hc juris test 1 .docx

Lecture 3 healthy aging and community based programs for older adults - Evidence based programs highest level of effectiveness - Tested models - Falls prevention programs - 1 in 4 older adults died due to a fall in 2021 - Not a natural part of aging - Matter of bala...

Lecture 3 healthy aging and community based programs for older adults - Evidence based programs highest level of effectiveness - Tested models - Falls prevention programs - 1 in 4 older adults died due to a fall in 2021 - Not a natural part of aging - Matter of balance group session to prevent future falls - View falls as more controllable - Evaluate environmental factors such as rugs to reduce risks - Group discussion - Stepping on similar to "matter of Balance" - Look at vision and falls, safe footwear and walking - Discuss coping after having a fall - Guest experts from the community present - Exercise physical therapist - Environmental safety police and/or firefighters - Tai chi - Good for arthritis, increase strength - Ongoing class provided in community - Takes roughly 50 hours to have the most fall reduction risk benefit - Learn movement control, weight transference (good for balance) and integrate mind and body (relax, proper breathing) - Increases flexibility, muscle, less pain - Otago exercise program provided by physical therapist - Take 6-12 months - Program to Encourage Active, Rewarding Living for Seniors (PEARLS) - Patient centered and patient directed approach to depression care **Lecture 4: home and community-based resources for older patients** - Eldercare locator every county listed, allows people to look up services within an area you need the assistance - National Family Caregiver Support Program helps care giver find needed resources to care for the elders - Family dynamics - Parents concern for care decisions based on independence and comfort - Kids concerns for care decisions based on health and safety - Relief for care giver - Adult day care \$85 per day average - Payments from private pay, insurance, VA, Medicaid - Day time hours during weekday - Respite care temporary (14-21 days) **Lecture 6-9: health care delivery** - Managed care - HMO act -- Medicare beneficiaries can enroll in HMO advantage plan (Medicare advantage plan) - Part c plan - Limited to IN NETWORK PROVIDER - Self-funded/employer-based plan -- 3^rd^ party insurer used and given limits of what's covered - Preferred provider organization (PPO) - Can see provider you want to see - Have wider network - Out of network providers can be seen but at higher cost - Accountable care organization - Value based model - HITECH Act - Developed an incentive program "MEANINGFUL USE" - Offered incentives for meeting specific criteria - Evidence based practice - Recognize role of all disciplines involved in delivery service - 2 categories - Clinical research -- measures impact of treatment and outcomes - Health service research -- looks at macro and micro level to evaluate health system - US preventative services task force (USPSTF) support rating of evidence-based practice - Level of certainty how competent they are with their ranking - High good treatment results - Moderate decent evidence, but there is other factors that can impact - Low - Grade definitions - A service very recommended - B - C - D - I can't recommend a treatment plan based on the research and surveys conducted - Quintuple aim - Health equity - Workforce well being - Reducing cost (triple aim) - Enhancing the care experience (triple aim) - Improving population health (triple aim) - Quality measure reporting programs - National Committee for Quality Assurance (NCQA) quality measure development and assessment - Certification of patient centered medical home - Health plan accreditation - Development and support of Healthcare Effectiveness Data and Information Set (HEDIS) measure - Measures standardized performance measurement to compare quality performance between entities - Establishes reimbursement rates with provider quality - National quality forum - Endorses healthcare quality measures across range of categories - Cost and resource use efficiency - Outcomes processes structure - Comprehensive primary care plus (CPC+) - Primary care medical home model providing additional financial resources to invest in innovative solutions for supporting primary care - Payment elements: - Care Management Fees (CMF) to support non-visit-based care - Performance based incentive payments based on organizational performance - Payment under Medicare FFS - Promoting interoperability - Encourage providers to adopt and meaningfully use HER tech. - Now knows as Merit-based incentive Payment System (MIPS) - Medicare Shared Savings Program (MSSP) - Create shared accountability for quality, cost, and experience of care rendered to Medicare beneficiaries - Accountable Care Organizations (ACOs) are responsible for their assigned Medicare Beneficiaries population - ACO performance assessed across different quality measures - Cost benchmarking -- approximate cost per beneficiary coding - Patient satisfaction surveys to ensure ACOs are meeting patient needs - Quality measures used for annual reporting - Fall risk - DM HBA1c - Different tracks exist with differing levels of risk the organizations willing to enter higher shared risk arrangements have opportunities to earn larger shared savings - ACO REACH Model - Builds on ACO model - Builders on promoting health equity to get accommodations for communities with specific health care disparities - Shift from fee for service (FFS) to value-based care - Capitated per member per month (PMPM) models with fixed reimbursement per beneficiary - You are given a fixed amount of money for each patient, and it is up to you to keep the cost of care low otherwise you eat the cost lost Lecture 10-11: health insurance and financing - Blue cross: - Blue Shield: American Medical Association offers services to approve plans - Health maintenance organizations (HMO) act - Organization that combines provision of health insurance and delivery of health care services - Medical insurance groups provide health services for fixed annual fee determined In advance - Health care triangle: access, quality, cost - Healthcare reform - 3 goals of affordable care act - Make affordable health insurance available to more people -- health insurance exchange - Expand the Medicaid program - Support innovative medical care delivery methods designed to lower the cost of health care - Managed care - Health maitanence organization (HMO) budget friendly plan - Uses smaller network of providers with no out of network coverage - Enrollees have to choose a PCP and receive referrals from them to other services - Point of Service (POS) affordable plan with out of network coverage - Hybrid between HMO and PPO and lets you choose a PCP and typically has lower out of pocket cost - Preferred provider organization (PPO) plan with freedom - Network of providers that let enrollees choose from list of Drs within network or area - High deductible health plan (HDHP) offset out of pocket costs with health saving account - Either an HMO or PPO. HDHP plan have no 1^st^ follar coverage and enrollee are responsible for 100% of cost of care until meeting deductible - Medicare - Part a in patient - Part b out patient - Part C medicare advantage Lecture 12: prevention of medical errors Lecture 13: HIPPA - Covered entities - Health care providers - Health plans - Health care clearinghouses Lecture 14: health insurance cost and quality Lecture 15: billing and coding Lecture 16: patient experience