites and increasing the capacity of community health centers to meet the health care needs of underserved populations. PMID:7610223

  15. 5 CFR 890.1018 - Determining length of debarment for an entity owned or controlled by a sanctioned provider.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Permissive Debarments § 890...

  16. 5 CFR 890.1018 - Determining length of debarment for an entity owned or controlled by a sanctioned provider.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Permissive Debarments § 890...

  17. A Mating of Tarantulas

    ERIC Educational Resources Information Center

    Lewis, Robert L.

    1978-01-01

    The role of the trustee in interinstitutional cooperation is discussed. Benefits include: plant facilities sharing, joint credit unions, library exchange, joint health care facilities, joint counseling, joint apprenticeship programs, cross registration, faculty exchange joint appointments, etc. (Author/LBH)

  18. 5 CFR 890.1018 - Determining length of debarment for an entity owned or controlled by a sanctioned provider.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Permissive Debarments § 890...

  19. 1995 Federal Highway Administration Research And Technology Program Highlights

    DOT National Transportation Integrated Search

    2001-08-01

    When carefully planned and properly applied, data integration can bring substantial benefits to any transportation agency. This primer provides information to assist agencies in undertaking a data integration initiative that will support their busine...

  20. 5 CFR 890.1018 - Determining length of debarment for an entity owned or controlled by a sanctioned provider.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Permissive Debarments § 890...

  1. Medication therapy management and condition care services in a community-based employer setting.

    PubMed

    Johannigman, Mark J; Leifheit, Michael; Bellman, Nick; Pierce, Tracey; Marriott, Angela; Bishop, Cheryl

    2010-08-15

    A program in which health-system pharmacists and pharmacy technicians provide medication therapy management (MTM), wellness, and condition care (disease management) services under contract with local businesses is described. The health-system pharmacy department's Center for Medication Management contracts directly with company benefits departments for defined services to participating employees. The services include an initial wellness and MTM session and, for certain patients identified during the initial session, ongoing condition care. The initial appointment includes a medication history, point-of-care testing for serum lipids and glucose, body composition analysis, and completion of a health risk assessment. The pharmacist conducts a structured MTM session, reviews the patient's test results and risk factors, provides health education, discusses opportunities for cost savings, and documents all activities on the patient's medication action plan. Eligibility for the condition care program is based on a diagnosis of diabetes, hypertension, asthma, heart failure, or hyperlipidemia or elevation of lipid or glucose levels. Findings are summarized for employers after the initial wellness screening and at six-month intervals. Patients receiving condition care sign a customized contract, establish goals, attend up to four MTM sessions per year, and track their information on a website; employers may offer incentives for participation. When pharmacists recommend adjustments to therapy or cost-saving changes, it is up to patients to discuss these with their physician. A survey completed by each patient after the initial wellness session has indicated high satisfaction. Direct cost savings related to medication changes have averaged $253 per patient per year. Total cost savings to companies in the first year of the program averaged $1011 per patient. For the health system, the program has been financially sustainable. Key laboratory values indicate positive clinical outcomes. A business model in which health-system pharmacists provide MTM and condition care services for company employees has demonstrated successful outcomes in terms of patient satisfaction, cost savings, and clinical benefits.

  2. Evaluation of a patient navigation program.

    PubMed

    Koh, Catherine; Nelson, Joan M; Cook, Paul F

    2011-02-01

    This study examined the value and effectiveness of a patient navigation program in terms of timeliness of access to cancer care, resolution of barriers, and satisfaction in 55 patients over a six-month period. Although not statistically significant, the time interval between diagnostic biopsy to first consultation with a cancer specialist after program implementation was reduced from an average of 14.6 days to 12.8 days. The time interval between diagnostic biopsy to initiation of cancer treatment also was reduced from 30 days to 26.2 days (not statistically significant). In addition, 71% of patient barriers were resolved by the time treatment was initiated. Overall, patients were highly satisfied with their navigated care experience. Consistent evaluation and monitoring of quality-of-care indicators are critical to further develop the program and to direct resource allocation. Oncology nurses participating in patient navigation programs should be encouraged to evaluate their importance and impact in this developing concept. Nurses should seek roles that allow them to optimize the effective use of their specialized knowledge and skills to the benefit of patients along the cancer care continuum.

  3. Defining and evaluating quality for ambulatory care educational programs.

    PubMed

    Bowen, J L; Stearns, J A; Dohner, C; Blackman, J; Simpson, D

    1997-06-01

    As the training of medical students and residents increasingly moves to ambulatory care settings, clerkship and program directors must find a way to use their limited resources to guide the development and evaluation of the quality of these ambulatory-based learning experiences. To evaluate quality, directors must first define, in operational and measurable terms, what is meant by the term "quality" as it is applied to ambulatory-based education. Using educational theories and the definition of quality used by health care systems, the authors propose an operational definition of quality for guiding the planning, implementation, and evaluation of ambulatory care educational programs. They assert that quality is achieved through the interaction of an optimal learning environment, defined educational goals and positive outcomes, participant satisfaction, and cost-effectiveness. By describing the components of quality along with examples of measurable indicators, the authors provide a foundation for the evaluation and improvement of instructional innovations in ambulatory care education for the benefit of teachers, learners, and patients.

  4. Portfolio theory and cost-effectiveness analysis: a further discussion.

    PubMed

    Sendi, Pedram; Al, Maiwenn J; Rutten, Frans F H

    2004-01-01

    Portfolio theory has been suggested as a means to improve the risk-return characteristics of investments in health-care programs through diversification when costs and effects are uncertain. This approach is based on the assumption that the investment proportions are not subject to uncertainty and that the budget can be invested in toto in health-care programs. In the present paper we develop an algorithm that accounts for the fact that investment proportions in health-care programs may be uncertain (due to the uncertainty associated with costs) and limited (due to the size of the programs). The initial budget allocation across programs may therefore be revised at the end of the investment period to cover the extra costs of some programs with the leftover budget of other programs in the portfolio. Once the total budget is equivalent to or exceeds the expected costs of the programs in the portfolio, the initial budget allocation policy does not impact the risk-return characteristics of the combined portfolio, i.e., there is no benefit from diversification anymore. The applicability of portfolio methods to improve the risk-return characteristics of investments in health care is limited to situations where the available budget is much smaller than the expected costs of the programs to be funded.

  5. QRIS and Inclusion: Do State QRIS Standards Support the Learning Needs of All Children? CEELO FastFact

    ERIC Educational Resources Information Center

    Horowitz, Michelle; Squires, Jim

    2014-01-01

    As the country quickly builds its efforts to enhance quality in early education and care classrooms, states are implementing Quality Rating and Improvement Systems (QRIS) to recognize and improve the quality of programs. QRIS also provides technical support and increased financial benefits for participating programs to attain higher levels of…

  6. Benefits a Community College Can Realize by Providing Older Adult Programs: A Trustee's Viewpoint.

    ERIC Educational Resources Information Center

    Hartstein, Ray

    Board members of community colleges need to carefully consider and actively support feasible programs for older people with a firm commitment to fiscal and programmatic decisions assuring lifelong learning opportunities and public service activities. Trustees must be aware of and understand problems and issues of older adults, secure data for…

  7. 38 CFR 3.361 - Benefits under 38 U.S.C. 1151(a) for additional disability or death due to hospital care, medical...

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... surgical treatment, examination, training and rehabilitation services, or compensated work therapy (CWT... rehabilitation services or CWT program cannot cause the continuance or natural progress of a disease or injury... CWT program proximately caused a veteran's additional disability or death, it must be shown that the...

  8. 38 CFR 3.361 - Benefits under 38 U.S.C. 1151(a) for additional disability or death due to hospital care, medical...

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... surgical treatment, examination, training and rehabilitation services, or compensated work therapy (CWT... rehabilitation services or CWT program cannot cause the continuance or natural progress of a disease or injury... CWT program proximately caused a veteran's additional disability or death, it must be shown that the...

  9. 38 CFR 3.361 - Benefits under 38 U.S.C. 1151(a) for additional disability or death due to hospital care, medical...

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... surgical treatment, examination, training and rehabilitation services, or compensated work therapy (CWT... rehabilitation services or CWT program cannot cause the continuance or natural progress of a disease or injury... CWT program proximately caused a veteran's additional disability or death, it must be shown that the...

  10. 38 CFR 3.361 - Benefits under 38 U.S.C. 1151(a) for additional disability or death due to hospital care, medical...

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... surgical treatment, examination, training and rehabilitation services, or compensated work therapy (CWT... rehabilitation services or CWT program cannot cause the continuance or natural progress of a disease or injury... CWT program proximately caused a veteran's additional disability or death, it must be shown that the...

  11. Love, Money, or Flexibility: What Motivates People to Work in Consumer-Directed Home Care?

    ERIC Educational Resources Information Center

    Howes, Candace

    2008-01-01

    Purpose: The purpose of this study was to investigate the impact of wages and benefits (relative to other jobs available to workers), controlling for personal characteristics, on the recruitment and retention of providers working in a consumer-directed home care program. Design and Methods: I used the results of focus groups to design a survey…

  12. Effect of music therapy on oncologic staff bystanders: a substantive grounded theory.

    PubMed

    O'Callaghan, Clare; Magill, Lucanne

    2009-06-01

    Oncologic work can be satisfying but also stressful, as staff support patients and families through harsh treatment effects, uncertain illness trajectories, and occasional death. Although formal support programs are available, no research on the effects of staff witnessing patients' supportive therapies exists. This research examines staff responses to witnessing patient-focused music therapy (MT) programs in two comprehensive cancer centers. In Study 1, staff were invited to anonymously complete an open-ended questionnaire asking about the relevance of a music therapy program for patients and visitors (what it does; whether it helps). In Study 2, staff were theoretically sampled and interviewed regarding the personal effects of witnessing patient-centered music therapy. Data from each study were comparatively analyzed according to grounded theory procedures. Positive and negative cases were evident and data saturation arguably achieved. In Study 1, 38 staff unexpectedly described personally helpful emotional, cognitive, and team effects and consequent improved patient care. In Study 2, 62 staff described 197 multiple personal benefits and elicited patient care improvements. Respondents were mostly nursing (57) and medical (13) staff. Only three intrusive effects were reported: audibility, initial suspicion, and relaxation causing slowing of work pace. A substantive grounded theory emerged applicable to the two cancer centers: Staff witnessing MT can experience personally helpful emotions, moods, self-awarenesses, and teamwork and thus perceive improved patient care. Intrusive effects are uncommon. Music therapy's benefits for staff are attributed to the presence of live music, the human presence of the music therapist, and the observed positive effects in patients and families. Patient-centered oncologic music therapy in two cancer centers is an incidental supportive care modality for staff, which can reduce their stress and improve work environments and perceived patient care. Further investigation of the incidental benefits for oncologic staff witnessing patient-centered MT, through interpretive and positivist measures, is warranted.

  13. The influence of maternal health literacy and child’s age on participation in social welfare programs

    PubMed Central

    Pati, Susmita; Siewert, Elizabeth; Wong, Angie T.; Bhatt, Suraj K.; Calixte, Rose E.; Cnaan, Avital

    2013-01-01

    Objective To determine the influence of maternal health literacy and child’s age on participation in social welfare programs benefiting children. Methods In a longitudinal prospective cohort study of 560 Medicaid-eligible mother-infant dyads recruited in Philadelphia, maternal health literacy was assessed using the Test of Functional Health Literacy in Adults (short version). Participation in social welfare programs (Temporary Assistance to Needy Families [TANF], Supplemental Nutrition Assistance Program [SNAP], Special Supplemental Nutrition Program for Women, Infants, and Children [WIC], child care subsidy, and public housing) was self-reported at child’s birth, and at the 6, 12, 18, 24 month follow-up interviews. Generalized estimating equations quantified the strength of maternal health literacy as an estimator of program participation. Results The mothers were primarily African-Americans (83%), single (87%), with multiple children (62%). Nearly 24% of the mothers had inadequate or marginal health literacy. Children whose mothers had inadequate health literacy were less likely to receive child care subsidy (adjusted OR= 0.54, 95% CI: 0.34–0.85) than children whose mothers had adequate health literacy. Health literacy was not a significant predictor for TANF, SNAP, WIC or housing assistance. The predicted probability for participation in all programs decreased from birth to 24 months. Most notably, predicted WIC participation declined rapidly after age one. Conclusions During the first 24 months, mothers with inadequate health literacy could benefit from simplified or facilitated child care subsidy application processes. Targeted outreach and enrollment efforts conducted by social welfare programs need to take into account the changing needs of families as children age. PMID:23990157

  14. Building a patient-centered and interprofessional training program with patients, students and care professionals: study protocol of a participatory design and evaluation study.

    PubMed

    Vijn, Thomas W; Wollersheim, Hub; Faber, Marjan J; Fluit, Cornelia R M G; Kremer, Jan A M

    2018-05-30

    A common approach to enhance patient-centered care is training care professionals. Additional training of patients has been shown to significantly improve patient-centeredness of care. In this participatory design and evaluation study, patient education and medical education will be combined by co-creating a patient-centered and interprofessional training program, wherein patients, students and care professionals learn together to improve patient-centeredness of care. In the design phase, scientific literature regarding interventions and effects of student-run patient education will be synthesized in a scoping review. In addition, focus group studies will be performed on the preferences of patients, students, care professionals and education professionals regarding the structure and content of the training program. Subsequently, an intervention plan of the training program will be constructed by combining these building blocks. In the evaluation phase, patients with a chronic disease, that is rheumatoid arthritis, diabetes and hypertension, and patients with an oncologic condition, that is colonic cancer and breast cancer, will learn together with medical students, nursing students and care professionals in training program cycles of three months. Process and effect evaluation will be performed using the plan-do-study-act (PDSA) method to evaluate and optimize the training program in care practice and medical education. A modified control design will be used in PDSA-cycles to ensure that students who act as control will also benefit from participating in the program. Our participatory design and evaluation study provides an innovative approach in designing and evaluating an intervention by involving participants in all stages of the design and evaluation process. The approach is expected to enhance the effectiveness of the training program by assessing and meeting participants' needs and preferences. Moreover, by using fast PDSA cycles and a modified control design in evaluating the training program, the training program is expected to be efficiently and rapidly implemented into and adjusted to care practice and medical education.

  15. Veterans Affairs Geriatric Scholars Program: Enhancing Existing Primary Care Clinician Skills in Caring for Older Veterans.

    PubMed

    Kramer, B Josea; Creekmur, Beth; Howe, Judith L; Trudeau, Scott; Douglas, Joseph R; Garner, Kimberly; Bales, Connie; Callaway-Lane, Carol; Barczi, Steven

    2016-11-01

    The Veterans Affairs Geriatric Scholars Program (GSP) is a continuing professional development program to integrate geriatrics into the clinical practices of primary care providers and select associated health professions that support primary care teams. GSP uses a blended program educational format, and the minimal requirements are to attend an intensive course in geriatrics, participate in an interactive workshop on quality improvement (QI), and initiate a local QI project to demonstrate application of new knowledge to benefit older veterans. Using a retrospective post/pre survey design, the effect of GSP on clinical practices and behaviors and variation of that effect on clinicians working in rural and nonrural settings were evaluated. Significant improvement was found in the frequency of using evidence-based brief standardized assessments, clinical decision-making, and standards of care. Significant subgroup differences were observed in peer-to-peer information sharing between rural and nonrural clinicians. Overall, 77% of the sample reported greater job satisfaction after participating in GSP. The program is a successful model for advancing postgraduate education in geriatrics and a model that might be replicated to increase access to quality health care, particularly in rural areas. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.

  16. Clinical Informatics Fellowship Programs: In Search of a Viable Financial Model: An open letter to the Centers for Medicare and Medicaid Services.

    PubMed

    Lehmann, C U; Longhurst, C A; Hersh, W; Mohan, V; Levy, B P; Embi, P J; Finnell, J T; Turner, A M; Martin, R; Williamson, J; Munger, B

    2015-01-01

    In the US, the new subspecialty of Clinical Informatics focuses on systems-level improvements in care delivery through the use of health information technology (HIT), data analytics, clinical decision support, data visualization and related tools. Clinical informatics is one of the first subspecialties in medicine open to physicians trained in any primary specialty. Clinical Informatics benefits patients and payers such as Medicare and Medicaid through its potential to reduce errors, increase safety, reduce costs, and improve care coordination and efficiency. Even though Clinical Informatics benefits patients and payers, because GME funding from the Centers for Medicare and Medicaid Services (CMS) has not grown at the same rate as training programs, the majority of the cost of training new Clinical Informaticians is currently paid by academic health science centers, which is unsustainable. To maintain the value of HIT investments by the government and health care organizations, we must train sufficient leaders in Clinical Informatics. In the best interest of patients, payers, and the US society, it is therefore critical to find viable financial models for Clinical Informatics fellowship programs. To support the development of adequate training programs in Clinical Informatics, we request that the Centers for Medicare and Medicaid Services (CMS) issue clarifying guidance that would allow accredited ACGME institutions to bill for clinical services delivered by fellows at the fellowship program site within their primary specialty.

  17. Strategic Planning for Recruitment and Retention of Older African Americans in Health Promotion Research Programs.

    PubMed

    Dreer, Laura E; Weston, June; Owsley, Cynthia

    2014-01-01

    The purpose of this study was to 1) describe a strategic plan for recruitment and retention used in conducting eye health education research with African-Americans living in urban and rural areas of Alabama and 2) characterize recruitment and retention patterns for this community-based project. We evaluated an eye health education program tailored specifically to older African Americans. InCHARGE© was designed to promote eye disease prevention by conveying the personal benefits of annual, dilated, comprehensive eye care and teaching strategies to minimize barriers to regular eye care. The InCHARGE© program or a social contact control program was delivered at 20 senior centers in predominately African American urban and rural communities. From pooled data across three studies, 380 African Americans completed a questionnaire about knowledge and attitudes/beliefs about eye disease and eye care before the program and by telephone at either 3 or 6 months after the presentation. The project consisted of 4 phases and a total of 10 strategic objectives for recruitment as well as retention of older African Americans that were implemented in a systematic fashion. Overall, retention rates for follow-up at either 3 or 6 months were 75% and 66% respectively. African Americans from rural areas were more likely to be lost to follow-up compared to those from urban areas. We discuss the benefits of utilizing a strategic plan that serves to address problems with underrepresentation of minorities in clinical research.

  18. Patterns of Service Use in Two Types of Managed Behavioral Health Care Plan

    PubMed Central

    Merrick, Elizabeth Levy; Hodgkin, Dominic; Hiatt, Deirdre; Horgan, Constance M.; Azzone, Vanessa; McCann, Bernard; Ritter, Grant; Zolotusky, Galina; McGuire, Thomas G.; Reif, Sharon

    2009-01-01

    Objective To describe service use patterns by level of care in two managed care products: employee assistance program (EAP) combined with behavioral health benefits, and standard behavioral health benefits. Methods This is a cross-sectional analysis of administrative data for 2004 from a national managed behavioral health care organization (MBHO). Utilization of 11 specific service categories was compared across products. The weighted sample reflected exact matching on sociodemographics (N= 710,014 unweighted; 286,750 weighted). Results In the EAP/behavioral health product,, the proportion of enrollees with outpatient mental health and substance abuse office visits (including EAP) was higher (p<.01), as was substance abuse day treatment/intensive outpatient care (p<.05). Use of residential substance abuse rehabilitation was lower (p<.05). Other differences were also found. Conclusion EAP/behavioral health and standard behavioral health care products had distinct utilization patterns in this large MBHO. In particular, greater use of certain outpatient services was observed within the EAP/behavioral health product. PMID:20044425

  19. The business concept of leader pricing as applied to heart failure disease management.

    PubMed

    Hauptman, Paul J; Bednarek, Heather L

    2004-01-01

    The implementation of a disease management approach for patients with heart failure has been promoted as a way to improve outcomes, including a decrease in hospitalizations. However, in the absence of rigorous cost analyses and with revenues limited by professional fees, heart failure disease management programs may appear to operate at a loss. The literature outlining the importance of disease management for patients with heart failure is summarized. We review the limitations of current cost analyses and outline the economic concepts of leader pricing, vertical integration and transaction costs to argue that heart failure disease management programs may provide significant "downstream" revenue for an integrated system of health care delivery in a fee-for-service payment structure, while reducing overall costs of care. Pilot data from a university-based program are used in support of this argument. In addition, the favorable impact on patient satisfaction and loyalty can enhance market share, a vital consideration for all health systems. Options for improving the reputation of heart failure disease management within a health system are suggested. Viewed as a loss leader, disease management provides not only quality care for patients with heart failure but also appears to provide financial benefits to the health system that funds the infrastructure and administration of the program. The actual magnitude of this benefit and the degree to which it mitigates overall administration costs requires further study.

  20. A marketing plan for health care in the financial district of San Francisco.

    PubMed

    Evans, S

    1987-01-01

    The development of a corporate health marketing program for the Medical Pavilion was based on three assumptions. 1. Medical Pavilion will contribute positively to health care cost containment for employers by providing convenient, quality medical care which will help to reduce employee time lost from work due to physician visits, and through health screening, early diagnosis, and out-patient procedures, decrease unnecessary hospitalization. 2. The level of awareness among chief executive officers, benefits directors, corporate medical directors, and employees will be positively related to utilization of health services at the Medical Pavilion. 3. The Medical Pavilion will be organized on a private practice model; although special programs related to employer coverage and specific benefits may be considered separately. The recommended goals of the corporate health program of the Medical Pavilion were as follows: 1. To develop demographic profiles based on current utilization of medical services in a random sample to corporations in the Financial District. 2. To design a survey of corporate leadership to determine a needs assessment strategy for the development of preventive health services programs to be offered at the Medical Pavilion. 3. To select an advertising and public relations agency; and determine the marketing bridges, for the first year and the following five year period. 4. To evaluate effectiveness of the corporate health marketing plan referral data collected through the Management Information System to be established at the Medical Pavilion.

  1. Mobile Integrated Health Care and Community Paramedicine: An Emerging Emergency Medical Services Concept.

    PubMed

    Choi, Bryan Y; Blumberg, Charles; Williams, Kenneth

    2016-03-01

    Mobile integrated health care and community paramedicine are models of health care delivery that use emergency medical services (EMS) personnel to fill gaps in local health care infrastructure. Community paramedics may perform in an expanded role and require additional training in the management of chronic disease, communication skills, and cultural sensitivity, whereas other models use all levels of EMS personnel without additional training. Currently, there are few studies of the efficacy, safety, and cost-effectiveness of mobile integrated health care and community paramedicine programs. Observations from existing program data suggest that these systems may prevent congestive heart failure readmissions, reduce EMS frequent-user transports, and reduce emergency department visits. Additional studies are needed to support the clinical and economic benefit of mobile integrated health care and community paramedicine. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  2. The accountability of nonprofit hospitals: lessons from Maryland's community benefit reporting requirements.

    PubMed

    Gray, Bradford H; Schlesinger, Mark

    2009-01-01

    Under Internal Revenue Service requirements, nonprofit hospitals will begin filing new community benefit reports in 2010. Maryland has had similar requirements since 2004. This paper, based on interviews at 20 hospitals, describes how Maryland's requirements affected hospitals and their activities. Increases in reported community benefit expenditures since the program began are due to both changes in activities and better data capture. Charity care accounts for one-third of community benefit dollars. A key distinction concerns whether hospitals take an accounting or managerial approach to community benefit. The Maryland experience suggests the issues that will arise when the national requirements are implemented.

  3. Getting to Family-Friendly in Your Department

    NASA Astrophysics Data System (ADS)

    Pilachowski, Catherine A.

    2012-01-01

    These days, most academic and research institutions recognize the importance of a family-friendly workplace, and have implemented at least some policies to support a sustainable work-life balance: family and medical leave, parental leave, stopping or extending tenure clocks, modified duty policies, breast feeding policies and lactation rooms, partner hiring programs, childcare programs, eldercare programs, emergency and sick child care programs, dependent care travel funds, etc. But while institutions may offer a menu of policies and free or low-cost services to support families, what's happening in your department? Achieving a supportive workplace culture requires that we dispel some of the myths associated with family-friendly policies, and establish that family-friendly policies not only benefit all employees, but also help the institution be more successful.

  4. Using the cost distribution report in estimating private sector payments: what adjustments should researchers make?

    PubMed

    Nugent, Gary; Grippen, Glen; Parris, Y C; Mitchell, Mary

    2003-06-01

    To reapportion Veterans Health Administration (VA) annual expenditures into benefit categories for comparison with estimated payments by private sector providers. Total expenditures for six VA medical centers for federal fiscal year 1999 were reapportioned by benefit category using the cost distribution report (CDR). Health benefit categories were based on those of health care insurers. Cost reapportionment was based on CDR data and reviews of source accounting and payroll documents. Actual expenditures for many benefits can be accurately identified and reapportioned using CDR data, but other expenditures were not identifiable in the CDR and required inspection of source documents. Inpatient expenditures amounting to $75,110,094 US dollars and outpatient expenditures amounting to $73,594,284 US dollars were reapportioned into other benefit categories, primarily professional fees. Expenditures for some VA benefits could not be identified because of differences in accounting and clinical practice between the VA and the community. Revisions to bring the CDR more in line with private sector payment categories would improve effectiveness for internal VA analyses and external expenditure comparisons. CDR revisions would require changes in recording some clinical workload (eg, rehabilitation and extended care) and classifying residential and domiciliary programs separate from inpatient care. Benefits that were not assigned expenditures for comparison with payments represent a potential liability if the VA were to purchase health care services in the marketplace. Variation among hospitals on expenditures not clearly identified in the CDR was significant and raises questions about the effectiveness of capitated budget methodologies using either the CDR or the decision support system.

  5. 5 CFR 890.1022 - Contesting proposed permissive debarments.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    .... 890.1022 Section 890.1022 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Permissive Debarments § 890.1022 Contesting proposed permissive debarments...

  6. 5 CFR 890.1022 - Contesting proposed permissive debarments.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    .... 890.1022 Section 890.1022 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Permissive Debarments § 890.1022 Contesting proposed permissive debarments...

  7. 5 CFR 890.1004 - Bases for mandatory debarments.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... Section 890.1004 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Mandatory Debarments § 890.1004 Bases for mandatory debarments. (a) Debarment...

  8. 5 CFR 890.1011 - Bases for permissive debarments.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... Section 890.1011 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Permissive Debarments § 890.1011 Bases for permissive debarments. (a) Licensure...

  9. Interactive educational simulators in diabetes care.

    PubMed

    Lehmann, E D

    1997-01-01

    Since the Diabetes Control and Complications Trial demonstrated the substantial benefits of tight glycaemic control there has been renewed interest in the application of information technology (IT) based techniques for improving the day-to-day care of patients with diabetes mellitus. Computer-based educational approaches have a great deal of potential for patients use, and may offer a means of training more health-care professionals to deliver such improved care. In this article the potential role of IT in diabetes education is reviewed, focusing in particular on the application of compartmental models in both computer-based interactive simulators and educational video games. Close attention is devoted to practical applications-available today-for use by patients, their relatives, students and health-care professionals. The novel features and potential benefits of such methodologies are highlighted and some of the limitations of currently available software are discussed. The need for improved graphical user interfaces, and for further efforts to evaluate such programs and demonstrate an educational benefit from their use are identified as hurdles to their more widespread application. The review concludes with a look to the future and the type of modelling features which should be provided in the next generation of interactive diabetes simulators and educational video games.

  10. Clinical and financial considerations for implementing an ICU telemedicine program.

    PubMed

    Kruklitis, Robert J; Tracy, Joseph A; McCambridge, Matthew M

    2014-06-01

    As the population in the United States increases and ages, the need to provide high-quality, safe, and cost-effective care to the most critically ill patients will be of great importance. With the projected shortage of intensivists, innovative changes to improve efficiency and increase productivity will be necessary. Telemedicine programs in the ICUs (tele-ICUs) are a successful strategy to improve intensivist access to critically ill patients. Although significant capital and maintenance costs are associated with tele-ICUs, these costs can be offset by indirect financial benefits, such as decreased length of stay. To achieve the positive clinical outcomes desired, tele-ICUs must be carefully designed and implemented. In this article, we discuss the clinical benefits of tele-ICUs. We review the financial considerations, including direct and indirect reimbursement and development and maintenance costs. Finally, we review design and implementation considerations for tele-ICUs.

  11. NASA spinoffs to bioengineering and medicine

    NASA Technical Reports Server (NTRS)

    Rouse, D. J.; Winfield, D. L.; Canada, S. C.

    1991-01-01

    Through the active transfer of technology, the National Aeronautics and Space Administration (NASA) Technology Utilization (TU) Program assists private companies, associations, and government agencies to make effective use of NASA's technological resources to improve U.S. economic competitiveness and to provide societal benefit. Aerospace technology from areas such as digital image processing, space medicine and biology, microelectronics, optics and electrooptics, and ultrasonic imaging have found many secondary applications in medicine. Examples of technology spinoffs are briefly discussed to illustrate the benefits realized through adaptation of aerospace technology to solve health care problems. Successful implementation of new technologies increasingly requires the collaboration of industry, universities, and government, and the TU Program serves as the liaison to establish such collaborations with NASA. NASA technology is an important resource to support the development of new medical products and techniques that will further advance the quality of health care available in the U.S. and worldwide.

  12. Biomedical applications of NASA technology

    NASA Technical Reports Server (NTRS)

    Friedman, Donald S.

    1991-01-01

    Through the active transfer of technology, NASA Technology Utilization (TU) Program assists private companies, associations, and government agencies to make effective use of NASA's technological resources to improve U.S. economic competitiveness and to provide societal benefit. Aerospace technology from such areas as digital image processing, space medicine and biology, microelectronics, optics, and electro-optics, and ultrasonic imaging have found many secondary applications in medicine. Examples of technology spinoffs are briefly discussed to illustrate the benefits realized through adaptation of aerospace technology to solve health care problems. Successful implementation of new technologies increasingly requires the collaboration of industry, universities, and government and the TU Program serves as the liaison to establish such collaborations with NASA. NASA technology is an important resource to support the development of new medical products and techniques that will further advance the quality of health care available in the U.S. and worldwide.

  13. The Asia-Pacific Academy of Ophthalmology's Grand Rounds Around the World-An Online Educational Program Freely Accessible to All.

    PubMed

    Lam, Dennis; Leung, Christopher; He, Mingguang; Tham, Clement; Liu, Yizhi; Pang, Calvin; Martin, Frank

    2012-01-01

    Grand rounds are excellent learning platforms for physicians and other health care professionals to keep up with important evolving areas in the management and treatment models of various diseases. However, there are hardly any freely accessible grand rounds in ophthalmology to meet the need for ophthalmic education in the Asia-Pacific region and beyond. The Asia-Pacific Academy of Ophthalmology would like to meet the need by sponsoring a new initiative "Grand Rounds Around the World" so that ophthalmologists and eye care professionals in the Asia-Pacific region and beyond can benefit from the program, leading to improved patient care and the elimination of learning barriers.

  14. Patient Segmentation Analysis Offers Significant Benefits For Integrated Care And Support.

    PubMed

    Vuik, Sabine I; Mayer, Erik K; Darzi, Ara

    2016-05-01

    Integrated care aims to organize care around the patient instead of the provider. It is therefore crucial to understand differences across patients and their needs. Segmentation analysis that uses big data can help divide a patient population into distinct groups, which can then be targeted with care models and intervention programs tailored to their needs. In this article we explore the potential applications of patient segmentation in integrated care. We propose a framework for population strategies in integrated care-whole populations, subpopulations, and high-risk populations-and show how patient segmentation can support these strategies. Through international case examples, we illustrate practical considerations such as choosing a segmentation logic, accessing data, and tailoring care models. Important issues for policy makers to consider are trade-offs between simplicity and precision, trade-offs between customized and off-the-shelf solutions, and the availability of linked data sets. We conclude that segmentation can provide many benefits to integrated care, and we encourage policy makers to support its use. Project HOPE—The People-to-People Health Foundation, Inc.

  15. Study protocol: translating and implementing psychosocial interventions in aged home care the lifestyle engagement activity program (LEAP) for life

    PubMed Central

    2013-01-01

    Background Tailored psychosocial activity-based interventions have been shown to improve mood, behaviour and quality of life for nursing home residents. Occupational therapist delivered activity programs have shown benefits when delivered in home care settings for people with dementia. The primary aim of this study is to evaluate the effect of LEAP (Lifestyle Engagement Activity Program) for Life, a training and practice change program on the engagement of home care clients by care workers. Secondary aims are to evaluate the impact of the program on changes in client mood and behaviour. Methods/design The 12 month LEAP program has three components: 1) engaging site management and care staff in the program; 2) employing a LEAP champion one day a week to support program activities; 3) delivering an evidence-based training program to care staff. Specifically, case managers will be trained and supported to set meaningful social or recreational goals with clients and incorporate these into care plans. Care workers will be trained in and encouraged to practise good communication, promote client independence and choice, and tailor meaningful activities using Montessori principles, reminiscence, music, physical activity and play. LEAP Champions will be given information about theories of organisational change and trained in interpersonal skills required for their role. LEAP will be evaluated in five home care sites including two that service ethnic minority groups. A quasi experimental design will be used with evaluation data collected four times: 6-months prior to program commencement; at the start of the program; and then after 6 and 12 months. Mixed effect models will enable comparison of change in outcomes for the periods before and during the program. The primary outcome measure is client engagement. Secondary outcomes for clients are satisfaction with care, dysphoria/depression, loneliness, apathy and agitation; and work satisfaction for care workers. A process evaluation will also be undertaken. Discussion LEAP for Life may prove a cost-effective way to improve client engagement and other outcomes in the community setting. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12612001064897. PMID:24238067

  16. Mentoring the Next Generation of Social Workers in Palliative and End-of-Life Care: The Zelda Foster Studies Program.

    PubMed

    Gardner, Daniel S; Gerbino, Susan; Walls, Jocelyn Warner; Chachkes, Esther; Doherty, Meredith J

    2015-01-01

    As Americans live longer with chronic illnesses, there is a growing need for social workers with the knowledge and skills to deliver quality palliative care to older adults and their families. Nevertheless, there remains a critical shortage of social workers prepared to provide quality palliative and end-of-life care (PELC) and to maintain the field into the next generation. Formal mentorship programs represent an innovative approach to enhancing practice, providing support and guidance, and promoting social work leadership in the field. This article reviews the literature on mentorship as an approach to professional and leadership development for emerging social workers in PELC. The Zelda Foster Studies Program in Palliative and End-of-Life Care bolsters competencies and mentors social workers in PELC over the trajectory of their careers, and enhances the capacity in the field. Findings from the first six years of two components of the ZF Program are examined to illustrate the feasibility, benefits, and challenges of formal mentorship programs. The authors describe the background, structure, and evaluation of the initiative's mentorship programs, and discuss the implications of mentorship in PELC for social work education, practice, and research.

  17. Reducing overall health care costs for a city municipality: a real life community based learning model.

    PubMed

    Hodges, Linda C; Harper, Tricia Satkowski; Hall-Barrow, Julie; Tatom, Iris D

    2004-06-01

    City municipalities implementing health and wellness programs patterned after North Little Rock, Arkansas, can significantly reduce the cost of health care for employees, as well as reduce costs associated with workers' compensation claims and lost time caused by injury. In addition to primary care services, effective programs include health risk assessments through pre-placement physicals, employee physicals, drug screening, employee health and wellness promotion programs, and immunization and registry. In implementing the program, a team from the University of Arkansas for Medical Sciences College of Nursing worked with city officials to establish a steering committee, safety initiatives through first responders, systems for monitoring immunizations, criteria for pre-placement physicals, and an employee health and wellness program. While the benefits for the city are well documented, the contract also created opportunities for education, research, and services in a real life community based learning laboratory for students in the College of Nursing. In addition, it provided opportunities for faculty to participate in faculty practice and meet the College's service missions. The College's model program holds promise for use by other major health care centers across the region and nation.

  18. Quality of Life and Compassion Satisfaction in Clinicians: A Pilot Intervention Study for Reducing Compassion Fatigue.

    PubMed

    Klein, Colleen J; Riggenbach-Hays, Jami J; Sollenberger, Laura M; Harney, Diane M; McGarvey, Jeremy S

    2018-06-01

    Compassion fatigue (CF) is prevalent in healthcare professionals, particularly in those caring for chronic, acutely ill, and/or those patients who might be moving toward comfort care. Over time, CF can lead to burnout (BO) and secondary traumatic stress and an overall decrease in professional quality of life. In this pilot study, participants completed a resiliency program focused on education about CF and self-awareness of its individualized impact and were expected to develop ongoing self-care practices to prevent/address the untoward effects. Healthcare professionals ( N = 15) participated in a formalized educational program consisting of three 90-minute educational sessions held 2 weeks apart. Preassessment and postintervention data were collected electronically in survey format. A postprogram evaluation was also offered. Upon completion of the program, participants noted an increase in compassion satisfaction (CS) and a small reduction in BO. Secondary traumatic stress remained unchanged. Feedback about the program was positive, and participants reported the impact on their clinical practice and life to be moderately high. At 6 months, over half of the participants continued to report positive impact on their personal/professional lives. While the small sample size of this pilot study limits the generalizability of the findings, there were positive effects for CS and BO in participants over time, indicating possible benefits of providing self-care education to healthcare providers. Additional research with a larger sample size is needed to address how healthcare providers might further benefit from resiliency education and interventions to improve professional quality of life.

  19. Integrating Environmental Management of Asthma into Pediatric Health Care: What Worked and What Still Needs Improvement?

    PubMed

    Roberts, James R; Newman, Nicholas; McCurdy, Leyla E; Chang, Jane S; Salas, Mauro A; Eskridge, Bernard; De Ybarrondo, Lisa; Sandel, Megan; Mazur, Lynnette; Karr, Catherine J

    2016-12-01

    The National Environmental Education Foundation (NEEF) launched an initiative in 2005 to integrate environmental management of asthma into pediatric health care. This study, a follow-up to a 2013 study, evaluated the program's impact and assessed training results by 5 new faculty champions. We surveyed attendees at training sessions to measure knowledge and the likelihood of asking about and managing environmental triggers of asthma. To conduct the program evaluation, a workshop was held with the faculty champions and NEEF staff in which we identified major program benefits, as well as challenges and suggestions for the future. Trainee baseline knowledge of environmental triggers was low, but they reported robust improvement in environmental triggers knowledge and intention to recommend environmental management. The program has a broad, national scope, reaching more than 12 000 physicians, health care providers, and students, and some faculty champions successfully integrated materials into health record. Program barriers and future endeavors were identified.

  20. Clinical considerations for an infant oral health care program.

    PubMed

    Ramos-Gomez, Francisco J

    2005-05-01

    The American Academy of Pediatric Dentistry and the American Association of Pediatrics recommend dental assessments and evaluations for children during their first year of life. Early dental intervention evaluates a child's risk status based on parental interviews and oral examinations. These early screenings present an opportunity to educate parents about the medical, dental, and cost benefits of preventive--rather than restorative-care and may be more effective in reducing early childhood caries than traditional infectious disease models. A comprehensive infant oral care program includes: (1) risk assessments at regularly scheduled dental visits; (2) preventive treatments such as fluoride varnishes or sealants; (3) parental education on the correct methods to clean the baby's mouth; and (4) incentives to encourage participation in ongoing educational programming. Recruiting mothers during pregnancy improves the likelihood that they will participate in the assessment program. To maximize interest, trust, and success among participating parents, educational and treatment programs must be tailored to the social and cultural norms within the community being served.

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