Value-based formulas for purchasing. Pursuing value in Medicaid managed care: access to care and enrollee information management

Medicaid and other publicly funded health coverage programs face special challenges in managed care purchasing. This article discusses two of those challenges based on the state of Minnesota's experience: how to develop, evaluate, and communicate access to care; and how to manage the transfer of enrollee eligibility and health status information.     

Value-based formulas for purchasing. PEHP's designated service provider program: value-based purchasing through global fees

In many circles, managed care and capitation have become synonymous; unfortunately, the assumptions informing capitation are based on a flawed unidimensional model of risk. PEHP of Utah has rejected the unidimensional model and has therefore embraced a multidimensional model of risk that suggests that global fees are the optimal purchasing modality. A globally priced episode of care forms a natural unit of analysis that enhances purchasing clarity, allows providers to more efficiently focus on the Marginal Rate of Technical Substitution, and conforms to the multidimensional reality of risk. Most importantly, global fees simultaneously maximize patient choice and provider cost consciousness.     

Value-based formulas for purchasing. Employers shift to quality to evaluate and manage their health plans

Employers have traditionally focused on cost and plan design in the management of their employees' health care programs. This cost focus has led most large employers to enroll employees in managed care programs and resulted in a new focus on the quality of care delivered by these plans. By evaluating cost and quality, employers attempt to understand the total value these health plans deliver. Hewitt Associates' Health Value Initiative, a health plan analysis based on employers' increased need for cost and quality information, is an example of a tool used by some employers to evaluate and strategically manage their health plans. A case study shows how one large employer used this information to shift to a more comprehensive cost and quality analysis, resulting ultimately in better health care costs and quality for its employees.     

A new "loyalty rewards" program in health care customer relationships

"Loyalty rewards" in sponsored DM and HRM programs can apply to both providers and consumers. Physicians and hospitals can be paid to "loyally" adhere to payers' guidelines for managing diseases and risks. Many payer and their outsourced vendor programs include significant efforts to create collaborations between payer and provider, rather than relying on unilateral efforts. And growing numbers are rewarding providers for their efforts and results achieved.     

Sharps injuries in the home health care setting: risks for home health care workers.

Home health care nurses are at risk of needlesticks and blood exposures, yet few studies have been conducted related to such exposures in the home health care setting. This article describes a cross sectional prevalence pilot study of needlesticks and blood exposures conducted among three home health care agencies in the San Francisco Bay area. Needlestick and blood exposure reports from 1993 to 1996 were submitted from three home health care agencies. The exposures were categorized using an existing categorization system and compiled into a composite report. A total of 52 exposures occurred; nurses sustained 92% of exposures. Twenty-three percent occurred before, during, or after needle disposal; 17% from manipulating intravenous/access ports; 15% from improper disposal; and 13.5% during or after blood draw. Needle safety devices need to be specifically designed for the unique home health care setting and for a standardized rate of calculating needlestick injuries in this setting.     

Customer centered health care: why managed care organizations must capitalize on new technology to build brands and customer loyalty

Now, more than ever, health care organizations are desperately trying to reach out to customers and establish stronger relationships that will generate increased loyalty and repeat business. As technology, like the Internet and related mediums, allow us to do a better job of managing information and communication, health care executives must invest the time and resources necessary to bring these new advances into the day-to-day operations of their businesses. Those that do will have a head start in building their brand and their customer loyalty.     

Suggestions for the health care system of the future: family-oriented primary health care

This paper will describe one of the major trends in health care delivery: family oriented primary care. Implications and future directions for practice, education and research in the United States and Germany will be described and contrasted. The paper is a result of an ongoing dialogue between the first author, a Fulbright Professor at the University of Witten/Herdecke, and the second and third authors. The authors believe that, contextualizing emerging trends in health care delivery in this way, helps to clarify both what is unique to each country and what is actually or potentially shared in common.     

Regional health care systems: implications for health care reform

Not only should there be payment reform, but health care delivery should be redesigned to achieve the triple goals of access to services, quality improvement, and cost control. The authors review the forces that have formed multihospital and health care systems in the past, and the seven stages that health care systems traverse toward competency. They briefly discuss the implications of those realities for reform implementation. One premise is that the natural evolution of such health care systems toward competency will take a longer time than most nonproviders expect.     

Preparation for cancer care: perceptions of newly qualified health care professionals.

The present paper is derived from a larger survey which examined the perceptions of recently qualified health care professionals' experience on evidence-based practice, team working and cancer care. This study reports solely on the findings relating to cancer care. The perceptions of recently qualified professionals in relation to their initial educational input on issues such as confidence, anxiety, communication skills and practice in cancer care as well as adequacy of support, professional supervision and use of reflection were gathered using a cross-sectional postal survey design. A total of 50 graduates from each professional category in nursing, occupational therapy, physiotherapy, and social work were sampled yielding a total sample of 200. Eighty-five questionnaires were returned yielding a response rate of 43%. Twenty-eight (33%) respondents stated that they were currently involved in working with people with cancer. These were as follows: 5 nurses, 8 physiotherapists, 9 occupational therapists and 6 social workers. Despite the low response rate, the findings suggest that health care professionals' educational input and experiences of working with people with cancer were overall positive; for example, in the respondents' confidence, communication skills, decrease in anxiety and application of knowledge gained in classroom to professional practice. Moreover, most respondents learnt about caring for cancer patients through practice rather than classroom teaching. A high percentage (i.e. 64%;18) across all groups felt supported when caring for people with cancer and reported receiving professional supervision as well as being able to actively reflect on their practice. The implications for education and practice were discussed particularly as there have been few studies conducted in relation to the specific needs and collaborative learning of these health care professional groups.     

Employee health surveillance in the health care industry.

This article provides an overview of the fundamental and inherent challenges in developing a health surveillance program for a health care facility. These challenges are similar to those facing individuals responsible for developing health surveillance programs for multiple industries because several "mini-industries" exist within hospitals. Hazards can range from those that are regulated by the Occupational Safety and Health Administration to those that are unregulated but pose a threat to health care workers. Occupational hazards that are unique to the health care industry also exist. A health surveillance program can be developed with focused assessment and a strong occupational safety and health program. Implementation can occur within a health care setting with the buy-in of the many stakeholders involved, especially supervisors managing departments where chemical and other hazards are present.