NMNC 4520 FINAL13
Vertical Integration model - ANSWERSConsolidates all levels of care, staff and facilities under
one organizational ownership
consolidates health services under one roof
virtual integration model - ANSWERScontacting services with HMOs, physicians maintain
ownership but can still practice in HMO
involves contractual links between HMOs and physician groups, hospitals, and other provider
units.
Dawson's model - ANSWERShigh value placed on primary care, Regionalized/Coordinated
Care/Regulated, british NHS
free flowing model - ANSWERSWhat model of healthcare organization allows for a more fluid
role for caregivers, and more free-flowing movement of pts, across all levels of care, that tends
to pace higher value on services at the tertiary care apex than the primary care base?
First Generation HMOs - ANSWERSfull time salary model, vertical integration (Kaiser
Permanente) -> health plan, hospitals and medical group -> consolidated model, salaried
physicians, global budget hospitals -> helps control costs, ensure continuity of care -> less
choice for patient, less physician autonomy
Second Generation HMOs - ANSWERSvirtual integration -> doesn't own but has contracts with
hospitals, physicians, pharmacies, IPAs and home health agencies.
result of provider resistance of moving into group practice or being limited to one HMO
, Four habits of high value HCOs - ANSWERSuSpecification and planning: This includes both
operational decisions and clinical decisions. These decisions are based on specific criteria.
u2. Infrastructure design: This element includes microsystems such as technology, physical
design, and policies and procedures.
u3. Measurement and oversight: High-performing organizations seem to collect more data—and
use it—than other organizations.
u4. Self study: This habit involves introspection about any deviations from expected results,
both positive and negative. The goal is to increase the positive deviations and intervene when
the deviations are negative. Outcomes are viewed as critical to the organization, not just to an
individual or unit.
Primary Care Nursing Exs - ANSWERSuIndependent Nursing Visit
uinjections and procedures, newborn weight and color assessments, lactation support, first
prenatal visits, complex medication reconciliations, wound care, and follow-up with patients
after a visit to the emergency department.
umedication titration protocols to collaborate with PCPs in the management of patients with
common chronic illnesses, patient-specific "order sets" to be implemented by the RN care
manager over a series of visits for chronic illness management prior to a return visit with the
PCP
uTransition of Care
uCoumadin Panel Management
uCollaborative PCP and RN visit for complex patients
uHome Visiting
Levels of Care - ANSWERSPrimary - common health probs, preventive care
secondary- specialized clinical expertise, hospital/acute care, urgent care
tertiary - management of rare complex disorders, combination of highly specialized care and
hospital care
Painless cost control - ANSWERSControlling fees and provider incomes
Vertical Integration model - ANSWERSConsolidates all levels of care, staff and facilities under
one organizational ownership
consolidates health services under one roof
virtual integration model - ANSWERScontacting services with HMOs, physicians maintain
ownership but can still practice in HMO
involves contractual links between HMOs and physician groups, hospitals, and other provider
units.
Dawson's model - ANSWERShigh value placed on primary care, Regionalized/Coordinated
Care/Regulated, british NHS
free flowing model - ANSWERSWhat model of healthcare organization allows for a more fluid
role for caregivers, and more free-flowing movement of pts, across all levels of care, that tends
to pace higher value on services at the tertiary care apex than the primary care base?
First Generation HMOs - ANSWERSfull time salary model, vertical integration (Kaiser
Permanente) -> health plan, hospitals and medical group -> consolidated model, salaried
physicians, global budget hospitals -> helps control costs, ensure continuity of care -> less
choice for patient, less physician autonomy
Second Generation HMOs - ANSWERSvirtual integration -> doesn't own but has contracts with
hospitals, physicians, pharmacies, IPAs and home health agencies.
result of provider resistance of moving into group practice or being limited to one HMO
, Four habits of high value HCOs - ANSWERSuSpecification and planning: This includes both
operational decisions and clinical decisions. These decisions are based on specific criteria.
u2. Infrastructure design: This element includes microsystems such as technology, physical
design, and policies and procedures.
u3. Measurement and oversight: High-performing organizations seem to collect more data—and
use it—than other organizations.
u4. Self study: This habit involves introspection about any deviations from expected results,
both positive and negative. The goal is to increase the positive deviations and intervene when
the deviations are negative. Outcomes are viewed as critical to the organization, not just to an
individual or unit.
Primary Care Nursing Exs - ANSWERSuIndependent Nursing Visit
uinjections and procedures, newborn weight and color assessments, lactation support, first
prenatal visits, complex medication reconciliations, wound care, and follow-up with patients
after a visit to the emergency department.
umedication titration protocols to collaborate with PCPs in the management of patients with
common chronic illnesses, patient-specific "order sets" to be implemented by the RN care
manager over a series of visits for chronic illness management prior to a return visit with the
PCP
uTransition of Care
uCoumadin Panel Management
uCollaborative PCP and RN visit for complex patients
uHome Visiting
Levels of Care - ANSWERSPrimary - common health probs, preventive care
secondary- specialized clinical expertise, hospital/acute care, urgent care
tertiary - management of rare complex disorders, combination of highly specialized care and
hospital care
Painless cost control - ANSWERSControlling fees and provider incomes
