Veterans' Health Care: Balancing Resources and Responsibilities

This paper looks at the health care benefits and services administered by the U.S. Department of Veterans Affairs. It examines management strategies adopted within the department to allocate resources, structure benefits, and improve quality. Some recommendations made by the General Accounting Office and the President's Task Force to Improve Health Care Delivery for Our Nation's Veterans are reviewed, in particular the emphasis of the latter on increased collaboration with the Department of Defense. Long-term proposals to balance service commitments and financing also are considered

Contracting for Quality: Medicare\u27s Quality Improvement Organizations

This paper examines the role of quality improvement organizations (QIOs, formerly known as PROs, or peer review organizations) in improving the quality of medical care delivered to Medicare beneficiaries in both fee-for-service and managed care environments. It looks at the expansion of the QIOs\u27 portfolio in their seventh contract cycle to include quality improvement activities in nursing homes, home health services, and physicians\u27 offices as well as responsibilities for public education. The paper explores the evolution of QIOs, changes in their priorities over time, and the projects in which they are engaged. It also considers their role in the formulation and execution of a national quality agenda

Improving Quality and Preventing Error in Medical Practice

Drawing on the Institute of Medicine\u27s report To Err Is Human, this issue brief looks at quality-improvement and error-reduction efforts at the institutional, regional, and state levels and analyzes the roles of government and the private sector in bringing such efforts into national focus. Questions considered include whether error reporting should be mandatory or voluntary, who should perform error analysis, and the role of the individual in an institutional accountability model

Site Visit to Detroit — Henry Ford Health System

This event was one in a series of three site visits leading to an April 27–28, 2000, conference in Annapolis, Maryland, on hospital-based health care systems in transition after the enactment of the Balanced Budget Act of 1997 (BBA) and the Medicare, Medicaid, SCHIP Balanced Budget Refinement Act of 1999 (BBRA). The site visit explored the responses of a large integrated system, the Henry Ford Health System, to the BBA and how the BBA has interacted with other changes in the system\u27s local market and state Medicaid program. Panel presentations highlighted financing and information systems, the integration of diversified services, academic mission and outreach, safety net services, and hospital operations

Telehealth: Into the Mainstream?

Teleheath, and its subset telemedicine, extend across a range of technologies allowing patients to seek diagnosis, treatment, and other services from clinicians by electronic means. Telephone, videoconferencing, iPads, and apps are all employed. In its most established form, hospitals and medical centers use telehealth to reach patients in underserved rural areas. Proponents of telehealth suggest it can relieve medical workforce shortages; save patients time, money, and travel; reduce unnecessary hospital visits; improve the management of chronic conditions; and improve continuing medical education. But telehealth also faces ongoing challenges. States require physicians to be licensed in each state where they treat patients, even if from a distance. Most clinicians have not been trained in telehealth. Security concerns linger. Who should have access to telehealth and how it should be reimbursed are questions without fixed answers. This issue brief looks at telehealth’s promise and its challenges and considers opportunities for policymakers to help in charting its future course

Primary Care Case Management: Lessons for Medicare?

This issue brief looks at primary care case management (PCCM) as a tool that states have used to manage the delivery of care to their Medicaid populations, an alternative to contracting with commercial managed care plans. (States had found PCCM a flexible means of advancing state policy goals, including quality improvement, disease management, and coverage of special-needs populations.) The issue brief considers provider and beneficiary perspectives on PCCM as well as state agency objectives and accomplishments. Finally, it raises the question of adapting the PCCM model for Medicare

Managed Care: As Good As It Gets? (Los Angeles)

This site visit was a return trip to southern California to examine the state of managed care. Between the Forum\u27s last visit (in late 1998) and this one, the marketplace underwent considerable change, including significant movement away from global capitation, the collapse of physician practice management firms, and the development of new insurance products. Site visitors were briefed on managed care trends in the state, and panel discussions focused on issues related to physician group solvency, employer and consumer expectations, managed care regulation, and plan and provider strategies for surviving and prospering in the difficult southern California market. Site visitors met with representatives of two physician groups — HealthCare Partners Medical Group and Facey Medical Foundation — that were continuing to practice under global capitation and continued to believe the delegated risk model holds promise for managing costs and improving the quality of care. They also visited California Hospital Medical Center to discuss the challenges facing an inner-city safety-net hospital and engaged representatives of Wellpoint Health Networks in a discussion of the insurer\u27s business model for meeting needs in the individual and small group markets

TANF and Work Support Services: On the Job in Greater Philadelphia

This site visit looked at programs in the greater Philadelphia area to move welfare recipients into employment and support services aimed at keeping them employed. Four years after implementation of the Personal Responsibility and Work Opportunity Reconciliation Act, welfare caseloads were much reduced, but challenges remained. Pennsylvania officials described their plans to assist beneficiaries who would reach their five-year lifetime cash assistance limit beginning in 2002. Site visitors met with state and county assistance office staff, employers, consumer advocates, and employment and training contractors. They participated in discussions of how work support services, such as medical assistance, child care, and transportation assistance, were delivered and the policy issues surrounding them

Converging on Nursing Home Quality

This paper looks at nursing home quality initiatives, built around public reporting of quality data, that have been inaugurated by the Centers for Medicare and Medicaid Services and the California HealthCare Foundation. How the projects were developed is explored, along with preliminary indicators of their impact on consumers and providers and likely next steps in their evolution