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Methods of Documentation VI: Case Management Model01:15

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The case management model is a multidisciplinary approach that involves healthcare professionals from diverse disciplines, such as physicians, nurses, therapists, social workers, and pharmacists, working collaboratively to address the various needs of patients. Each healthcare professional brings unique expertise and perspectives, contributing to a more comprehensive understanding of the patient's condition and tailoring treatment plans accordingly.
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Federal statutes profoundly impact nursing practice, providing critical guidelines to ensure patient care is equitable, accessible, and of the highest quality. The following laws address distinct aspects of healthcare provision and patient rights:
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Inverse Probability of Treatment Weighting Propensity Score using the Military Health System Data Repository and National Death Index
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Thinking About Clinical Outcomes in Medicaid.

Kevin Quinn1, Dawn Weimar, Jeffrey Gray

  • 1Xerox Corporation, Helena, Montana.

The Journal of Ambulatory Care Management
|March 6, 2016
PubMed
Summary

Medicaid is shifting to purchasing quality health care, focusing on clinical outcomes. This involves measuring and incentivizing results, especially in areas like maternity and newborn care, to improve value-based purchasing.

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Area of Science:

  • Health Services Research
  • Public Health Policy
  • Healthcare Quality Improvement

Background:

  • Medicaid is increasingly influential and transitioning to a purchaser of quality healthcare.
  • Managed care growth within Medicaid necessitates new approaches to quality assessment.
  • Existing quality metrics may not fully capture the value delivered by Medicaid services.

Purpose of the Study:

  • To discuss the measurement and incentivization of clinical outcomes within the Medicaid program.
  • To compare outcome measures with process measures, detailing their respective advantages and disadvantages.
  • To provide recommendations for implementing outcome-oriented value-based purchasing in Medicaid.

Main Methods:

  • A commentary analyzing the strategic shift of Medicaid towards value-based purchasing.
  • Discussion of the distinct roles of Medicare and Medicaid in quality incentivization.
  • Presentation of data on key Medicaid outcomes: preventable hospital admissions, readmissions, and complications.

Main Results:

  • Medicaid's purchasing power is significant, particularly in obstetric, pediatric, newborn, and long-term care.
  • Analysis highlights the complexities of outcome versus process measurement in Medicaid.
  • Data illustrates specific areas where Medicaid outcomes can be tracked and potentially improved.

Conclusions:

  • Outcome-based measures are crucial for Medicaid's evolution into a quality-focused purchaser.
  • Strategic implementation of value-based purchasing initiatives can enhance healthcare value for Medicaid beneficiaries.
  • Further development and adoption of outcome-oriented strategies are recommended for Medicaid programs.