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This report presents findings from the first four years of the five-year evaluation of Medicaid health homes, a new integrated care model authorized in Social Security Dating cafe gmbh bedeutung synonym for amazing talent Section and created by Section of the Affordable Care Act.
The model is designed to target high-need, high-cost beneficiaries with chronic conditions or serious mental illness. The Urban Institute is conducting the evaluation, which will conclude in early The first four years of the evaluation focus on the structure of health homes and implementation issues.
Quantitative analysis in the last year of the evaluation will assess the impact on quality, cost, utilization patterns, and dating chinese girlfriend deep puke pictures funny outcomes.
This evaluation will assess:. This report summarizes program progress and presents the key lessons learned to date. They do not necessarily reflect the views of the Department of Health and Human Services, the reviews for christian mingle dating site or any other funding organization. The Medicaid health home option, created in the Affordable Care Act ACAis an innovative model of care that allows states to provide coordinated and integrated care for beneficiaries with chronic physical, mental, or behavioral conditions.
Some of the key elements of the health home model include a focus on high-cost, high-need populations; dating cafe norwall animal with buddy of physical and behavioral health care; coordination of medical as well as nonmedical services; and inclusion of a wide variety of providers that may serve as health homes, such as hospitals, care management networks, home health agencies and community mental health centers.
Findings are drawn from qualitative data collected during the long-term evaluation of health home implementation and outcomes, which the Urban Institute is conducting under contract to the U.
The Medicaid health home option, established in Section of the ACA in and authorized by Section of the Social Security Act, allows states to create health homes as an optional state Medicaid plan service. All participating states must identify a target population of persons with chronic speed dating lublin opinie or behavioral conditions and offer them six required health home services: 1 comprehensive care management; 2 care coordination and health promotion; 3 comprehensive transitional care, including appropriate follow-up; 4 patient and family support; 5 referral to community and social support services; and 6 use of health information technology HIT to link services, as feasible and appropriate.
Three major organizational structures emerged women seeking men new england the 11 health home states studied in this evaluation: medical home-like programs are variations on or extensions of the patient-centered medical home PCMH ; specialty provider-based programs use entities that traditionally serve special-needs populations, such as mental health providers, but integrate specialized care with primary care; and care management networks bring together a variety of organizations, including both clinical and nonclinical providers, to jointly care for health home enrollees.
At the time the information for this report was collected and analyzed, all 13 programs examined had completed their two-year intervention period during which they qualified for an enhanced federal match for health home services.
In all but one state health home programs were still operating. The exception was Oregon, which ended health homes as a distinct program and folded it into the state's patient-centered primary care home initiative. Two other states--Idaho and Ohio--were considering major changes to their programs. Idaho was contemplating subsuming health homes into its PCMH initiative and Ohio was planning to dissolve health homes altogether as part of an overall behavioral system redesign.
The remaining eight states in our evaluation are continuing their health home programs online dating scammer database the foreseeable future, although in Iowa there was uncertainty about how other Medicaid program changes would affect health homes. Some states are moving forward with their original design and others are making or planning modifications, such speed dating databases examples of hyperbole geographic and population expansions, or payment system personal dating ads inland empire methodology adjustments.
Iowa, Maine, New York, and Rhode Island are developing or have developed additional health home programs. Most states have not been able to conduct self-evaluation studies, most often because of insufficient infrastructure for collecting and analyzing data from providers. Three states--North Carolina, Oregon, and Rhode Island--did not conduct internal evaluations to determine the effect of the programs. Missouri, Iowa, and Ohio conducted evaluations covering part of their early experience and published results, and five others--Alabama, Idaho, New York, Maine, and Wisconsin--are finalizing their reports or are in the process of data analysis.
For the most part, early results appear to indicate that the health home program is improving care for patients and, in some cases, having desired impacts on utilization and costs. Important caveats to these assessments of health home impacts are: 1 it is very difficult, if not impossible, to distinguish health home-specific effects from the effects of other initiatives and changes occurring at dating sites manitoba canada same time; 2 results available to date are from periods early in the program when implementation was still ongoing; and 3 all evaluation activities to date have been based solely on Medicaid data, even though 11 of the 13 programs include persons dually eligible for Medicare.
Because quantitative analyses generally were not yet available, the information in this report relies solely on informant impressions of changes taking place in the delivery system, which may or may not be attributable to the health home program. Most informants believe there have been improvements in the care enrolled members are receiving because of changes brought about by health homes and other delivery system reforms.
In the areas of care coordination, integration of behavioral and physical health, and member engagement, our informants felt health homes were making continuous improvements. Transitional care, especially after hospitalizations, seems to be an area of ongoing concern for many states and providers, with some health home programs experiencing changes in the right direction and others still intensively working on improvements.
Most health homes felt enrollee access to nonclinical services has improved during the course of the program, although few saw any changes related to access to long-term services and dating a divorced lady over 50 im 69, mostly due to relatively small proportion of their patients in need of dating coach abdel nader basketball player. Importantly, providers in our evaluation states appreciated the benefits of health homes for their patients and were largely supportive of the model as a way to address needs of Medicaid beneficiaries with physical and mental chronic conditions and complex socio-economic situations.
Given the relatively short intervention period and often slow and challenging implementation of the program, many providers were concerned that the full potential of the health home program is yet to be realized and asked that policymakers keep this in mind when they consider early utilization and cost outcomes.
Many states have participated in multiple pilots and demonstration projects simultaneously with health homes, making it difficult for providers to identify health home program-specific impacts and further complicating objective evaluation of the health home program. In a few states, health home programs may have caused unintended consequences for participating providers.
Notably, in Maine, implementation of the Stage B behavioral health homes diverted some of the patients from Stage A primary care health homes which caused confusion and administrative burden for Stage A providers. In New York, a claims-based payment structure initially implemented by the state failed to recognize factors such as mental illness or homelessness as contributing to high-need, and underestimated provider costs to care for these complex patients.
Although health homes are expected to use HIT to coordinate and integrate services to the extent feasible, we found that there continues to be considerable variation among health home states in availability and functionality of HIT infrastructure and technical or financial assistance offered to providers, as well as in the extent to which individual providers use HIT and data analytics tools to coordinate and manage care.
In some states, improvements in terms of growing provider adoption of electronic health records EHRs or greater capacity and utilization of health information exchange HIE systems have taken place over the course of the health home program.
However, respondents attribute most of these improvements to HIT initiatives and grants that have been or are being implemented alongside the health homes, such as the HITECH programs, rather than tying them with the participation in the health home program.
Barriers to greater adoption and use of HIT to coordinate care cited include the cost and limits of the technology needed to engage in HIE, use of different EHR products among providers in a community, misconceptions about federal and state health information privacy laws and regulations, lack of technical assistance to providers, patient resistance to using electronic portals, and workflow issues. Challenges to engaging providers in data analytics include difficulty using the technology, low adoption of available reports and tools, and the lack of baseline data for examining changes over time.
Characteristics of successful health home providers identified by the respondents include strong leadership and staff buy-in, well-developed infrastructure including HITtechnical and financial resources needed to make necessary practice changes, and previous experience with patient-centered care management.
In states with medical home-like health home programs, federally qualified health centers were found to be particularly successful in implementation of the health home model due to their organizational structure and previously established connections with social service providers.
Providers using the care management network model to coordinate services generally performed well as health homes, but the degree of success largely dependent on each health home's ability to build trust and develop relationships with both clinical and nonclinical provider organizations in the community.
In our evaluation states, many providers had to undertake practice changes e. Often, these practice changes were undertaken at the same time as enrollment and treatment of health home-eligible patients, placing additional strain on providers and slowing the pace of practice transformation. Many health homes are still working to improve fundamental aspects of the health home model, including comprehensive care management and coordination, behavioral health integration, hospital transitions, and effective use of HIT.
Except in New York, the only state that made financial assistance available to providers specifically for practice transformation, state support to providers largely has been limited to providing program guidance and technical assistance. While informants in all evaluation states emphasized the strengths of the health home model and its value to high-need, high-cost Medicaid enrollees, many suggested changes and improvements to designs of specific health home programs and presented recommendations that have broader implications to federal and state policymakers and are particularly relevant to states that are developing or considering health homes.
Among other things, providers recommended that states assist health homes in fostering productive relationships with hospitals, as well as other health care providers and payers, to help them meet care coordination and management requirements. Other areas in which respondents made a number of suggestions include care team roles and composition, enrollee eligibility criteria, data availability and reporting infrastructure, payment structure and financial support for infrastructure development, duplication of services concerns, and program structure and flexibility, including provider preparation and participation criteria.
Because practice or health system change and implementation of a new program inevitably takes time, many respondents warned that a two-year intervention period may not be long enough to show measurable impacts, which may not necessarily mean the program is failing. A number of important lessons were gleaned from the national health home evaluation activities. Among the suggestions and lessons these first 11 health home states have to offer are the need to:.
Develop the health home design and implement the program in collaboration with providers and other stakeholders. Ensure that HIT and other infrastructure is in place to support communication, care coordination, exchange of data, and monitoring of outcomes.
In this report we described the status of the 13 health home programs and early findings from state evaluations; overall experience, perceptions, and opinions of providers, state program staff, and other stakeholders regarding the strengths and weaknesses of designs and operation of state models; and key lessons learned. Overall, respondents agree that the model is well-suited to serve the targeted, high-need populations selected, and the few state evaluations available to date show promise with respect to reduced utilization and costs.
Most states in our evaluation plan to continue the program in the near-term, and some have implemented or are planning to implement new health homes for additional populations. An underlying issue in many health home states, and probably the most important lesson learned, is the importance of having the infrastructure for operating and monitoring the program in place before it begins, so providers can focus on enrollee care needs and meeting the program objectives.
The Medicaid health home option, established in Section of the Affordable Care Act ACA in and authorized by Section of the Social Security Act, enables states to provide coordinated and integrated care for beneficiaries with chronic physical, mental, or behavioral conditions as an optional state Medicaid plan service.
Another important distinction is that while primary care providers PCPs are key players, a wide variety of providers may serve as health homes, including hospitals, care management networks, and specialized providers such as home health agencies and community mental health centers CMHCs. As of October20 states have implemented a total of 28 health home programs. The Urban Institute is conducting the long-term evaluation of health home implementation and outcomes mandated in the ACA, under contract to the U.
The evaluation includes the first 13 programs approved in 11 states. Effective dates range from October 1,to January 1, Detailed descriptions of the 13 health home programs are available in the second-year report.
Program adjustments, future plans, and sustainability issues are also discussed. Finally, the report presents suggestions for changes to program design and implementation processes based on insights from our informants. Lessons learned from the early adopters of the program can provide important insights to other states and to policymakers. The five-year long-term evaluation of Medicaid health home programs in selected states began on October 1, The aims of the evaluation are to assess: 1 what models, providers, and processes states are choosing for health homes; 2 the extent to which state health home designs result in increased monitoring and coordination across clinical and nonclinical domains of care; and 3 whether the models result in better quality of care and outcomes, specifically, reduced use of hospitals, skilled nursing facilities, and emergency departments, and lower costs.
The health home model is intended to provide enhanced integration and coordination of primary, acute, behavioral health mental health and substance use services, and long-term services and supports LTSS for persons with chronic illness. The first four years of evaluation activities have focused on qualitative and quantitative data collection, and the final year will focus on conducting quantitative analyses and preparation of findings for use in the Secretary's Report to Congress on the long-term evaluation, required in Section of the ACA.
Findings in this report are drawn from information collected during a final round of annual follow-up telephone interviews with state program staff, health home providers, provider associations, and other stakeholders, conducted between April and July Most informants were selected from a pool of persons initially interviewed during site visits to each state during the first and second year of the evaluation. In a few instances where the original informant was no longer part of the state agency or provider organization, alternative informants with intimate knowledge of the program were identified and interviewed.
Health home providers participating in this evaluation range from sole-provider rural primary care practices to large urban clinics, capturing a range of experience with the new responsibilities inherent in the health home model and different patient populations. In total, we conducted 39 interviews during this follow-up year. A limitation is that this report summarizes information and perceptions obtained from a relatively small number of informants.
Thus, some perspectives may not have been captured, and some information or opinions may not be generalizable. Protocols developed for this round of qualitative interviews focused on state experience with the health home program during the two-year intervention period, as well as program changes and plans for the future.
Topics covered included informant assessments of program design and outcomes; impacts of the program on delivery of care and beneficiary experience; use of HIT; attributes of successful provider types; and provider experience with practice transformation.
We also asked about sustainability and suggestions for specific program changes as well as advice for policymakers and others considering the health home program, including the HHS Centers for Medicare and Medicaid Services CMSstates, and providers.
Two sets of protocols were developed, one for state officials and advocates and one for provider organizations, and customized as needed to reflect unique characteristics of each health home program. Core protocols are provided in Appendix A.
We also asked program staff in each state to fill out a status table collecting basic information about program enrollment and participating providers to supplement information collected during telephone interviews see Appendix A.
Each interview was recorded, transcribed, and coded using NVivo a qualitative research software program to organize the data, identify common patterns and themes, and synthesize the information. Additional detail about qualitative activities and methods, the quantitative component of the evaluation, and the evaluation design and timeline are available in the second-year and third-year reports.
Section outlines basic requirements and options for states interested in establishing a health home program. All participating states must offer their target beneficiaries six required health home services, although they have flexibility in defining particular features and delivery methods for each service. The required services are: 1 comprehensive care management; 2 care coordination and health promotion; 3 comprehensive transitional care, including appropriate follow-up; 4 patient and family support; 5 referral to community and social support services; and 6 use of HIT to link services, as feasible and appropriate.
States must provide assurances in their SPAs that hospitals participating in the Medicaid program will establish procedures for referring potentially eligible patients treated in emergency departments to health home providers. Consistent with the focus of the health home model on integration of physical and behavioral health care services, all states are required to consult with the Substance Abuse and Mental Health Services Administration in developing their health home programs.
The law allows states latitude in most components of the health home model, including the choice of conditions targeted, types of providers and program participation requirements, health home team composition, geographic coverage, and payment methodology and rates. To qualify for health home services Medicaid beneficiaries must have at least: 1 two or more chronic conditions; 2 one chronic condition and be at risk of developing another; or 3 one serious and persistent mental illness SPMI.
Chronic conditions may include mental illness, substance abuse, asthma, diabetes, heart disease, obesity, and or others approved by CMS.
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