Blue Cross and Blue Shield: Pioneering Managed Care Solutions for Tomorrow’s Health Care Need

An informational booklet about Blue Cross and Blue Shield: Pioneering Managed Care Solutions for Tomorrow’s Health Care Need

Implementing a Community Bipolar Screening Questionnaire in VT

The National Institute of Mental Health estimates the number of adults with a diagnosed mental disorder is nearly 1 in 5, this equates to about 43 million Americans. The national shortage of psychiatrists has hit Vermont particularly hard. There has been both a lack of funding and a lack of psychiatrists. For example there is often a waiting line for acute level 1 beds at the Vermont Psychiatric Care Hospital since it opened after the flooding of the state hospital in 2011. In light of the shortage of resources and psychiatrists in Vermont it is important to maximize the limited time that family practitioners have with patients with mental illness. With regards to diagnosing bipolar spectrum disorder the best method is using the Mood Disorder Questionnaire (MDQ) which is a 17 question survey and practical for an outpatient setting. A study examining the validity of the MDQ found that it provided good sensitivity (0.73, 95% [CI]=0.65–0.81) without sacrificing specificity (0.90, 95% CI=0.84–0.96). Another study was conducted in a community setting and it was found that the MDQ had a sensitivity of 0.28 and a specificity of 0.97. The MDQ has been proven to be effective in a psychiatric outpatient setting and been proven to be less effective or limited in the outpatient setting. However we must weigh the risks and benefits. In a setting like Vermont, with restricted resources, limited inpatient beds, lack of psychiatrists and a population of individuals with undiagnosed bipolar spectrum disorder the MDQ can prove to be more useful than harmful and can aid in identifying patients who potentially have bipolar spectrum disorder.https://scholarworks.uvm.edu/fmclerk/1319/thumbnail.jp

M-health review: joining up healthcare in a wireless world

In recent years, there has been a huge increase in the use of information and communication technologies (ICT) to deliver health and social care. This trend is bound to continue as providers (whether public or private) strive to deliver better care to more people under conditions of severe budgetary constraint

Central Florida Future, Vol. 18 No. 12, November 13, 1985

University may soon regulate PC lab use; College Bowl (photo of the College Bowl competition); Kiosk complete but still on hold; Over $9 million in student aid coffers; News: New children\u27s show produced by UCF; Library offers new services; Anti-apartheid protests falling off with season; News clips: From all over; A big bust; Extended hours; Money, money; Computer mail causing fuss; Discoveries: Mensa is a meeting of minds; How do you measure up? Some sample questions from Mensa\u27s preliminary test; Opinion: Buzz word needs to become policy for growth control; Boycott \u27The Pig\u27 to bring back staple food; Male Kiosk central location for finding dates; Letters: Sick of attitudes, Sincere criticism, deliver on preserve; Sports: Men\u27s soccer over: season ends with 2 ties, 10-2-3 mark; Eagles soar to victory (with photo of UCF quarterback Tony Lanham); Lady Knights\u27 year without bid (with photo of The Lady Knights; Home team dominates the Knights Brawl; NSWAC tournament at UCF; Schedule, division important; Tournament finals tomorrow; Crew novice meet ahead. Also includes the entertainment and feature supplement Confetti : Born to Die (animals in the Seminole County Animal Shelter, with photos); Entertainment: Wonder sued, Lennon film due out; Video: \u27Sun City\u27 video features bizarre mix of talent.https://stars.library.ucf.edu/centralfloridafuture/1593/thumbnail.jp

Strategies to Prevent and Reduce Medical Identity Theft Resulting in Medical Fraud

Medical identity fraud is a byproduct of identity theft; it enables imposters to procure medical treatment, thus defrauding patients, insurers, and government programs through forged prescriptions, falsified medical records, and misuse of victim\u27s health insurance. In 2014, for example, the United States Government lost $14.1 billion in improper payments. The purpose of this multiple case study, grounded by the Health Insurance Portability and Accountability Act as the conceptual framework, was to explore the strategies 5 healthcare leaders used to prevent identity theft and medical identity fraud and thus improve business performance in the state of New York. Data were collected using telephone interviews and open-ended questions. The data were analyzed using Yin\u27s 5 step process. Based on data analysis, 5 themes emerged including: training and education (resulting to sub-themes: train employees, train patients, and educate consumers), technology (which focused on Kiosk, cloud, off-site storage ending with encryption), protective measures, safeguarding personally identifiable information, and insurance. Recommendations calls for leaders of large, medium, and small healthcare organizations and other industries to educate employees and victims of identity theft because the problems resulting from fraud travel beyond the borders of medical facilities: they flow right into consumers\u27 residences. Findings from this study may contribute to social change through improved healthcare services and reduced medical costs, leading to more affordable healthcare

Development and impact of a telemedicine platform with a task-shifting digital assistant to support frontline health workers and its dissemination as a Digital Public Good

Telemedicine improves access for women and helps reduce the geographic, financial, and social barriers that women face in receiving the care they need. In this dissertation, I describe the design and development of an open-source telemedicine technology platform, Intelehealth, through a user-centered bioengineering innovation and design process. I describe the desiderata of a provider-to-provider telemedicine approach connecting rural frontline health workers with remote doctors to facilitate teleconsultations for patients. I describe the development of a digital assistant, called Ayu, to enable this health worker to doctor teleconsultation and task shift the process of collecting a comprehensive medical history and physical examination. Through an evaluation of the information retrieval ability of this digital assistant I show that a nurse using Ayu can capture 65% of patient history information and 42% of physical exam information that a doctor would collect. This information was deemed sufficient to arrive at the correct diagnosis in 68-74% of patient cases and a correct triage decision in 88% of cases. I demonstrate that health workers can successfully use the digital assistant and the telemedicine platform and that they have a high degree of acceptability towards its use. One of the key concerns in telemedicine is whether telemedicine-based care is comparable to in-person care for patients and whether it should be used in settings where in-person care delivery is not possible. I conducted a randomized crossover trial comparing telemedicine with face-to-face care and observed a 74% diagnostic concordance and an 80% concordance in the treatment plan between the two. Patients reported a 98% decrease in distance traveled and a 99% decrease in average spend. We also found that these benefits were higher for women who spend 1.5 times more than men to get health care services. Thus, telemedicine can provide comparable outcomes to in-person care at lower cost and greater convenience for patients, especially women. Finally, I present the Telemedicine Program Design Canvas - a framework to aid in the design of sustainable telemedicine programs and their implementation and present a telemedicine project case study through the eyes of a female community health worker in rural India

Engineering system approach to fix the U.S. health care system

Thesis (S.M. in Technology and Policy)--Massachusetts Institute of Technology, Engineering Systems Division, Technology and Policy Program, 2009.Includes bibliographical references (p. 75-78).The ailing U.S. health care system faces two tremendous challenges: a rising health care bill and a growing number of uninsured individuals. Several policies have been enacted to tackle these challenges but they are short-term patchwork solutions rather than long-term holistic solutions needed to address structural issues. Despite the market-based aspect of the U.S. healthcare system, self-correction of structural inefficiencies is unlikely to happen. A new care model has to disrupt the current care system. In line with this observation, we propose to analyze the potential of a new primary care delivery as a solution to address the two key challenges threatening to destabilize the U.S. health care. Based on our analysis of the literature, we note that chronic diseases account for a large proportion of the health care bill. Yet, the delivery model to provide chronic care, where primary care plays a central role, is inefficient, fragmented and insufficient. Compounding these ailments, primary care is facing its own crisis resulting from the shortage of generalist doctors and the inflating demand for primary care services. As primary care is critical for the continuity and coordination of medical care, resolving the urgent situation facing this branch of practice should be a top priority to improve quality of care while reducing health care costs. Every stakeholder in the current health care system should collectively contribute to the primary care model redesign endeavor.(cont.) To this end, we apply an engineering system approach to devise an appropriate course of actions for health care businesses, health care providers and policy-makers in redesigning primary care. We discuss insights gained through a collaborative project with a local hospital to model and simulate a new primary care practice. These insights were geared to guide decision-makers in the design of care processes, resources allocation and appointment rules. In conclusion, we show that primary care has a critical role to play in the much-needed revolution of the U.S. health care system. It will require active collaboration of health care providers, business leaders and policy-makers to enable this disruptive change.by Stéphane Chong.S.M.in Technology and Polic

The use of cost accounting methodologies to determine prices in German health care

In many sectors of the health care system, prices at which providers are reimbursed by payers are not determined by the market mechanism, but rather by a defined administrative process. Depending on the sector, prices are set politically and are negotiated between different actors or are calculated according to a defined procedure, considering cost data from a sample of providers. The selected approach for price setting determines decisively, to which extent prices for certain services reflect the actual costs incurred for these services. A lack of reflection of actual costs can lead to unintended incentives for providers and therefore have implications on the allocative efficiency. Our analysis shows that in Germanys inpatient and outpatient sector, cost data is increasingly considered for price setting while in other sectors such as long-term care and rehabilitation, the use of cost data is still very limited. However, DRG-cost-weights in the inpatient sector insufficiently reflect actual costs incurred. Thus, decision makers in the German health care system rely more on cost data for price setting and improving the accuracy of cost calculations in order to increase allocative efficiency. -- Die Preisbildung für die Erstattung von Leistungserbringern erfolgt in vielen Sektoren des Gesundheitswesens nicht durch den Marktmechanismus, sondern durch einen administrativ definierten Prozess. Je nach Sektor werden politische Preise vorgegeben, unter den Akteuren verhandelt oder nach einem festgelegten Verfahren, unter Berücksichtigung von Kostendaten aus einer Stichprobe von Leistungserbringern, berechnet. Das gewählte Verfahren der Preisbildung determiniert in entscheidendem Maße, inwieweit die Preise für die erbrachten Leistungen die realen Kosten der Leistungserbringer für diese abbilden. Eine mangelnde Reflektion der Kosten in den Preisen kann zu Fehlanreizen für die Leistungserbringer und mithin zu einer Fehlallokation von Ressourcen führen. Im Rahmen dieser Untersuchung zeigt sich, dass in Deutschland im stationären und ambulanten Bereich zunehmend detaillierte Kostendaten für die Preisberechnung herangezogen werden, während dies in anderen Sektoren wie Pflege und Rehabilitation bislang nur sehr bedingt erfolgt. Es zeigt sich jedoch, dass auch im stationären Sektor die DRG-Relativgewichte bislang nur unzureichend die Kosten für die entsprechenden Leistungen abbilden. Insgesamt muss in Deutschland für die Preisbildung im Gesundheitswesen mehr auf Kosteninformationen für die Preisberechnung zurückgegriffen und die Verursachungsgerechtigkeit der Kostenkalkulationen verbessert werden, um die Allokationseffizienz zu erhöhen.