Home Health Care Case Study

Medicare Parts A and B. There is a monthly premium for this coverage (Medicare 2013 costs at

Moreover, Medicare has improved quality of life and covers the essential health benefits one needs to stay healthy. Further, Medicare covers short-term home health care and covers the cost of paid companions who assist ‘seniors’ with activities of daily living at an affordable price.

Healthcare is often driven by consumers and insurance companies; there is strong pushes for insurance companies to start paying better through Patient Care Medical Homes (PCMH) or Accountable Care Organizations (ACO) rather than paying at a per-visit basis (Hamlin, 2015). With PCMH or ACOs payment is made on a continuum of care, encouraging the provider to be involved in all aspects affecting health of the patient (Derksen, & Whelan,

Medicare Part A is otherwise called the Hospital Insurance and covers up to 100 days of the Skilled Nursing Facility stay. To be qualified for it the patient first has to have been hospitalized for more than 3 days in a hospital (qualifying hospital stay) so the stay in it would not be considered outpatient. After the hospital stay the doctor that followed the patient in the hospital or the PCP that releases the patient from the hospital needs to write the order for the SNF services. In order for a patient to receive the services from the SNF they have to:

The Medicare offers three types of insurance coverage. Medicare part A hospital insurance covers inpatient care in hospitals, and skilled nursing facilities. It also helps cover hospice care and some home health care. This coverage does not cover custodial or long-term care (Center for Medicare and Medicaid Services, 2013). Medicare also offers part B Medical insurance that covers preventative care and outpatient care. Prescription drug

Since it’s founding in 1951, The Joint Commission has set standards and completed evaluations and accreditations for over 20,000 health facilities. Though not a government agency,The Joint Commission has a great level of authority in the field of healthcare and approval from the organization is often required by local health departments and CMS. Receiving the Commission’s seal of approval also goes a long way with potential clients familiar with the high standard of

Medicare is the federal health insurance program for people with certain disabilities, end stage renal disease, and for those who are over the age of 65. There are four different parts to Medicare, part A, part B, part C, and part D. Medicare Part A, also known as hospital insurance, covers inpatient hospital stays, care in nursing facilities, hospice care, and some in home health care. Part B is often referred to as medical insurance; it covers certain doctors’ services, outpatient care, medical supplies, and preventative care services. Medicare Part C, otherwise known as Medicare advantage plan is offered by a private

Representatives whose quality performance for the previous quarter falls in the middle third of the population will be placed in Tier 2. This group will receive approximately 5 - 10 quality evaluations for the quarter.

There are several types of health agencies within the United States that share common goals and complete similar tasks. Most agencies works together to provide good quality of care and patient’s safety. In today’s society, every health care organization should provide a proof of accreditation and are subject to a three-year

The Joint Commission is a nonprofit organization that certifies more than 18,000 health care organization and programs throughout the world. Founded in 1951, the Joint Commission provides a national symbol of quality for health care as well as analyzes each organization’s commitment to meeting high quality performance standards. The Joint commission focuses on accrediting Acute Care Hospitals, ambulatory, behavior health, long term care, health care facilities, clinical laboratories, health care networks and hospice. Numerous of accreditation organization is also taking place within the United States, but the Joint commission remains the largest The Joint commission accredits 20,000 organization” which” one third are Hospitals.

Medicare is a health insurance program purposely created for people over sixty five (65) years of age. However the service is open to people with certain disabilities or permanent kidney failures. The process of choosing the right Medicare involves having to weigh different plans on account of benefits of their cover. Different types of Medicare plans are important in: Inpatient hospital care, outpatient services, doctor visits, home health care, prescription drugs, and care in a skilled nursing facility among others. In addition, the program covers the cost of health care but does not cover all medical expenses including cost of long term care. If one ought to choose an original Medicare coverage, one may buy a Medicare supplement policy from a private insurance company to aid in coverage of costs that are not supported by Medicare. Most of these Medicare expenses are covered by a part of the pay role offered to workers by their employer. This paper covers different Medicare plans; A, B, C, D and their influence towards my decision on the best preferred option.

Other programs under DM that have shown to be beneficial to both the members and the health plans are, shared decision-making programs and medical informatics. PPOs, HMOs and CDHPs have preventive services programs being implemented. Preventive services include services such as: immunizations, mammograms, physicals, and counseling. An independent study on an indemnity plan that had prenatal preventive services showed that members who enrolled into this program had an average of $3200 less per delivery than those who had not (p.194). Health risk appraisals are a program geared to obtain information from members regarding activities or behaviors that can affect their health status (Kongstvedt, 2007,p.193). When the health plan obtains this information it

Ashton, C., Kuykendall, David H., Johnson, Michael M. (1999). An Empirical Assessment of the Validity of Explicit and Implicit Process-of-Care Criteria for Quality Assessment. 27(8). 798-808.

• Resource: Applying the Results and Conclusion of the Research Process to Problems in Health Care Grading Criteria.

Firstly, the old system was prone to central tendency error. It had 13 rating levels and lacked a described evaluation criteria. As one can understand, if the rating scale is large and the different levels are not sufficiently explained, the evaluators will be more likely to evaluate less accurately. In the case, one can read that managers gave almost to everyone a B or a C,