Utilization review and Utilization management in health care

/in /by

Utilization review and Utilization management in health care

This is an assignment that focuses on the utilization review and Utilization management in health care. The paper also explains the roles of each method in survival.

The utilization review and Utilization management in health care

Assignment Overview:

Firstly, with the consistently rising costs of health care services, utilization management and utilization review are routinely used in the vast majority of current health care settings. How are they evolving over time, and what is involved in these processes? What do health care managers need to be aware of as the processes play out? In the absence of sweeping policy change (or the complete restructuring of the United States health care system), utilization management and utilization review are much more moderate processes to attempt to preserve the quality of care provided while controlling overall health care expenditures. Let’s learn a bit about each of these processes, and how they are implemented in our current health care environment.

Assignment: Using the information in the required readings as well as some additional research in peer reviewed sources, complete your Case Assignment by answering the following:

1. Firstly, compare and contrast utilization review and utilization management in health care. What are the similarities and the differences between each type of assessment? (Hint: One is generally a prospective process, and the other is generally a retrospective process).

2. Secondly, explain the specific role of each method in providing value-based health care. Who benefits from the method—the health care system, the insurance company, and/or the patient?

3. Thirdly, articulate how individual case management is critical to a hospital’s long-term survival. In what way does this practice protect your patients while keeping your doors open for business?

4. Fourthly, what are the ethical pitfalls to be aware of in performing these‌‌‍‌‌‍‍‍‌‍‍‌‍‍‍‌‌‌‍ types of quality reviews? What must health care managers be aware of in terms of ethical pitfalls and also potential unintended negative consequences?

Learning Outcomes:

Compare and also contrast utilization review and utilization management in health care. – Investigate the specific roles of utilization management methods in providing value-based health care. – Articulate how utilization management is critical to a hospital’s long-term survival.

Then, discuss ethical pitfalls—including unintended consequences—that managers should be aware of in utilization management. Background References (Use at least 2 references with other peer reviewed references): Baker, J. (2018). Improving quality of care through utilization management [Video file]. Retrieved from https://youtu.be/g-T-YeP53nY Carasso, S. (2017). However, is that test necessary? The key to laboratory utilization management. The Journal of Medical Practice Management: MPM, 33(3), 160-164. Desai, S., Gruber, P. F., Eiting, E., Seabury, S. A., Mack, W. J., Voyageur, C., . . . Terp, S. (2017).

Lastly, the effect of utilization review on emergency department operations. Annals of Emergency Medicine, 70(5), 623-631.e1. El-Othmani, M. M., Sayeed, Z., Ramsey, J. A., Abaab, L., Little, B. E., & Saleh, K. J. (2019). The joint utilization management program: Implementation of a bundle payment model and also a comparison between year 1 and 2 results. The Journal of Arthroplasty, 34(11), 2532-2537. Parast, M. M., & Golmohammadi, D. (2019).

Conditions to Benefit from Medicare or Medicaid

/in /by

Conditions to Benefit from Medicare or Medicaid

This paper focuses on Medicare and Medicaid. Consider how people qualify to receive Medicare and/or Medicaid write a paper that addresses the bullets below:

Consider how people qualify to receive Medicare and/or Medicaid

Firstly, Consider how people qualify to receive Medicare and/or Medicaid. Write a paper that addresses the bullets below:

Secondly, Describe the Quality Improvement Organization (QIO) and explain how the QIO improves policies and healthcare for Medicare beneficiaries.

Thirdly, Briefly define the qualifications for Medicare and Medicaid benefits.

Fourthly, How can qualifications be modified to serve more people who are considered a vulnerable population?

Further, Discuss the impact (including at least two positive and two negative aspects) that the ACA has had on benefits and coverage for Medicare and Medicaid recipients.

Also, Describe your role(s) as a healthcare leader as it applies to the practice of advocating for cost effective care for vulnerable populations.

 

More details;

How do you qualify for both Medicare and Medicaid?
Dual eligibility

If you have Medicare and full Medicaid coverage, most of your health care costs are likely covered. You can get your Medicare coverage through Original Medicare or a Medicare Advantage Plan (Part C). If you have Medicare and full Medicaid, you’ll get your Part D prescription drugs.

What does Medicaid cover?
Medicaid provides comprehensive inpatient and outpatient health care coverage, including many services and costs Medicare does not cover, most notably, prescription drugs, diagnostic and preventive care, and eyeglasses.

What is the function of the quality improvement organization?

QIO Program Mission
The mission of the CMS Quality Improvement Organization program is to improve the effectiveness and quality of services delivered to Medicare beneficiaries. The program strives to do this in several ways, including pay for performance, disease management, and accountability measures.
What does a peer review organization quality improvement organization primarily do?
Quality Improvement Organizations (QIOs), formerly called Peer Review Organizations (PROs), are the primary means by which the Centers for Medicare and Medicaid Services (CMS) promote quality of care for Medicare’s 40 million beneficiaries.
What is the role of the beneficiary and family centered care?
Beneficiary and Family Centered Care-Quality Improvement Organizations (BFCC-QIOs) help people who have Medicare exercise their right to high-quality health care by: Managing all complaints and quality of care reviews to ensure consistency in the review process. Also, Providing Health Care Navigation services.
Lastly, What makes a good healthcare leader?
Successful healthcare leaders need clinical skills, business competencies, and interpersonal or soft skills to guide their organizations to success. … Becker’s Hospital Review cites listening, vision, integrity, empathy, and optimism as core skills for medical leaders.

 

 

 

 

 

 

Elements and structure of major health care models

/in /by

Elements and structure of major health care models

This is a paper that requires focus on the discussion on elements and structure of major health care models. The paper also provides additional information to use in the writing of the assignment paper. Below is the assessment description to follow:

Discussion on elements and structure of major health care models

Scenario: Imagine you are on the staff of a newly elected congressional representative who has just been appointed to a health care committee. You have been tasked with developing a briefing for the representative that gives a balanced overview of both the global health care organizations and the three major health care models (entrepreneurial, mandated health insurance, and national health service).

Your executive summary should contain three parts:

Part 1: An Overview of Major Global Health Organizations

Firstly, organize your executive summary by using the name of each organization as a subheading to address the requirements below.

Secondly, summarize the mission and major initiatives of each global health organization.
Thirdly, analyze how each global health organization aligns to the basic principles of the World Health Organization Constitution.

Part 2: An Overview of Health Care Models

This information as a chart.

Firstly, summarize the elements and structure of major health care models (entrepreneurial, mandated health insurance, and national health service).
Secondly, identify the elements of a health care system that make it effective for disease treatment.
Thirdly, explain the key performance indicators used to measure heath system performance.
Compare specific health care models in terms of (choose one) cost, quality, access to service and care, staffing, or prevention.
Part 3: An Explanation of Key Performance Indicators
Summarize how key performance indicators for structure, process, and outcomes are to assess performance and management.

Ensure that you follow the instructions provided keenly. Marking of the assignment is on how you do the task and how you submit the assignment too. In case of any question feel free to ask your instructor for more guidelines before doing the assignment.

 

Flint water crisis potential long term health effects

/in /by

Flint water crisis potential long term health effects

This is an essay discussing the flint water crisis potential long term health effects. Additionally, the essay describes the Chemistry involved in nursing.

The flint water crisis potential long term health effects

Firstly, focus on the potential long term health effects of the Flint water crisis. Then, discuss the chemistry involved along with the connection nursing Chemistry and public health effects of the Flint River crisis.

Secondly, apply the scientific method to propose a hypothesis and set up an experiment including positive and negative controls and appropriate units of measurement. Then, predict the numbers of protons, neutrons, and electrons given the atomic symbol or limited information for a specific isotope of an element and relate them to atomic mass and charge.

Thirdly, determine chemical names and/or chemical formula for diatomic or simple polyatomic compounds. Then, draw a Lewis structure, construct a molecular geometry and determine the polarity for a covalent compound. Balance chemical equations, calculate the molar mass of all compounds in the reaction and demonstrate how mole ratios play a role in stoichiometry.

Fourthly, predict how a change in one or more of the parameters of a gas alters dependent gas parameters. Such parameters include pressure, volume or temperature. Additionally,

  • calculate the concentration and volume of a solution given solute and solvent parameters.
  • Predict the properties of identify reduction and oxidation agents. This is as well as to acids and bases by analysis of chemical formulas, chemical reactions, and solution pH values.
  • Differentiate the common classes of organic functional groups and identify the appropriate common or IUPAC names, applications, and chemical structures for simple organic compounds.
  • Differentiate between the types of radio-active decay at the subatomic level and provide real-world applications, sources, and risks.
  • Contrast the synthesis, composition, structure and functions of major biological macromolecules and Illustrate the process of flow of genetic information

Designing a telehealth intervention for a rural population

/in /by

Designing a telehealth intervention for a rural population

This paper focuses on designing a telehealth intervention for a rural population. Write a 25-page research paper in current APA format that focuses on an applied topic of your choosing related to healthcare economics

Designing a telehealth intervention for a rural population

Write a 25-page research paper in current APA format that focuses on an applied topic of your choosing related to healthcare economics and decision-making in the healthcare industry or a healthcare facility. The paper must include at least 20 references

More details;

Designing a multifaceted telehealth intervention for a rural population using a model for developing complex interventions in nursing

Background

Telehealth interventions offer an evidenced-based approach to providing cost-effective care, education, and timely communication at a distance. Yet, despite its widespread use, telehealth has not reached full potential, especially in rural areas, due to the complex process of designing and implementing telehealth programs. The objective of this paper is to explore the use of a theory-based approach, the Model for Developing Complex Interventions in Nursing, to design a pilot telehealth intervention program for a rural population with multiple chronic conditions.

Methods

In order to develop a robust, evidenced based intervention that suits:

Firstly, the needs of the community, stakeholders,

Secondly, healthcare agencies involved,

Thirdly, a design team comprised of state representatives,

Fourthly, telehealth experts,

Further, patient advocates was convene.

Also, each design team meeting was guided by major model constructs

(i.e., problem identification,

defining the target population and objectives,

measurement theory selection,

building and planning the intervention protocol).

Overarching the process was a review of the literature to ensure that the developed intervention was congruent with evidence-based practice and underlying the entire process was scope of practice considerations.

Results

Ten design team meetings were held over a six-month period. An adaptive pilot intervention targeting home and community-based Medicaid Waiver Program participants in a rural environment with a primary objective of preventing re-institutionalizations was developed and accepted for implementation.

Blood cancers problem populations affected

/in /by

Blood cancers problem populations affected

Provide an introduction and overview of what blood cancers are, the extent of the problem, populations affected, and how organizations such as be the Match address the problem.

What blood cancers are the extent of the problem populations affected

Provide an introduction and overview of what blood cancers are, the extent of the problem, populations affected, and how organizations such as be the Match address the problem.

More details;

The three main types of blood cancer are leukemia, lymphoma and myeloma: Leukemia is a diseases that originates in the blood and bone marrow. It occurs when the body creates too many abnormal white blood cells and interferes with the bone marrow’s ability to make red blood cells and platelets.

What are the first signs?
Some common symptoms include:

Firstly, Coughing or chest pain.

Secondly, Fever or chills.

Thirdly, Frequent infections.

Fourthly, Itchy skin or rash.

Further, Loss of appetite or nausea.

Moreover, Night sweats.

Additionally, Persistent weakness and fatigue.

Lastly, Shortness of breath.

Which blood cancer is most dangerous?
Leukemia: 108,740 lives There are many types of leukemia, but all affect the blood-forming tissues of the body, such as the bone marrow and the lymphatic system, and result in an overproduction of abnormal white blood cells, according to the NCI.

What are the most common blood cancers?

The most commonly diagnosed are non-Hodgkin lymphoma, chronic lymphocytic leukemia, acute myeloid leukemia, acute lymphoblastic leukemia, and multiple myeloma.
Is it curable?
Usually blood cancers have a cure rate, but it all depends upon the type the patient is suffering from. Some such as chronic lymphocytic leukemia and myeloma aren?t necessarily curable, but patients can live for decades, sometimes with minimal treatment.
What is the main cause of blood cancer?
Leukemia is a caused by a rise in the number of white blood cells in your body. Those white blood cells crowd out the red blood cells and platelets that your body needs to be healthy. The extra white blood cells don’t work right.

 

 

 

Evidence-Based Healthcare Decisions evidence-based intervention

/in /by

Evidence-Based Healthcare Decisions evidence-based intervention

This paper focuses on Create a professional presentation of your evidence-based intervention and change proposal to be disseminated to an interprofessional audience of leaders and stakeholders.

Professional presentation of your evidence-based intervention

Firstly, create a professional presentation of your evidence-based intervention and change proposal to be disseminated to an inter-professional audience of leaders and stakeholders.

Secondly, include the intervention.

Also, evidence-based literature.

Further, objectives.

Moreover, resources needed.

Additionally, anticipated measurable outcomes.

Finally, how the intervention would be evaluated.

Lastly, submit the presentation in Loud Cloud for feedback from the instructor.

Write a solid academic, and write a documentation of sources using APA formatting guidelines.

More details;

Firstly, evidence-based interventions are practices or programs that have peer-reviewed, documented empirical evidence of effectiveness.

Secondly, evidence-based interventions use a continuum of integrated policies, strategies, activities, and services whose effectiveness has been proven or informed by research and evaluation.

Thirdly, What are research based interventions?

Also, scientific Research-Based Interventions. Scientific Research-Based Interventions (SRBI) emphasize successful instruction for all students through high- quality core general education practices.
Further, the target ed interventions for students experiencing learning, social-emotional or behavioral difficulties.
Also, what are evidence based interventions in social work?
Evidence-based practice (EBP) is a process in which the practitioner combines well-researched interventions with clinical experience and ethics. The client preferences and culture to guide and inform the delivery of treatments and services.
What are examples of evidence based practices?
Examples of Evidence-Based Practice
  • What Is Evidence-Base Practice? …
  • Evidence-Based Healthcare Decisions. …
  • The Benefits of a Dress Code. …
  • Evidence-Based Dress Code. …
  • Nurses and Alarm Fatigue. …
  • Evidence-Based Action Against Alarm Fatigue. …
  • Online RN to BSN Program Incorporates Evidence-Based Practice in Nursing.
What is an example of an intervention?
noun. The definition of an intervention is something that comes between two things or something that changes the course of something. An example of intervention is a group of friends confronting a friend about their drug use and asking the friend to seek treatment.

 

 

 

 

Healthcare Informatics EHR in moving toward compliance HIPAA

/in /by

Healthcare Informatics EHR in moving toward compliance HIPAA

This is a assignment that discusses Healthcare Informatics in moving toward compliance. The paper discusses the featherwall medical center scenario.

Healthcare Informatics in moving toward compliance

Milestone Two: Moving Toward Compliance Overview:

Imagine you have been contracted to consult on the recent developments at the Feather fall Medical Center. Feather fall has been struggling of late; it has had a series of problems that have prompted your hiring. It has faced the following issues:

1. Firstly, feather fall has recently violated several government regulations regarding the current state of its technology. The technology system is vastly out of date, and staff are not always using the technology that is in place or they are using the technology inappropriately. These problems have lost the institution lots of money for not meeting government regulations and have caused operational and ethical problems from inefficient and ineffective use of technology.

Healthcare Informatics in moving toward compliance

2. Secondly, the staff at Feather fall are not well-trained on the use of technology and do not communicate appropriately about technology use. The roles that pertinent to your consult are the health information management team. Also, the clinical staff (doctors, nurses, etc.), and administrative staff. The health information management team uses proper coding practices, and the current technology system serves them well, despite its age. However, other roles in the hospital have had issues with the system. Clinical staff, for instance, have had record-keeping issues both due to lack of training on the system and the system itself being out of date.

Also, administrative staff within the organization have taken issue with the lack of communication about the technology and its use between the various roles. When the current technology system was chosen many years ago, the needs of these various roles were not considered. Instructions You will submit an analysis of how the company in the case study is non compliant and the strategies (general, not specifics) to move them toward compliance. To complete this assignment, review the Milestone Two Guidelines:

Overview:

In this milestone, you will submit an analysis of how the company in the case study is non compliant and the strategies (general, not specifics) to move it toward compliance. Specifically, the following critical elements must be addressed: II. Health Regulations and Laws Ramifications:

In this section‌‌‍‌‌‍‍‍‌‍‍‌‍‍‍‌‌‌‍ of your final project, you will finish your preparation by reviewing. Also, explaining the ramifications for the organization if it decides to wait on addressing its recent violations regarding technology use.

A. Determine how violating health regulations and laws regarding technology could impact the finances of the institution if these violations are not addressed. Be sure to support your response with examples.

B. Determine how violating health regulations and laws regarding technology could impact the daily operations of the institution if these violations are not addressed. Be sure to support your response with examples.

C. Determine how violating health regulations and laws regarding technology could impact the security of the health information.

Global Health Care Organizations and Health Care Model

/in /by

Global Health Care Organizations and Health Care Model

This is a paper that requires focus on the Global Health Care Organizations and Health Care Model. The paper also provides additional information to use in the writing of the assignment paper. Below is the assessment description to follow:

Global Health Care Organizations and Health Care Model

Global Health Care Organizations and Health Care Model
Scenario: Imagine you are on the staff of a newly elected congressional representative who has just been appointed to a health care committee. You have been tasked with developing a briefing for the representative that gives a balanced overview of both the global health care organizations and the three major health care models (entrepreneurial, mandated health insurance, and national health service).

Your executive summary should contain three parts:

Part 1: An Overview of Major Global Health Organizations

Firstly, organize your executive summary by using the name of each organization as a subheading to address the requirements below.

Secondly, summarize the mission and major initiatives of each global health organization.
Thirdly, analyze how each global health organization aligns to the basic principles of the World Health Organization Constitution.

Part 2: An Overview of Health Care Models

This information as a chart.

Firstly, summarize the elements and structure of major health care models (entrepreneurial, mandated health insurance, and national health service).
Secondly, identify the elements of a health care system that make it effective for disease treatment.
Thirdly, explain the key performance indicators used to measure heath system performance.
Compare specific health care models in terms of (choose one) cost, quality, access to service and care, staffing, or prevention.
Part 3: An Explanation of Key Performance Indicators
Summarize how key performance indicators for structure, process, and outcomes are to assess performance and management.

Ensure that you follow the instructions provided keenly. Marking of the assignment is on how you do the task and how you submit the assignment too. In case of any question feel free to ask your instructor for more guidelines before doing the assignment.

Dietary evaluation -​‌‌‍‌‌‍‍‍‌‍‍‌‍‍‍‌‌‌‍ Recommended Dietary Allowance (RDA)

/in /by

Dietary evaluation -​‌‌‍‌‌‍‍‍‌‍‍‌‍‍‍‌‌‌‍ Recommended Dietary Allowance (RDA)

This is an essay that discusses the dietary evaluation and what role Recommended Dietary Allowance (RDA) plays nutrients requirements. This analysis is to figure out why RDA is important in health.

Diet evaluation -​‌‌‍‌‌‍‍‍‌‍‍‌‍‍‍‌‌‌‍ Recommended Dietary Allowance (RDA)

Firstly, identify what is Recommended Dietary Allowance (RDA). Then,  establish if you meet the RDA recommendations that are in place? During your research, analyze which nutrients are high and which are low as per the RDA recommendation?

Secondly, suggest how could you make improvements. In addition, list 3 good food sources for each nutrient that was less than the RDA. How could you incorporate these into your diet? How is the sodium intake? Saturated fat intake? What changes might be needed if any?

In conclusion, comment on your fiber intake. How do your total daily ca‌‌‍‌‌‍‍‍‌‍‍‌‍‍‍‌‌‌‍lorie needs compare to your average calorie intake? Also, If you continue to eat this way what weight changes may occur, if any? Consider these questions in your paper.

  • What changes could you make if needed?
  • What do you think were the most important findings in your Diet Analysis Project?
  • Are you regularly including nutrient dense foods in your diet?
  • Have you set any nutritional goals as a result of this project? If so, what are they‌‌‍‌‌‍‍‍‌‍‍‌‍‍‍‌‌‌‍?