Health Care Delivery System
Ambulatory Care
Outpatient services requiring no overnight stay
Acute Care
Treatment of medical conditions of recent
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chronic Care
Treatment of a chronic condition: any illness or impairment expected to last a year or longer that limists
what one can do, or requires ongoing medical care.
Long-term Care
A range of supportive, rehabilitative, nursing, and palliative services provided to people whose capacit to
perform daily activities is restricted due to chronic disease or disability.
End of Life Care
Care given to patients in their final stages of life, including symptom, pain, and medication management.
Palliative Care
A comprehensive type of care, addressing physcial and mental health issues, spirituality, and family care.
Reasons for PCP shortages
Cost of medical school, workload.
Sources of Fragmentation Page 189
Physician Silos, Underdeveloped Health Information Technology, Lack of Care Coordination, lack of
incentives to coordinate care, focus on Acute care.
Models of better coordinated and integrated care Page 194
These models place the responsibility for change on practitioners, health plans, and health information
systems.
The Chronic Care Model Page 194
Keeping providers focused on maintaining health rather than restoring it, requires a combination of case
management, aggressive follow-up, and ensuring that information I relayed to patients in ways that are
compatible with their culture and background. A crucial aspect is patient's own self-management.
Patient-Centered Medical Homes Page 195Physician directed medical practice with a team of providers in which each patient has an ongoing
relationship with a personal physician.
Accountable Care Organizations
An integrated healthcare delivery system that includes physicians, hospitals, and other providers and that
takes responsibility for the overall health of a covered population
Four Model of Health Care Delivery-Model 1
Integrated Delivery System (IDS) or Multispecialty Group Practice (MSGP) with a health plan. Including
a health ins. function in an IDS provides flexibility, aligned incentives and expertise in organizing leading
to high value care. Ex. Kaiser Permanente. physicians are paid capitation.
Four Model of Health Care Delivery-Model 2
IDS OR MSGP without a health plan. integrated clinical practice, education, and research. Physicians are
paid on a salary.
Four Model of Health Care Delivery-Model 3
Private Networks of independent providers. organize independent providers to deliver health care services
under contract to one or more insurers.
Four Model of Health Care Delivery-Model 4
Government-Facilitated networks of independent providers. Govt. takes an active role in organizing
independent providers, usually to create a delivery system for Medicaid beneficiaries.
Attributes of an Ideal Health Care Delivery System
1-Easy access to appropriate care, culturally competent-responsive to patients needs. 2-Information
continuity-EHR integration to all providers at point of care. 3-Care coordination and transitions: patient
care is coordinated among multiple providers, and transitions across care settings are actively managed
Attributes of an Ideal Health Care Delivery System
4-Peer review and team work for high value care 5-Continuos innovation: Continuously innovating and
learning in order to improve the quality, value, and patients' experiences of health care delivery.6-System
Accountability: There is clear accountability for the total care of patients.
High Quality Health Care
The degree to which health services for individuals and populations increase the likelihood of desire
outcomes.
Core competencies for health administrators - Page 253
Policy/Procedure, Quality improvement from the administrative level, focus on quality/safety- Align
goals, Strategic imperatives, Implementation and continually enhance work environment.Rationing of Health Care Page 259
Limiting the services to situations that add the greatest value. Rationing or setting treatment priorities.
Centers of Excellence (COE's)
Participation is based on quality indicators. Usually very specific like transplant services.
Cost Shifting Page 268
The provider shifts costs not covered by Medicare and Medicaid to other payers, by requiring higher
reimbursement rates from them.
Third Party Payer
Entity paying on behalf of a patient or a provider. Payers identifies a set of services for which they will
cover a set population for a certain premium.
Supply Chain
Group Purchasing, negotiate better prices-volume equity. Aligning supply logistics, reduce storage.
CER System Page 278
The comparison of two or more health care interventions in which technologies, products, or procedures
are evaluated against each other and against conventional standards of care. Outside medical care-Rare
due to scientific complexity- enormous range of costs, inputs and outcomes. [Show Less]