Medical expenses are shared between TRICARE and the beneficiary under TRICARE Standard. Annual deductibles must be paid by enrollees, and families of active-duty members are responsible for 20 percent of outpatient charges. A 25 percent cost-share for outpatient services is paid by retirees and their families, former spouses, and families of deceased personnel. A beneficiary is responsible for a provider’s additional charges of up to 115 percent of the allowable charge are the provider treats them and doesn’t accept assignment. There is a catastrophic cap in which patient cost-share payments are subject to.
Home Health Continuum of Care I. Introduction II. Stakeholders and IDS 1) Description of the roles of various stakeholders in the health care industry who are involved in the continuum of care a. Employers b. Payers c. Providers d. Patients 2) How the component contributes to or detracts from the overall management of health care resources e. Does it affect health care; positively or negatively 3) The characteristics of an integrated delivery system (IDS): f. Cottage industry g. Healthcare organizations h. Community healthcare i. Vertically integrated systems III. Services and employees 1) Discussion of the services provided and how these services fit into the continuum of care a.
Understanding Healthcare Organizations: External Influences Week 4 Socioeconomic Status and Cultural Influences in Healthcare External Influences Socioeconomic Status and cultural factors are external influences in health care. Socioeconomic Status a complex characteristic, generally understood to encompass not only income and education level, the measures most commonly used, but also a wide range of associated factors that may affect the quality of health care patients receive, including insurance status, access to care, patients’ health beliefs, and many facets of the doctor-patient relationship, such as trust and communication (Bernheim SM, Ross JS, Krumholz HM, Bradley EH, 2008). The idea that people have better education, income and lifestyles, are less exposed to factors that contribute to stress-related diseases such as heart disease. Because the level of stress is less than those who experience significant differences in environment, health risks are greater in those who experience job loss, crime infested neighborhoods and poor education systems. Those who experience stress could turn to drug abuse, smoking and alcoholism.
Performance measures indicate where an organization needs to make improvements in order to provide quality care. Consumer/patient satisfaction is the ultimate guide that indicates if an organization’s ongoing QI Plan is effective. One of the driving forces behind management in an organization is the overall basic aspect of performance measures. Quality Improvement process is based on customer/patient satisfaction and measures how the health care organization accommodates or exceeds consumer/patient
The Quality Indicators (QIs) developed and maintained by the Agency for Healthcare Research and Quality (AHRQ) are one response to the need for multidimensional, accessible quality measures that can be used to gage performance in health care. The QIs are evidence based and can be used to identify variations in the quality of care provided on both an inpatient and outpatient basis. These measures are currently organized into four modules: the Prevention Quality Indicators (PQIs), the Inpatient Quality Indicators (IQIs), the Patient Safety Indicators (PSIs), and the Pediatric Quality Indicators (PDIs). Prevention Quality Indicators (PQIs)- The AHRQ PQIs are one set of quality measures that can be used to identify potential problems and ascertain disparities across regions, communities, and providers. They mainly focuses on preventive care services—outpatient services that assist individuals with either staying healthy or managing chronic illness.
Agency for Health Care Administration (AHCA) is responsible for Medicaid (AHCA, 2011). The funding is provided by state and federal funds. The House and Senate budgets approved by state lawmakers make the financial decisions. CMS is located in Baltimore, Maryland. Medicare is funded through the Trust Fund of Hospital Insurance and through employees’ payroll taxes, employers, and self-employed individuals.
The citizens interested in purchasing of health insurance policies do so in the private sector, or they are provide by government aided groups. In the US, private health insurance covers can be purchased from various profit oriented commercial insurance companies or from nonprofit making insurance companies. An approximated 84% of the US population is covered in either public or private health
Promoting person centered approaches In health and social care Person centered care Person centered care, or personalized care and individual care consistently feature within government documents for health and social care services. Within the essence of care, the term 'person centered' is used to signify 'activities that are based on what is important to a person from their own perspective'. 'Person centered care' has been defined as treating people as individuals and enabling them to make choices about their care. Concepts central to person centered care: · communication · advocacy · involvement · participation · trust · partnership · empowerment · empathy · choice · holism · assessment Person centered care concepts explained Communication relates to a two way process that involves exchanging information; it is important for the sender of the information to establish that the receiver understand the message and that it is communicated in a way that meets any individual communication needs that the receiver may have. An advocate is a person who intercedes on behalf of another person in a bid to ensure that their best interests are communicated.
Many people believe in order to do this that the United States needs to adopt Universal health care. However, there are a number of other thing that the United States need to do but to make them short they are sometimes referred to as the three core public health functions. The first one is Assessment, in order to accomplish this goal they would need to monitor health status in order to identify health issues with the community, regions, and the entire United States. The next step would be to investigation and diagnosis of health issues and hazards within the community and within the population. In order to complete this function you need to evaluate the effectiveness, accessibility and quality of the health services that is currently available to the citizens.
Comparison of Health Plans Allison Hershberger HCR/230 September 22, 2013 Jill Frawley Comparison of Health Plans PPO stands for preferred provider organization and is a managed care organization of medical doctors, hospitals, and other health care providers who have a binding agreement with an insurer or a third-party administrator, which usually pay participating providers based on a discount from their physician fee schedules, called discounted fee-for-service (Valerius et al, 2008). Providers in the PPO will provide the insured members of the group a substantial discount below their regularly-charged rates. These arrangements help to ensure that the insurer will be billed at a reduced rate when it’s insured utilize the services