Healthcare Changes and the Affordable Care Act : A Physician Call to Action

Healthcare Changes Reach Main Street: A Call to Action for Physicians provides guidance, examples, and information on processes and time lines for physicians based on the implementation of The Affordable Care Act (ACA) that was established in 2010. This volume focuses on how geriatricians and other healthcare professionals can be engaged in responding to the roll-out of the ACA in their communities, and through this engagement assume leadership roles in local hospitals, healthcare organizations, and medical societies to advance quality improvement and new models of care for older adults. In-depth chapters provide an update on quality improvement efforts at the state level, as well as changes in Medicaid financing and the significant impact this will have for older adults, particularly dual-eligibles. Many elements of the ACA are yet to be rolled out and many healthcare decisions are yet to be made. Healthcare Changes Reach Main Street: A Call to Action for Physicians will guide healthcare decision makers and help them to play a leadership role in advancing quality care for older adults in our changing healthcare environment.​ Healthcare Changes and the Affordable Care Act: A Physician Call to Action provides guidance, examples, and information on processes and timelines for physicians based on the implementation of The Affordable Care Act (ACA) that was established in 2010. This volume focuses on how geriatricians and other healthcare professionals can be engaged in responding to the roll-out of the ACA in their communities, and through this engagement assume leadership roles in local hospitals, healthcare organizations, and medical societies to advance quality improvement and new models of care for older adults. In-depth chapters provide an update on quality improvement efforts at the state level as well as changes in Medicaid financing and the significant impact this will have for older adults, particularly dual-eligibles. Many elements of the ACA are yet to be rolled out and many healthcare decisions are yet to be made. Healthcare Changes and the Affordable Care Act: A Physician Call to Action will guide healthcare decision makers and help them to play a leadership role in advancing quality care for older adults in our changing healthcare environment Geriatricians Involvement In Healthcare Changes -- Healthcare Changes And Teh Affordable Care Act: A Physician Call To Action Quality Improvement Organizations -- Leadership Opportunities For Physicians -- The Abcs Of Acos -- Our Failing System: A Reasoned Approach Toward Single Payer -- Geriatric And Primary Care Workforce Development -- Medicare And Medicaid Coordination ? Special Case Of The Dual Eligible Beneficiary -- Care Management: From Channeling To Grace -- Program Evaluation: Defining And Measuring Appropriate Outcomes -- Targeting Interventions And Populations -- Accountable Care Organizations -- A Case Study In The Use Of Care Coordination: Montefiore Medical Center -- University Of Michigan Case Study: The Physician Group Practice Demonstration. James S. Powers, Editor. Includes Bibliographical References And Index. Mode Of Access: World Wide Web.

The New Third Edition Of Managed Health Care: What It Is And How It Works Is A Concise Introduction To The Foundations Of The American Managed Health Care System. Written In Clear And Accessible Language, This Handy Guide Offers An Historical Overview Of Managed Care And Then Walks The Reader Through The Organizational Structures, Concepts, And Practices Of The Managed Care Industry. This Thorough Revision Has Been Completely Updated With All The Newest Data On This Dynamic Industry And Features All New Sections On: Pay For Performance, Consumer Directed Health Plans, New Approaches To Care Management, As Well As Advances In Information Technology.

Provides an introduction to the foundations of the American managed health care system. Written in clear and accessible language, this handy guide offers an historical overview of managed care and then walks the reader through the organizational structures, concepts, and practices of the managed care industry. This thorough revision has been completely updated with all the newest data on this dynamic industry and features all new sections on: pay for performance, consumer directed health plans, new approaches to care management, as well as advances in information technology. Role of the Physician in the QIOSkills Needed; Stakeholder Engagement; Trade Association; Conclusion; References; Chapter 3: Leadership Opportunities for Physicians; Introduction; Defining Leadership; Characteristics of Good Leaders; Emotional Intelligence; Personality Types; How to Lead; Leadership Styles; Managing Physician and Patient Expectations; Why Some Leaders Succeed and Others Fail; Should I Take a Physician Leadership Job?; Specific Skills for Physician Leaders; Physician Recruitment; Negotiation; Credentialing and Privileging for Accountable Care; Quality of Care Oversight of Systems of Care and Patient Safety Performance Evaluation; Financial and Legal Skills for Physician Leaders; References; Chapter 4: The ABCs of ACOs; Introduction; Brief History of the Medicare Program; Medicare FFS Versus Managed Care History and Payment Mechanics; Cost Pressures and Medicare Managed Care Expansion and Contraction; Provider-Based Accountability: A Throwback; The Affordable Care Act and ACOs; Key Features of Medicare Pioneer and MSSP ACO Programs; Provider Participation and Length of Programs; Patient Alignment and Engagement; Financial Model Chapter 6: Geriatric and Primary Care Workforce DevelopmentReferences; Chapter 7: Medicare and Medicaid Coordination: Special Case of the Dual Eligible Beneficiary; Background; "Duals" Illness Burden and Diversity; Care Coordination Challenges; Models of Care Prior to the ACA; Medicare Advantage; Special Needs Plans (A Form of Medicare Advantage); State Demonstration Waiver Programs; The Program of All-Inclusive Care for the Elderly; Lessons from Previous Demonstration Projects; ACA Provisions Directly Related to the Care of the Duals; Financial Alignment Demonstrations Physician Payment Quality Monitoring; Care Coordination; Other ACO Models; Conclusion; References; Chapter 5: Our Failing System: A Reasoned Approach Toward Single Payer; Follow the Money; The Affordable Care Act; Lessons from Around the World; Medicare Today; Medicare Tomorrow: A Solution Hiding in Plain Sight; Key Provisions of HR676; The New Savings from a Single Payer Model Would Outweigh the New Expenses; Single Payer Would Level the Global Business Playing Field for Employers and Labor; The Roads to Single Payer; At the End of the Day; References The origins of managed health care -- Types of managed care organizations and integrated health care delivery systems -- Network management and reimbursement -- Management of medical utilization and quality -- Internal operations -- Medicare and Medicaid -- Regulation and accreditation in managed care Role of Geriatrics and Primary Care Providers in Implementing New Models of Care for the Dual Eligible Beneficiaries