Health Informatics to Improve Healthcare for Medicaid Recipients My practice is one of three or four primary care practices, including the community health center, that accept patients with Medicaid in Slidell, Louisiana. Medicaid recipients make up approximately 35 to 40 percent of my patient panel. Most patients come to their first appointment with a history of being uninsured for a long period of time prior to receiving recent coverage with Medicaid. As a result, it has been several years since they have been to a primary care provider or had any preventative care. In addition, many have known chronic health problems like hypertension, depression, or diabetes that have been untreated for years due to low income, no health insurance, and lack of accessibility to low-cost or free care and medications. Unfortunately, even with the assistance of Medicaid, a large percentage of this population fails to get the recommended care and testing, consistently do not keep appointments for follow-up or no-show scheduled appointments. Methods of health care informatics will be identified to improve care outcomes among the vulnerable population of those with public health insurance through the state Medicaid system. Issues to Improve Outcomes among Medicaid Recipients In Louisiana, Medicaid is available in several different forms. Few patients have a plain Medicaid policy, while most are enrolled in one of the five available managed care organizations (MCOs) collectively
In today’s society, the accuracy of health information, the availability of health records, and the professional resources in which one live are vital in decision making for health conditions. Meaningful Use (MU) is a program developed by CMS Medicare and Medicaid that awards, incentives in the health care industry in which the certified electronic health records (EHRs) are used to improve patient care (Practice Fusion, 2016). These incentives are for professionals that care for about 30% of their adult patient volume or 20% of their children’s volume for Medicare and Medicaid patients (CMS, 2016). In addition, adjusting from paper charts to electronic charts of patient’s information is beneficial for MU. Furthermore, the American
The U.S. health care system faces challenges that indicate that the people urgently need to be reform. Attention has rightly focused on the approximately 46 million Americans who are uninsured, and on the many insured Americans who face rapid increases in premiums and out-of-pocket costs. As Congress and the Obama administration consider ways to invest new funds to reduce the number of Americans without insurance coverage, we must simultaneously address shortfalls in the quality and efficiency of care that lead to higher costs and to poor health outcomes. To do otherwise casts doubt on the feasibility and sustainability of coverage expansions and also ensures that our current health care system will continue to have large gaps even for those with access to insurance coverage.
In a survey conducted in 2003, it highlighted that the recurrent problem is the reimbursement rate from Medicaid to the physician (O’Shea, 2007). The Center for Studying Health System Change (HSC) show that 21% of physicians that state they accept Medicaid have reported they will not accept a new Medicaid patient in 2004-2005(O’Shea, 2007). This number would only logically be assumed to have risen in 2013 A survey conducted by the U.S. National Health reported that researchers have found two standout trends among Medicaid beneficiaries: they have more difficulty getting primary care and specialty care and they visit hospital emergency departments more often than those with private insurance (Seaberg, 2012). The lack of primary and specialty care access is mostly contributed to the following barriers; unable to reach the MD by phone, not having a timely appointment with the MD and lastly unable to find a specialty MD that will accept Medicaid. In a recent report released by the Partnership to Fight Chronic Disease, it stated that about 30% of Medicaid patients experience “extreme uncoordinated care”, there is a strong correlation between this situation and higher Medicaid spending and less quality of care given (Bush, 2012). After January 1st 2013, healthcare providers have experienced a 2% reduction in payments for Medicaid beneficiary, this will only create more of a problem for these patients to seek the
Medicaid has help many qualified Americans who were historically unable to access health care. At the same time, it has raised questions and controversies as how efficient is the plan overall. Various research studies were conducted and contradicting results were presented. According to Paradise and Garfield (2013), some said that having no coverage at all is better that having a Medicaid coverage. On the other hand, some expressed that Medicaid paved a way to improved health due to increased access to services that provides prevention of diseases, health maintenance, and effective treatment (Paradise & Garfield, 2013). As for me I am in favor of the later, health care access for all. It comes down to equitable distribution of resources
Throughout the early 1980’s and 1990’s the Federal Medicaid program was challenged by rapidly rising Medicaid program costs and an increasing number of uninsured population. One of the primary reasons for the overall increase in healthcare costs is the
Though the American healthcare system has made big steps towards providing affordable healthcare for everyone, there remains a growing population of people who fall through the system’s cracks. These people are the medically underserved. They are typically the victims of unfortunate life circumstances that has left them without health insurance, or with insurance that provides inadequate coverage. The underserved also includes those who have trouble accessing healthcare for any reason. Anyone with illnesses or disabilities that require assistance beyond their coverage, or people who live in remote areas where healthcare services are sparse fall under this title. The term also does not exclude those who have sufficient insurance and resources, but struggle to understand and navigate our increasingly complex system of healthcare.
In this research paper it will identify how Medicaid came about and what Medicaid used for, the different between Medicare and Medicaid, the benefits and disadvantage in the use of Medicaid. Medicaid is a state administrated program that provides medical support for a broad range of people. Medicaid was established in 1965 through the Social Security Act, which was an act to provide for the general welfare by creating a system of senior citizen benefits as well as low income people not all but limited to and by enabling that many states to make more acceptable provision for aged people, blind, dependent and crippled children, maternal and child welfare, and public health. Medicaid program was one of many programs created to
Medicaid has grown exponentially after healthcare was expanded under the Affordable Care Act. However, this did not guarantee an increase in access to health care services, as many providers do not accept Medicaid beneficiaries, one of many reasons being low reimbursement rates. This discrepancy in rate reimbursement is further underscored when compared to those
In the current U.S. system the free market prevails and companies, in this case, major insurance providers “compete” for business. This competitive business approach should in theory drive costs down. For some reason, however, an argument can be made that it has produced the opposite result in profiteering. The nation’s largest insurer, UnitedHealth, boasted over a 10 percent revenue increase in 2013 according to Forbes (2013). Health insurance affordability contributes to the disparity in access to health care, as evidenced by the fact that there are millions that are still uncovered. A greater majority of certain minorities lack both health insurance and the financial resource to seek out either health care or insurance. While insurance companies reap huge profits the percent of private sector companies offering health insurance has dropped to less than 50 percent (Kaiser, 2013). There is decidedly a lack of coordination of care for this at risk population as well, since treatment is rendered sporadically and with continuously changing providers. The last major challenge is that of improving the quality of health care. According to a 2010 report by the U.S. Department of Health and Human Services, Office of Inspector General (OIG), an estimated 13.5 percent of Medicare beneficiaries experienced adverse events during their hospital stay and an additional 13.5 percent experienced a temporary
Within the United States some populations groups face greater challenges then the general public with being able to access needed health care services in a timely fashion. These populations are at a greater risk for poor physical, psychological, and social health. The correct term would be underserved populations or medically disadvantaged. They are at a disadvantaged for many reason such as socioeconomic status, health, and geographic conditions. Within these groups are the racial and ethnic minorities, uninsured children, women, rural area residents, mentally ill, chronic illness and the disabled. These groups experience greater barriers in access to care, financing of care, and cultural acceptance. Addressing these
Once Medicaid beneficiaries gain access to the health care system, they receive inferior quality of care compared to patients with private insurance. Research was done on patients treated for multiple types of heart attacks and other cardiac diseases. For example, patients with non-ST segment elevation acute coronary syndromes, a form of heart attack, benefit significantly from innovative therapeutic approaches, including minimally invasive strategies for management. According to a study in the Annals of Internal Medicine, however, Medicaid patients who suffered from this same form of heart attack were less likely to receive evidence-based therapies and had worse outcomes (O’Shea, 2012). Similarly, Medicaid patients had higher mortality rates than patients who had private insurance. This
The United States has a unique system of healthcare delivery, it is complex and massive. Twenty-five years ago; American citizens had guaranteed insurance, meaning the patient could see any physician and the insurance companies and patients would share the cost. But today, 187.4 million Americans have private health insurance coverage (Medicaid, 2014). The subsystems of American health care delivery are Managed care, military, vulnerable populations and integrated delivery
Health information management involves the practice of maintaining and taking care of health records in hospitals, health insurance companies and other health institutions, by the use of electronic means (McWay 176). Storage of medical information is carried out by health information management and HIT professionals using information systems that suit the needs of these institutions. This paper answers four major questions concerning health information systems.
Demographic shifts in the global population, greater levels of technological disruption due to the Internet, social media and the en masse adoption of smartphones and tablet PCs are together re-defining the healthcare informatics market. System and informatics theories have emerged as the foundational elements of healthcare informatics supported by the Data, Information. Knowledge (DIK) Model which acts as a taxonomy for these developments (Haugh, 2005). Systems and informatics theories along with the DIK Model form the ontological foundations of healthcare informatics field of research occurring today and will continue to provide a basis for further research (Braganza, 2004). The intent of this analysis is to evaluate the contributions of systems and informatics, the role of the DIK Model, expert systems in nurse care and medicine, and the use of decision aids and decision support systems. All of these elements are critically important to strategic information systems plans healthcare providers put into place to serve patients while giving healthcare professionals the applications, systems and software they need to excel in their roles (Djellal, Gallouj, 2007).
Technology and innovation have transformed the way people function personally and professionally. In the past, writing and mailing a letter was standard but now most people send electronic messages and text messages to phones. Healthcare has been changing tremendously as well, not only are paper charts and records becoming obsolete, but now many facilities are sharing test results, visit information details, and prescribed drug lists. This move into the digital age has helped improve healthcare by cutting costs in the long-term, increasing efficiency with decreased wait times, and reducing medical errors. This evolving technology expansion, commonly referred to as nursing informatics has created many