health assingments

8. What are four ways in which managed care tries to reduce costs?

- establishment of provider networks. - utilization management (payers decide what type of plan a person should be on based on their needs) - preventive care. -financial incentives to choose less expensive options

1. In 2016, how many people died of drug overdoses in America?

64,000

4. What is the purpose of Medicare requiring the hospital to pay part of the charges associated with those services that are often used after hospitalization?

Again, to prevent the hospital from discharging a patient too soon. This way, they are still responsible for what happens to the patient after they leave the hospital.

1. Did ACA improve healthcare access in America? How so?

Based on the article, 20 million more Americans have healthcare, so yes it has improved ACCESS.

5. How is the shared savings program unfair to providers who were already being careful about their spending?

Because the expected level set by the payer is based on past activity of a payer, providers who were already very careful which have a much lower expected amount and are already doing a lot of saving for insurance companies.

4. Why are some people worried that their companies that provide good health insurance plans may cancel those options?

Companies are willing to cancel their employees' good insurance plan because paying the penalties and forcing employees to get their insurance through the health exchanges is cheaper for these companies.

1. What does the article mean by "virtual care"?

Doctors being able to provide healthcare services through the use of relevant technologies, such as phone, email, webcam, or consulting other doctors or their patients electronically.

5. How did doctors contribute to the opioid epidemic?

Freely wrote prescriptions and overprescribed these drugs because they were exhausted from dealing with difficult-to-treat patients

4. Which ones require you to choose a primary care physician?

HMO and POS

2. Of the three types, which is the least flexible?

HMOs

1. List the three basic types of managed care organizations:

Health Maintenance Organizations (HMO's), Preferred Provider Organizations (PPO's), and Point of Service (POS)

2. What is the name of the websites where people who want to get Obamacare can choose their plans?

Health exchanges (Health insurance marketplace)

9. What are the three types of consumer-driven health plans?

Health savings accounts (HSAs), flexible spending account (FSAs), health reimbursement accounts (HRAs)

9. How do you feel about the transition from volume-based care to value-based care and why? (2 points)

I was just looking for a thoughtful answer that shows you are thinking and applying your own opinions to what you learn.

3. Why would the hospital's strategy focus on patients with chronic disease who need frequent follow up visits but infrequent physical exams?

If a patient doesn't need to be present physically but needs to be in touch with the doctor on a regular basis because of their chronic condition, they are the ideal candidate for virtual visits. Patients who need to be physically present would not benefit from virtual care.

3. Based on the article and class, why does Obamacare force everyone to get health insurance?

If more people have insurance, more people will go to the doctor when they are sick, instead of waiting until their illness turns into an expensive emergency, which lowers healthcare costs for everyone. Also, more money is pooled by insurance companies to subsidize healthcare services.

3. How do providers make a profit from the bundled payment/episodic payment system?

If they improve efficiency within an episode

8. How are PSHPs different than MCOs?

In PSHPs, the provider network and coverage is led by the provider/hospital itself, rather than an insurance company.

7. What is the difference between capitation and bundled/episodic payments?

In capitation, a set payment is per patient, and in bundled/episodic payments, payments are set based on a condition or specific procedure.

2. What is the major downside to DRGs?

It gives hospitals a reason to discharge patients prematurely because they don't want to spend more money on a patient than they will be reimbursed.

6. Why is it unclear whether Obamacare has reduced national healthcare spending?

It is hard to untangle the effects of other factors, such as the Great Recession.

1. What is the problem with the FFS model?

It rewards volume, which isn't always necessarily better care. Providers are more inclined to deliver more treatments, admissions, provedures, and tests, but that doesn't necessarily mean that's better for the patient.

3. If a managed care plan is less flexible, is it more likely to be (choose: More or Less) expensive?

Less expensive

3. What were the two general ways in which NYC made the smoking rate decline from 2002 to 2015?

Making tobacco less accessible (by banning smoking in public spaces and raising taxes to make cigarettes much more expensive) and making tobacco alternatives more accessible (easier to obtain nicotine patches or gum)

4. What types of healthcare services are more accessible than before under Obamacare?

Maternity services, treatment for drug addiction, cancer screenings, mental health counseling, contraception

1. In your own words, describe a DRG

Medicare and some other health insurance companies reimburse the hospital for a patient's stay based on the diagnosis. The fixed rate associated with a particular diagnosis is called a DRG.

3. How does Medicare ensure that hospitals don't discharge their patients too soon?

Medicare has rules in place that punish a hospital financially if a patient is re-admitted to the hospital with the same diagnosis within 30 days of discharge

10. The article suggests that one of the reasons the government hasn't done much about this epidemic is because there's a "stigma" associated with addiction. What is your interpretation of this idea?

Much of the public/government views drug addiction as a moral failure, rather than a medical condition. Thus, the epidemic isn't treated as much of a serious problem as it is.

2. If you have a pre-existing condition, can an insurance company deny you coverage?

No

7. Does a principal diagnosis have to be determined at the time of the patient's hospital admission in order to be reimbursed by Medicare through DRGs? Explain (2 pts).

No, the issue had to be present at the time of the patient's admission, because sometimes the doctor figures out what the diagnosis is after admission.

9. What is medication-assisted treatment?

Other medicines are used to combat cravings

2. How does P4P incentivize providers to perform well?

Providers are financially rewarded if they perform up to set measures

4. How did pharmaceutical companies contribute to the opioid epidemic?

Pushed doctors to prescribe opioids and mislead them about the safety anf efficacy of these drugs

4. What is one benefit to the provider of virtual care visits?

Reduces the number of no-shows to the doctor.

6. What is the difference between shared risk and shared savings?

Shared risk includes a penalty when spending excess.

6. Come up with an example on your own of a diagnosis and a comorbid condition:

Somebody being admitted for surgery, but during the surgery, their epilepsy acts up and they have a seizure.

2. Which substances account for the highest causes of drug overdoses?

Synthetic opioids, heroin, opioid painkillers

10. How would you describe consumer-driven health plans?

Tax-free bank accounts in which people put aside money to be used only for medical expenses. The upside to these is that they give people more choice and control over their health care spending.

8. In the article, what is meant by care continuity?

The concept that all a patient's providers are able to communicate and cooperate with each other so that the patient is delivered the highest quality health care that takes into consideration all of their medical needs and history.

A big component of managed care is provider networks. In your own words, describe what you think a provider network is.

The list of doctors from which a person can get care without having to pay out of pocket costs. To become a member of a network, providers have to meet specific quality standards and agree to pricing arrangements that lower overall costs.

5. What is the purpose of the questionnaires on the patient portal

The questionnaires covered the most common primary care complaints, including cough, red eye, urinary symptoms, and back pain. This helped to make the process of dealing with common symptoms more efficient for the patient and the provider.

3. What does redistributive law mean?

The transfer of wealth from the rich to the poor by the use of social initiatives such as taxes, in an effort to narrow the gap between the rich and the poor.

8. Why do Heroin and fentanyl pose the greatest risk of opiod overdose?

They are more potent and addictive, and fentanyl is often laced into heroin without the user's knowledge, so people would take bigger doses than they can handle

2. Do providers get paid more for virtual visits with patients of chronic disease than they would for an office visit?

They get paid the same.

7. Why are these options sometimes out of reach for pain patients?

They may not have insurance or the insurance may not cover these treatments

5. What is the purpose of a blended rate being assigned to each and every hospital?

To account for the fact that health care resource costs and labor vary across the country and even from hospital to hospital. In general, every hospital is different and has different financial needs.

5. Why have many customers of Obamacare switched health plans every year?

To avoid steep price increases. Moreover, the markets have been turbulent

7. What are the two aims of an e-consult?

To better support primary care providers so that more primary care can be managed without referrals, and (2) to assure that when referrals do take place, they are better packaged and triaged by the referring provider so that the specialty consultation is more effective for the patient

6. What is the purpose of gatekeeping and pre-authorization?

To prevent people from having unnecessary services, procedures, hospitalizations, etc., which ultimately reduces costs

4. According to this article, what are the two major goals of PCMHs?

To provide higher quality and better care coordination and prevent hospital readmissions & ER visits

1. Before Obamacare, how were uninsured people contributing to healthcare costs increasing?

Uninsured people were going to the hospital and not paying for the services, so hospitals were reimbursed from money coming from an emergency Medicaid plan, thereby leaving less money for subsidies.

6. Describe an "e-visit" in your own words

When a patient has a common, acute symptom that does not require a lot of time and attention from a doctor, but instead rapid triage, a patient can fill out the questionnaire provided by a doctor and submit it online. When the doctor checks his/her inbox, he/she will see that he/she received the questionnaire, and thus, he/she can order the appropriate medication or test, or even consult with other providers. Because the provider and patient did not need to be present and in communication at the same time, this is called asynchronous care.

5. What is gatekeeping in the context of managed care organizations?

When a patient is required to get a referral from the primary care physician (PCP) for specialty services

8. Do DRGs take into account that different patients with the same diagnosis may have different requirements based on their overall health? Explain (2 pts).

Yes, the DRG takes into consideration comorbid and major comorbid conditions and also factors such as age and gender.

6. What are other treatments for chronic pain that do not require opioids?

non-opioid medications, special physical exercises, alternative medicine approaches (such as acupuncture and meditation), and techniques for how to self-manage and mitigate pain.