Types And Implementation Of Care Coordination

Health Information Exchange (HIE) has become a major component in today’s healthcare. Health information exchange provides a secure way for providers to appropriately access and electronically share a patient’s medical information. Therefore, reducing duplicate testing, minimizing medication errors and providing a link among electronic health records (EHR) in order to provide quality healthcare.

Patient-Centered Medical Homes (PCMH) are growing in popularity as the right thing to do improve patient care. PCMH are growing in popularity, as there is early evidence of their effectiveness (Egge, M. 2012). The PCMH concept has been widely promoted as a way to enhance primary care and deliver better care to patients with chronic conditions. This model of care has stimulated the attention of payers, Medicaid policy makers, physicians, and patient advocates, as it has the potential to address several of the limitations of the current healthcare system (Wang, J. et al 2014). Currently, primary care in the United States is focused on acute and episodic illness, it inadvertently limits comprehensive, coordinated, preventive and chronic care (Bleser, W. et al 2014). The PCMH address these limitations through organizing patient care, emphasizing team work, and coordinating data tracking (Bleser, W. et al 2014). A PCMH and HMO have some similarities but are markedly different.

Life expectancy has increased over the last century. With this greater survival rate, there needs to be an increase in the rate of spending for Medicare. Despite what one does to improve their health behavior, the need for medical care cultivates as one ages. This need will continue to increase significantly as medicine continues to modernize.

Many experts in healthcare economics point out that chronic medical conditions are directly associated with higher costs (G., 2010). This association is mainly attributed to the high usage of all types of care (Kongstvedt, 2013). Reports show that the number of people suffering with chronic conditions is radically rising and forecasts suggest that the number of American’s with one or more chronic conditions will continue to grow by an estimated 37% between 2000 and 2030 (G., 2010). It is in our patient’s main interest to shift our current focus from treatment for acute conditions to target a better utilization of the recorded 78% of health spending devoted to people with chronic conditions. The new strategic approach is one of developing quality medical care for people with chronic conditions which require ongoing care and care management to improve their health status (Kongstvedt, 2013).

Costs have escalated for a host of reasons. Americans’ health needs increased as their for example. Coverage grew to include catastrophic illnesses, not just common ailments. Ma added retiree health benefits. Medical techniques and technology became more sophisticate prescription drugs acquired an expanding role in disease management and illness preventio medical inflation had become a serious business issue; by some yardsticks, costs rose at a f decade than in the 1990s.

Berry, L., Rock, B., Houskamp, B., Brueggeman, J., & Tucker, L., (2013). Care coordination for patients with complex health profiles in inpatient and outpatient settings. Mayo Clinic Proceedings, 88(2), 184-94. Retrieved from http://search.proquest.com/docview/1312503895?accountid=34574

Expansion of the Medicaid coverage to all new eligible adults and increase fee for service and managed care by primary care physicians will be financed by federal funding. This will cause an outreageous increase in the Federal deficit from the historical 2.9% Gross Domestic Product to more than 20% by 2050.

By 2027 Medicare spending is projected to rise to 17.5% from the recorded 15% in 2016. Then in 2029 Medicare Hospital Insurance trust fund is expected to be completely washed-out (Cubanski & Neuman, 2017).

Medicare payments to hospitals grew annually by 19 percent; the Medicare hospital deductible had expanded, placing a burden on beneficiaries; the solvency of the Medicare Trust Fund was endangered by escalating costs; expenditures for hospital inpatient care jeopardized Medicare's ability to fund other necessary health programs; Medicare's payments for comparable services were vastly different across hospitals nationwide; and the cost-based system imposed burdensome reporting requirements.

Healthcare spending growth rate trends show astounding estimates. Since 1960, spending has risen from $27 billion ($143 per capita, 5.1% pf GDP) to amazing $1,678.9 billion ($5,670 per capita, 15.3% of GDP, 2003 data) (HHS, 2005). Recent research estimated that by 2013, healthcare spending will be as high as 18.4% of the Growth Domestic Product. It is important to note that the gradual move from hospital to ambulatory setting has resulted in much higher spending on outpatient hospital services and prescription drugs. The spending growth for these two trends is much higher than the overall healthcare cost growth, which, in fact, increases faster than such important economic indicators as GDP growth, inflation growth, and population growth rates.

Overweight and obesity are risk factors for diabetes, heart disease, high blood pressure, and other health problems. Since there is no single cause of all overweight and obesity, there is no single way to prevent or treat overweight and obesity that will help everyone. Treatment may include a combination of diet, exercise, behavior modification, and sometimes weight-loss drugs. In some cases of extreme obesity, bariatric surgery may be recommended. Once the disease is there it plans on staying there is no easy way of getting rid of it. We have to plan early and quick that is the importance and the message trying to be conveyed. We must make an early strike to prevent further

Care coordination within health care systems ensures the client of an effective and short stay. Care coordination refers to the coordination between and among professional teams that serve valuable roles involved in providing care to clients. Different disciplines of health care professionals include nursing, medicine, case management, pharmacy, nutrition, social work, and allied health professionals, such as speech therapists and physical therapists. They are found in all health care delivery systems and are extremely effective when the focus is strictly on the needs of the client. Interprofessional teams are valuable because each health care professional has specialized knowledge and skills so that health care plans are determined with

Medicare is facing a fiscal crisis that threatens its sustainability. The need for significant Medicare reform is increasingly urgent as 76 million baby boomers are expected to retire over the next two decade. According to the 201 Medicare Trustees Report, the Hospital Insurance trust fund will be depleted in 2024. This translates to $27 trillion in unfunded liabilities over the next 75 years. Current projections indicate that health care costs will increase by more that 70 percent over the next ten years and will continue thereafter to consume an increasingly greater portion of personal income.

(Elhauge, 2010). Fragmentation leads to duplication of tests and effort. Often, physicians do not have test results and notes from prior treatments. This results in wasteful duplication of efforts. Fragmentation leads to unplanned hospitalizations. Approximately 20% of discharged Medicare patients are re-hospitalized within thirty days. (Jencks, Williams, Coleman, 2009) It is estimated that only 10% of those readmissions are planned. (Jencks, Williams, Coleman, 2009) Patients can receive better continuation of care if their doctors coordinated better, if there was better discharge planning and incentives for providers to control costs after the patient has been discharged.

Unnecessary services are provided far too often because there is little coordination across sites or among providers, yet care management, cross disciplinary care, and preventive care are often uncovered or poorly reimbursed. Notably, 45% of the U.S. population have chronic conditions requiring care management. Of this population, 60 million, or roughly half of those with chronic conditions, have multiple conditions. Current care delivery systems are not designed to support the care of these complex patients, which requires multiple providers and services.