CareOregon: Transforming the Role of a Medicaid Health Plan From Payer to Partner

Details Triple Aim pilot programs designed to offer patient-centered medical homes and multidisciplinary case management in an effort to improve population health, enhance patients' experience, and slow cost growth

An Interdisciplinary Team Approach to the Patient-Centered Medical Home as a Means of Meeting Meaningful Use Stage 2 Requirements

In an attempt to address the shortcomings of the current U.S. healthcare system, reimbursement structure is changing from fee-for-service to a value-based model. This requires drastic change in how care is delivered. Therefore, care delivery models and reimbursement incentive programs are evolving to promote advancements in care delivery. This project examined an interdisciplinary team model utilized at a rural, privately owned practice that is a Patient Centered Medical Home (PCMH). This practice has incorporated unique structures and processes to attain Stage 2 Meaningful Use requirements in the first year attesting for this stage became available as a means of addressing shortcomings within the current healthcare system. An understanding of this model was obtained through informal interviews, observation, shadowing staff members, and a comparison of Stage 2 attainment between the Clinic and national data. This project found high quality care is delivered through the structures and processes in place at this Clinic resulting in a greater proportion of Stage 2 attainment within the Clinic compared to national data regarding similar providers. In doing so, this model has not only obtained enhanced reimbursement but has also experienced improved patient outcomes. Nurses were found to be an integral part of this team, necessary for the success of Stage 2 attainment and optimizing patient outcomes. As reimbursement continues to evolve to promote improved quality and outcomes, to remain viable, U.S. care delivery must adapt. As this model has seen success, a toolkit was developed containing documents that can be used in replicating this interdisciplinary team model in other primary care sites. This toolkit can be used to assist other primary care practices progress to meet the demands of reimbursement reform

Strengthening Primary Care: Recent Reforms and Achievements in Australia, England, and the Netherlands

Outlines efforts to enhance primary care quality and access, including postgraduate training for family physicians, general practitioner accreditation, greater use of nurse practitioners, and after-hours care; their outcomes; and insights for U.S. reform

A Quality Improvement Program in a Safety Net Clinic Serving Vulnerable Populations

The Patient Protection and Affordable Care Act of 2010 resulted in major changes to healthcare infrastructure in the United States, with two main areas of concentration: healthcare financing and population health management. Quality improvement programs focus on improving healthcare quality for populations with conscious efforts to decrease healthcareassociated expenditures. Quality improvement interventions can include patient-reported outcomes, clinical decision support systems, and clinical dashboards. The purpose of the Doctor of Nursing Practice project was to formally implement a quality improvement program for chronic disease management in a safety net clinic serving vulnerable populations. The Donabedian model served as the conceptual model to frame the formal quality improvement program. The Plan-Do-Study-Act model guided the implementation of the formal quality improvement program. Despite the lack of statistically significant differences between pre- and post-implementation outcome measures, the Doctor of Nursing Practice project established a standard documentation process for several chronic diseases supported by a procedure manual, volunteer education modules, and clinical dashboards. Limitations of the project included the brief evaluation period, the low daily volume of patients with the selected chronic diseases, and the inadequate volunteer survey response rate. Recommendations for sustainability and future iterations involve an investigation into the documentation process of underperforming outcome measures, the identification of an effective process to solicit volunteer feedback on training modules, and the continuation of the clinical dashboard process to generate monthly compliance data to monitor documentation variation over time. The formalization of the quality improvement program in the safety net clinic during this Plan-Do-Study-Act cycle provided a strong foundation from which to launch the next Plan-Do-Study-Act cycle focusing on improved volunteer involvement

Risk and Stigma: Students’ Perceptions and Disclosure of ‘Disability’ in Higher Education.

There is a focus on increasing the numbers of students with disabilities to apply to and study in Higher Education (HE). Despite sector-wide criteria regarding what comprises a disability, there are still students who do not disclose a disability at the application stage. This study sought to explore perceptions of students across one UK university regarding their views and experiences of a range of disabilities and reasons why a disability may not be disclosed on application to HE. The findings suggest a lack of understanding regarding what constitutes a disability, and concerns that disclosure will negatively impact upon the application decision and disadvantage the student. This paper highlights the disconnect between the support that universities can provide to students with a disability and the perceptions that some students have about the disadvantages that disclosure can bring. The findings support initiatives at policy and practice level across the sector to recognise and address perceptions and experiences of risk and stigma that applicants may have but at the same time highlight that more needs to be done to reduce the anxieties and lack of clarity that some students experience

Strengthening Primary and Chronic Care: State Innovations to Transform and Link Small Practices

Presents case studies of state policies for reorganizing and improving primary and chronic care delivery among small practices, including leadership and convening, payment incentives, infrastructure support, feedback and monitoring, and certification

Quality improvement financial incentives for general practitioners

This report reviews outcomes of intervention programmes targeting reductions in potentially avoidable hospitalisations (PAHs) and/or avoidable Emergency Department presentations (ED presentations) among people with chronic disease. The focus is on the role of primary health care and where possible programmes targeting specific vulnerable populations, namely Indigenous Australians, rural and remote residents and those at socioeconomic disadvantage. This report also aimed to examine tQuality improvement includes aspects of self-reflection and benchmarking, with continued evaluation to identify where additional improvements to practice can be made. Measures of the quality of care are typically structure (e.g. related to an organisation’s operations), process (e.g. clinical guidelines or care pathways) or outcomes-based (e.g. physiological indicators). Improvements can be measured in relative or absolute terms. The likelihood of engaging with incentives and the behavioural responses of health professionals are affected by the different characteristics of financial incentives, which may be directed at networks of practices, individual practices, or specific health care professionals. Payments may be offered as a bonus or addition to usual earnings, or may be withheld if practices do not achieve desired outcomes. Payments may be prospective or retrospective and may be linked to fixed thresholds or individual patients.ends in PAHs and ED presentations among people with chronic disease

Implementing a Mobile Health System to Integrate the Treatment of Addiction Into Primary Care: A Hybrid Implementation-Effectiveness Study

Background: Despite the near ubiquity of mobile phones, little research has been conducted on the implementation of mobile health (mHealth) apps to treat patients in primary care. Although primary care clinicians routinely treat chronic conditions such as asthma and diabetes, they rarely treat addiction, a common chronic condition. Instead, addiction is most often treated in the US health care system, if it is treated at all, in a separate behavioral health system. mHealth could help integrate addiction treatment in primary care. Objective: The objective of this paper was to report the effects of implementing an mHealth system for addiction in primary care on both patients and clinicians. Methods: In this implementation research trial, an evidence-based mHealth system named Seva was introduced sequentially over 36 months to a maximum of 100 patients with substance use disorders (SUDs) in each of three federally qualified health centers (FQHCs; primary care clinics that serve patients regardless of their ability to pay). This paper reports on patient and clinician outcomes organized according to the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Results: The outcomes according to the RE-AIM framework are as follows: Reach—Seva reached 8.31% (268/3226) of appropriate patients. Reach was limited by our ability to pay for phones and data plans for a maximum of 100 patients per clinic. Effectiveness—Patients who were given Seva had significant improvements in their risky drinking days (44% reduction, (0.7-1.25)/1.25, P=.04), illicit drug-use days (34% reduction, (2.14-3.22)/3.22, P=.01), quality of life, human immunodeficiency virus screening rates, and number of hospitalizations. Through Seva, patients also provided peer support to one another in ways that are novel in primary care settings. Adoption—Patients sustained high levels of Seva use—between 53% and 60% of the patients at the 3 sites accessed Seva during the last week of the 12-month implementation period. Among clinicians, use of the technology was less robust than use by patients, with only a handful of clinicians using Seva in each clinic and behavioral health providers making most referrals to Seva in 2 of the 3 clinics. Implementation—At 2 sites, implementation plans were realized successfully; they were delayed in the third. Maintenance—Use of Seva dropped when grant funding stopped paying for the mobile phones and data plans. Two of the 3 clinics wanted to maintain the use of Seva, but they struggled to find funding to support this. Conclusions: Implementing an mHealth system can improve care among primary care patients with SUDs, and patients using the system can support one another in their recovery. Among clinicians, however, implementation requires figuring out how information from the mHealth system will be used and making mHealth data available in the electronic health (eHealth) record. In addition, paying for an mHealth system remains a challenge

Process evaluation of a community-based adolescent obesity prevention project in Tonga

<p>Abstract</p> <p>Background</p> <p>The rising burden of obesity in Tonga is alarming. The promotion of healthy behaviours and environments requires immediate urgent action and a multi-sectoral approach. A three-year community based study titled the Ma'alahi Youth Project (MYP) conducted in Tonga from 2005-2008 aimed to increase the capacity of the whole community (schools, churches, parents and adolescents) to promote healthy eating and regular physical activity and to reduce the prevalence of overweight and obesity amongst youth and their families. This paper reflects on the process evaluation for MYP, against a set of Best Practice Principles for community-based obesity prevention.</p> <p>Methods</p> <p>MYP was managed by the Fiji School of Medicine. A team of five staff in Tonga were committed to planning, implementation and evaluation of a strategic plan, the key planks of which were developed during a two day community workshop. Intervention activities were delivered in villages, churches and schools, on the main island of Tongatapu. Process evaluation data covering the resource utilisation associated with all intervention activities were collected, and analysed by dose, frequency and reach for specific strategies. The action plan included three standard objectives around capacity building, social marketing and evaluation; four nutrition; two physical activity objectives; and one around championing key people as role models.</p> <p>Results</p> <p>While the interventions included a wide mix of activities straddling across all of these objectives and in both school and village settings, there was a major focus on the social marketing and physical activity objectives. The intervention reach, frequency and dose varied widely across all activities, and showed no consistent patterns.</p> <p>Conclusions</p> <p>The adolescent obesity interventions implemented as part of the MYP program comprised a wide range of activities conducted in multiple settings, touched a broad spectrum of the population (wider than the target group), but the dose and frequency of activities were generally insufficient and not sustained. Also the project confirmed that, while the MYP resulted in increased community awareness of healthy behaviours, Tonga is still in its infancy in terms of conducting public health research and lacks research infrastructure and capacity.</p