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Related Concept Videos

Integrated Healthcare System01:20

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An integrated healthcare system (IHS) is a set of organizations that provides for or arranges to provide coordinated and continuous service to a defined population. The IHS takes responsibility for that particular population's health status and outcome, both clinically and fiscally. An integrated healthcare system is a well-organized, well-coordinated, and collaborative network. The integrated delivery system is a network that connects different healthcare providers to deliver organized,...
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Hospitals-II00:59

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Hospitals provide inpatient and outpatient services. Inpatient services provide care to patients that stay in the hospital for an extended period, ranging from days to months. Examples of inpatient services include intensive care units, hospital wards, or surgeries. Outpatient services provide care to patients who come to a hospital for a diagnostic or treatment but do not stay overnight —for example, diagnostic tests, surgical procedures, or health education.
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Professional accountability in nursing is a multifaceted concept that encompasses professional ethics, legal standards, and employment expectations. This framework ensures that nurses maintain and elevate the quality of care while upholding the values of their profession. It compels them to treat patients, families, and colleagues with respect, compassion, and integrity.
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At the different levels of the healthcare system, we see varying methods of healthcare used. These methods include managed care systems, case management, and primary healthcare.
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Related Experiment Video

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Improving IV Insulin Administration in a Community Hospital
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Community-based, Hospital-Affiliated Medical Group Becomes a Successful Accountable Care Organization.

Kathleen Madden1,2, Arnold DoRosario1, Ryan O'Connell1

  • 1Northeast Medical Group, Yale-New Haven Health, Stratford, CT.

American Journal of Medical Quality : the Official Journal of the American College of Medical Quality
|October 10, 2022
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Summary

This study details how a multispecialty group practice achieved significant shared savings and high quality outcomes by focusing on clinician engagement, prevention, and accurate coding within an Accountable Care Organization (ACO) framework.

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Area of Science:

  • Healthcare Management
  • Quality Improvement Science
  • Health Economics

Background:

  • Population health management necessitates quality improvement and cultural shifts within healthcare systems.
  • Existing literature lacks detailed accounts of academic health systems achieving both shared savings and high quality outcomes as Accountable Care Organizations (ACOs).

Purpose of the Study:

  • To describe the journey of a medical group within an academic health system in achieving shared savings and high quality outcomes.
  • To outline the strategies employed for successful Accountable Care Organization (ACO) participation.

Main Methods:

  • Implementing clinician education and engagement programs.
  • Prioritizing preventive care and performance benchmarks.
  • Developing supportive roles, enhancing diagnostic coding precision, and employing risk stratification.
  • Adapting to Centers for Medicare & Medicaid Services (CMS) quality measurement shifts from pay-for-reporting to pay-for-performance.

Main Results:

  • Initial dip in quality scores upon ACO participation, followed by a rise to 98.44% by 2020.
  • Achieved over $10 million below the financial threshold between 2015-2017.
  • Generated an aggregate of $24 million in shared savings from 2018-2020.

Conclusions:

  • A focused approach integrating quality improvement, clinician engagement, and precise financial/clinical management can lead to successful Accountable Care Organization (ACO) performance.
  • The strategies implemented demonstrate a viable model for academic health systems navigating population health management and value-based care.
  • Sustained effort in quality and financial performance is achievable despite evolving regulatory and performance measurement landscapes.