USHC Exam 2 pt 1 questions and answers 100% correct

USHC Exam 2 pt 1 questions and answers 100% correctDefine outpatient care any services that do not require an overnight stay in an institution includes long-term care and hospital *NO overnight stays Primary health care WHO definition 1) Essential care 2) Point of entry-gatekeeping 3) Coordination of care Primary health care IOM 1) Integrated (US does a good job w/ this) 2) Accessible (US does a good job w/ this) 3) Accountable clinical system and partners (US needs work) 4) Partnership with patients and community (US needs work) What are the 3 C's of integrated primary health care? Comprehensive Coordinated Continuous *These are critical for the development of US health care Changes due to COVID 1) More non-clinical health care workers 2) Telecommunication- is this good or bad for integrated and continuous care? 3) Trend toward corporate medicine Examples of outpatient and primary care settings 1) Community health clinics 2) Free clinics 3) Home health care 4) Hospice care 5) Hospitals Primary care models 1) Patient-centered medical homes (PCMH): comprehensive and continuous; increased quality and access, decreased costs 2) Community-oriented primary care (COPC): biopsychosocial method; collaborative and team-based approach; community and population approach Define population health the health outcomes of a group of individuals, including the distribution of such outcomes within the group AHA definition of population health Distribution of specific health statuses and outcomes wihtin a population, factors that cause the present outcome distribution, and interventions that may modify the factors to improve the health outcomes Examples of population health in practice 1) Cohort management (population medicine): improving health and reducing costs for specific groups of patients, often grouped by insurance type and focused on chronic disease 2) Community health (total population health): health outcomes of an entire group of individuals, often geographically defined, including the distribution/disparities of outcomes within the group Payer perspective of population health Any medical provider that has a contract with a payer to provide specific medical care to a specific group with 3 objectives: 1) Improve groups medical outcomes 2) Reduce group's per capita costs 3) Contractually capture the bulk of savings from 1 & 2 Motivation for population health 1) Mission of the hospital- supported by board 2) Vision of the hospital- supported by the community 3) Anchor instituion and focal point for all things health in the community- responsibility of leadership 4) Continued goodwill and loyalty; branding for continued success 5) Effectively manage resources- success in enw pay for value models Population health determinants 1) 10% (physical) environment (env. quality and built env.) 2) 20% health care (access and quality) 3) 30% health behaviors (diet, exercise, smoking, drinking) 4) 40% socioeconomic (education, employment, income, family/social support, community safety) Social determinants of health (SDoH) the numerous social factors such as income, education, and employment security that affect a person's health and well-being How to address the determinants of health 1) Collab with community to develop and sustain change 2) Ameliorate/improve consequences (community health needs assessment, collab w/ cross-sector partners) 3) Screen for patient needs (food security, transportation) 4) Results of screening may indicate service needs 5) Connect patients to community services Modest patient-centered medical homes (PCMH), bundled payments, values-based payments Intermediate care management payment, payment for different modalities of delivery, incorporating SDoH into payment policies (Medicare, Medicaid), primary care transformation networks Next steps Sharing risk to benefit from general revenues; Accountable Care Organizations (ACOs); limited global budgeting ACO= an integrated group of providers who are willing an d able to take responsibility for improving the overall health status, care efficiency, and satisfaction with care for a defined population Ultimate Payment for total cost of care PPE Public health Primary care Health equity Cultural beliefs in US re healthcare 1) Free market bias & price setting 2) Focus on treating me when I'm ill/injured- restore to as close to before as possible 3) Advance science and tech at all costs 4) Economic divide discussions of income distribution highly evident in healthcare Shared values 1) Belief in advancement through science (esp medicine) 2) Capitalism 3) Entrepreneurial spirit 4) Free enterprise and general distrust of the government US healthcare spending 2020 $4.1 billion $12,500 per capita 19.7% of GDP 9.7% increase GDP decreased but spending increased US healthcare spending 2019 17.6% of GDP 4.3% increase Why does the US spend so much on healthcare? 1) Changes in intensity of use (volume, frequency) 2) Changes in population (age, income, more spending for worse health) US spending and performance on healthcare compared to other countries Spending: spend the MOST ($11,945 compared to $5,900 in a comparable country average) Performance: perform the WORST (aside from care process which US is ranked 2nd of 11 countries) Wasteful spending 1) Pricing failures 2) Administrative complexity 3) Failrues in care delivery 4) Failures in care coordination 5) Overtreatment 6) Fraud and abuse COVID-19 pandemic and healthcare spending 1) Rise in federal gov't spending Assisting health care providers and states Funding public health activities Spending on social services Education income support Minimum wage Women Infant Children (WIC) SNAP EITC Transportation Public safety Housing States with higher ratios of social to health spending are associated with population health outcomes (w/ no causal inference) Better outcomes in states with higher share of spending in addressing factors affecting health Approaches to counter-balance spending growth Pressures from third party payers moderating price increases Example of reference pricing by CALPERS Innovation in delivery modalities may affect prices if there is an appropriate adjustment in prices w/o a counter-balance adjustment in volume Value for what we pay Broaden notion of spending on ehalth to include spending on social services that impact health Vulnerability Certain population groups that face greater challenges than the general public in accessing timely and needed health care services Examples of vulnerable populations Black Hispanic American Indian Alaska Native Asian Americans Women Children Migrant workers Homeless Rural (e.g., opioid, HIV) Uninsured Mental health Chronic illness (responsible for 7 of 10 deaths; heart disease; contribute to 88% of total healthcare costs) HIV/AIDS Vulnerability framework Predisposing (racial/ethnic; gender/age-women and children; geographic location) Enabling (insurance status; homelessness; cultural beliefs and norms) Need characteristics Vulnerability contributes to access and quality to care and subsequent health outcomes Systemic issues- how to deal with them 1) Raise questions of equity and deal with them 2) Manifest into clinical setting (collect data, use data to identify disparities, get to root cause of disparities, take stesp sto deal with causes- train workers to work w/ pts of diverse backgrounds) 3) Recognize and name (infant and maternal mortality; leading causes of death- COVID, cerebrovascular, diabetes) 4) Lifestyle (smoking, drinking, exercising, diet) 5) Upstream= SDoH, requires broader view Safety net providers 1) Community health workers (CHWs) 2) Federally qualified health centers (FQHCs) 3) Hospital emergency rooms (in US cities) 4) Hospitals and charity care 5) Physician clinics in rural US Contemporary realities 1) Characteristics compounded 2) COVID-19 rates: more per 100,000 in rural counties 3) COVID-19 rates in rural: higher in coutnies with higher proportion of vulnerable populations 4) COVID-19 rates are higher for vulnerable populations 5) ACA safety net was tested during COVID-19 recession 6) Need for equity in testing