The Impact of Accountable Care: Interactions between patients and payers – Where do pharmacists lie?

Introduction: Over the past several years, patient outcomes became the focus of health care. With increased accountability, pharmacy education must transform the next generation of health care providers according to the new 2016 Accreditation Council for Pharmacy Education standards, which includes preparing future pharmacists to provide patient-centered care and population health. Butler University College of Pharmacy and Health Sciences (COPHS) faculty have responded by creating a required, four semester, integrated course series: Pharmacy Practice and Healthcare Administration. Purpose: To design a chapter within a pharmacy based textbook, which will replace the physician based Health Care Handbook currently used in the series. Methods: A literature search utilizing EBSCO, MEDLINE, and Pharmacist’s Letter provided content for chapter outlines. Online patient-centered resources and personal experiences assisting patients provided examples of community pharmacy encounters. Both the outline and written chapter underwent multiple revisions based upon faculty feedback. Product: Chapter 2: Patient to Payer Interactions focuses on patient interactions with private and public payers and provides practice cases that can serve as application tools. Publishing involves seven faculty (six COPHS; one Library) and six COPHS students. With chapter structure revisions and final editing underway, the ebook is scheduled for release in Fall 2017. Conclusions: Chapter 2 content provides an additional perspective on patient-centered care focused on access, cost, and quality. By accessing quality care, future pharmacist will not only help patients select the care they want and need, but also manage the cost of care. Once completed, the book will undergo peer and student review

How Registries Can Help Performance Measurement Improve Care

Suggests ways to better utilize databases of clinical information to evaluate care processes and outcomes and improve measurements of healthcare quality and costs, comparative clinical effectiveness research, and medical product safety surveillance

Evaluation Framework for Water Quality Trading Programs in the Chesapeake Bay Watershed

Water quality trading programs are being proposed and implemented across the US in a variety of forms and with differing objectives. The programs being proposed and implemented in the Chesapeake Bay region are no exception. Against this background the Chesapeake Bay Program's Scientific and Technical Advisory Committee and the Mid-Atlantic Water Program requested a general framework to inform and guide the evaluation of the performance trading programs. This resulting report was developed by a workgroup comprised of ten individuals with extensive experience in the study, design, and evaluation of trading programs. While the impetus for this report was to improve evaluation of trading programs in the Chesapeake Bay region, the evaluation framework is broad enough to apply to trading programs in general

Vulnerable Youth: Federal Mentoring Programs and Issues

[Excerpt] Since the mid-1990s, Congress has supported legislation to establish structured mentoring programs for the most vulnerable youth. The Department of Justice’s Juvenile Mentoring Program (JUMP), the first such program, was implemented in 1994 to provide mentoring services for at-risk youth ages 5 to 20. The purpose of contemporary, structured mentoring programs is to reduce risks by supplementing (but not supplanting) a youth’s relationship with his or her parents. Some of these programs have broad youth development goals while others focus more narrowly on a particular outcome such as reducing gang activity or substance abuse, or improving grades. Research has shown that mentoring programs have been associated with some positive youth outcomes, but that the long-term effects of mentoring on particular outcomes and the ability for mentored youth to sustain gains over time are less certain. Although there is no single overarching policy today on mentoring, the federal government has supported multiple mentoring efforts for vulnerable youth since JUMP was discontinued in FY2003. In recent years, two mentoring programs—the Mentoring Children of Prisoners (MCP) program and Safe and Drug Free Schools (SDFS) Mentoring program—have provided a significant source of federal funding for mentoring services. However, the programs were short- lived: funding for the MCP program, carried out by the Department of Health and Human Services (HHS) since FY2003, was discontinued as of FY2011; and funding for the SDFS program, carried out by the Department of Education (ED) since FY2002, was discontinued as of FY2010. The federal government currently funds mentoring efforts through short-term grants and initiatives. Many of these grants are carried out by the Department of Justice (DOJ), which has allocated funding for multiple mentoring programs, including mentoring for certain vulnerable youth and research on mentoring. In addition, the federal government has provided funding to programs with vulnerable youth that have a strong, but not exclusive, mentoring component. Youth ChalleNGe, an educational and leadership program for at-risk youth administered by the Department of Defense, helps to engage youth in work and school, and leadership opportunities. Adult mentors assist enrolled youth with their transition from the program for at least one year. Finally, federal agencies coordinate on mentoring issues. The Federal Mentoring Council was created in 2006 to address the ways agencies can combine resources and training and technical assistance to federally administered mentoring programs, and to serve as a clearinghouse on mentoring issues for the federal government. The council has been inactive in recent years but federal agencies, including the Departments of Housing and Urban Development (HUD) and Justice, are collaborating to reconvene the council. This report begins with an overview of the purpose of mentoring, including a brief discussion on research of structured mentoring programs. The report then describes the evolution of federal policies on mentoring since the early 1990s. The report provides an overview of the federal mentoring initiatives that are currently funded. Note that additional federal programs and policies authorize funding for mentoring activities, among multiple other activities and services. These programs are not discussed in this report. The report concludes with an overview of issues that may be of interest to Congress. These issues include the limitations of research on outcomes for mentored youth, the potential need for additional mentors, grantees’ challenges in sustaining funding, and the possible discontinuation of federal mentoring funding. The Appendix includes a description of two federal mentoring programs that were funded until FY2010 and FY2011

Endogenous Decentralization in Federal Environmental Policies

Under most federal environmental laws and some health and safety laws, states may apply for "primacy," that is, authority to implement and enforce federal law, through a process known as "authorization." Some observers fear that states use authorization to adopt more lax policies in a regulatory "race to the bottom." This paper presents a simple model of the interaction between the federal and state governments in such a scheme of partial decentralization. Our model suggests that the authorization option may not only increase social welfare but also allow more stringent environmental regulations than would otherwise be feasible. Our model also suggests that the federal government may choose its policies so that states that desire more strict regulation authorize, while other states remain under the federal program. We then test this hypothesis using data on federal regulation of water pollution and of hazardous waste, which are two of the most important environmental programs to allow authorization. We find that states that prefer more environmental protection authorize more quickly under both policies. This evidence suggests that states seek authorization to adopt more strict policies instead of more lax policies compared to federal policies.

Principles for an Immigration Policy to Strengthen and Expand the American Middle Class: 2007 Edition

The Drum Major Institute for Public Policy contends that any debate over immigration policy must be connected to the larger conversation about America's squeezed middle class and those striving to attain a middle-class standard of living. Accordingly, DMI offers a lens through which to evaluate immigration policy that operates from the basic principle that immigration policy is sound only if it also helps to strengthen and expand America's middle class. With that premise as our starting point, we wrote "Principles for an Immigration Policy to Strengthen and Expand the American Middle Class: 2007 Edition." First published in December 2005, "Principles" is now updated to reflect recent legislative proposals and a discussion of issues that have emerged as important. It is intended to serve as a guide for those who wish to advance a progressive immigration agenda that reflects the best interests of America's current and aspiring middle class

Antipsychotic Drug Use: Managing Cardiometabolic and Cost Effects

Across the US, 30%, or approximately one third of people meet the criteria for at least one mental illness.1 Of those with severe mental illness (SMI), namely schizophrenia and bipolar disorder, the mortality rate is more than twofold compared to the general population.2 The cardiovascular risk factors that contribute to cardiovascular related deaths, including metabolic disease and type II diabetes, are not only modifiable, but staggeringly higher for those with SMI.3 Though antipsychotic drug prescription is the standard protocol for SMI treatment, such drug effects on cardiovascular risk factors and related deaths exacerbate the much higher mortality rate for the severely mentally ill population. Due to both the prevalence of SMI and the physical comorbidities that it entails, analysis of healthcare costs associated with this population are an essential part of general health and policy improvement for the U.S. Therefore, a breakdown of the healthcare costs of this population requires not only acknowledgment of the modes of treatment for mental illness specifically, but also the identification and cost-analysis of the commonly associated physical comorbidities. This is especially important considering SMI is almost always considered chronic, and many SMI patients qualify for either Medicare, Medicaid, or both. Certain gaps in coverage can lead to lack of preventive care, exacerbating the cost burden. From a clinician’s perspective, assessing relevant scientific studies and reviews to change the relationship between primary care and psychiatry is necessary to dampen the high mortality rate of the SMI population. From a policy-maker’s perspective, analyzing the cause and effect balance between managing costs of care directed at the SMI itself against the adjunct costs from physical comorbidity calls for a change in the structure of therapeutic care and how the SMI population accesses primary care. The Collaborative Care model is a health care model that unifies psychiatric, behavioral, and primary care to support the mental, behavioral, and physical health of patients. By supporting holistic healthcare, the high cost of care for the SMI population will be diminished. The model includes four parts: patient-centered care, populationbased care, measurement-based treatment to target, and evidence-based care. Swapping oral antipsychotics with injectable versions will be especially cost-effective by improving adherence rates, and thus, reducing institutionalization and other hospitalizations. By enforcing the Collaborative Care model through community health center interventions, clinicians and policy makers will be able to work together to effectively leverage the health of the SMI population while eroding the high health care expenditure that this population currently imposes on states

ROSA: Realistic Open Security Architecture for active networks

Proceedings of IFIP-TC6 4th International Working Conference, IWAN 2002 Zurich, Switzerland, December 4–6, 2002.Active network technology enables fast deployment of new network services tailored to the specific needs of end users, among other features. Nevertheless, security is still a main concern when considering the industrial adoption of this technology. In this article we describe an open security architecture for active network platforms that follow the discrete approach. The proposed solution provides all the required security features, and it also grants proper scalability of the overall system, by using a distributed key-generation algorithm. The performance of the proposal is validated with experimental data obtained from a prototype implementation of the solution.Publicad