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Primary Care Case Management
Primary Care Case Management (PCCM) is a system of managed care in the US used by state Medicaid agencies, in which a primary care provider is responsible for approving and monitoring the care of enrolled Medicaid beneficiaries, typically for a small monthly case management fee in addition to fee-for-service reimbursement for treatment.Joanne Rawlings Sekunda, Deborah Curtis and Neva Kaye. "Emerging Practices in Medicaid Primary Care Case Management Programs". Prepared by the National Academy for State Health Policy for the U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, June 2001 In the mid-1980s, states began enrolling beneficiaries in their PCCM programs in an attempt to increase access and reduce inappropriate emergency department and other high cost care. Use increased steadily through the 1990s. History In 1981, the 97th session of Congress enacted the Omnibus Budget Reconciliation Act (OBRA) which allowed sta ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Medicaid
Medicaid in the United States is a federal and state program that helps with healthcare costs for some people with limited income and resources. Medicaid also offers benefits not normally covered by Medicare, including nursing home care and personal care services. The main difference between the two programs is that Medicaid covers healthcare costs for people with low incomes while Medicare provides health coverage for the elderly. There are also dual health plans for people who have both Medicaid and Medicare. The Health Insurance Association of America describes Medicaid as "a government insurance program for persons of all ages whose income and resources are insufficient to pay for health care." Medicaid is the largest source of funding for medical and health-related services for people with low income in the United States, providing free health insurance to 74 million low-income and disabled people (23% of Americans) as of 2017, as well as paying for half of all U.S. births i ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Omnibus Budget Reconciliation Act Of 1993
The Omnibus Budget Reconciliation Act of 1993 (or OBRA-93) was a federal law that was enacted by the 103rd United States Congress and signed into law by President Bill Clinton on August 10, 1993. It has also been unofficially referred to as the Deficit Reduction Act of 1993. Part XIII of the law is also called the Revenue Reconciliation Act of 1993. The bill stemmed from a budget proposal made by Clinton in February 1993; he sought a mix of tax increases and spending reductions that would cut the deficit in half by 1997. Though every congressional Republican voted against the bill, it passed by narrow margins in both the House of Representatives and the Senate. The act increased the top federal income tax rate from 31% to 39.6%, increased the corporate income tax rate, raised fuel taxes, and raised various other taxes. The bill also included $255 billion in spending cuts over a five-year period. The effects of the bill helped the US federal government to experience in 1998 its firs ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Emergency Department
An emergency department (ED), also known as an accident and emergency department (A&E), emergency room (ER), emergency ward (EW) or casualty department, is a medical treatment facility specializing in emergency medicine, the acute care of patients who present without prior appointment; either by their own means or by that of an ambulance. The emergency department is usually found in a hospital or other primary care center. Due to the unplanned nature of patient attendance, the department must provide initial treatment for a broad spectrum of illnesses and injuries, some of which may be life-threatening and require immediate attention. In some countries, emergency departments have become important entry points for those without other means of access to medical care. The emergency departments of most hospitals operate 24 hours a day, although staffing levels may be varied in an attempt to reflect patient volume. History Accident services were provided by workmen's compensation ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Illinois
Illinois ( ) is a U.S. state, state in the Midwestern United States, Midwestern United States. Its largest metropolitan areas include the Chicago metropolitan area, and the Metro East section, of Greater St. Louis. Other smaller metropolitan areas include, Peoria metropolitan area, Illinois, Peoria and Rockford metropolitan area, Illinois, Rockford, as well Springfield, Illinois, Springfield, its capital. Of the fifty U.S. states, Illinois has the List of U.S. states and territories by GDP, fifth-largest gross domestic product (GDP), the List of U.S. states and territories by population, sixth-largest population, and the List of U.S. states and territories by area, 25th-largest land area. Illinois has a highly diverse Economy of Illinois, economy, with the global city of Chicago in the northeast, major industrial and agricultural productivity, agricultural hubs in the north and center, and natural resources such as coal, timber, and petroleum in the south. Owing to its centr ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
North Carolina
North Carolina () is a state in the Southeastern region of the United States. The state is the 28th largest and 9th-most populous of the United States. It is bordered by Virginia to the north, the Atlantic Ocean to the east, Georgia and South Carolina to the south, and Tennessee to the west. In the 2020 census, the state had a population of 10,439,388. Raleigh is the state's capital and Charlotte is its largest city. The Charlotte metropolitan area, with a population of 2,595,027 in 2020, is the most-populous metropolitan area in North Carolina, the 21st-most populous in the United States, and the largest banking center in the nation after New York City. The Raleigh-Durham-Cary combined statistical area is the second-largest metropolitan area in the state and 32nd-most populous in the United States, with a population of 2,043,867 in 2020, and is home to the largest research park in the United States, Research Triangle Park. The earliest evidence of human occupation i ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Texas
Texas (, ; Spanish language, Spanish: ''Texas'', ''Tejas'') is a state in the South Central United States, South Central region of the United States. At 268,596 square miles (695,662 km2), and with more than 29.1 million residents in 2020, it is the second-largest U.S. state by both List of U.S. states and territories by area, area (after Alaska) and List of U.S. states and territories by population, population (after California). Texas shares borders with the states of Louisiana to the east, Arkansas to the northeast, Oklahoma to the north, New Mexico to the west, and the Mexico, Mexican States of Mexico, states of Chihuahua (state), Chihuahua, Coahuila, Nuevo León, and Tamaulipas to the south and southwest; and has a coastline with the Gulf of Mexico to the southeast. Houston is the List of cities in Texas by population, most populous city in Texas and the List of United States cities by population, fourth-largest in the U.S., while San Antonio is the second most pop ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Louisiana
Louisiana , group=pronunciation (French: ''La Louisiane'') is a state in the Deep South and South Central regions of the United States. It is the 20th-smallest by area and the 25th most populous of the 50 U.S. states. Louisiana is bordered by the state of Texas to the west, Arkansas to the north, Mississippi to the east, and the Gulf of Mexico to the south. A large part of its eastern boundary is demarcated by the Mississippi River. Louisiana is the only U.S. state with political subdivisions termed parishes, which are equivalent to counties, making it one of only two U.S. states not subdivided into counties (the other being Alaska and its boroughs). The state's capital is Baton Rouge, and its largest city is New Orleans, with a population of roughly 383,000 people. Some Louisiana urban environments have a multicultural, multilingual heritage, being so strongly influenced by a mixture of 18th century Louisiana French, Dominican Creole, Spanish, French Canadian, Acadi ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Financial Risk
Financial risk is any of various types of risk associated with financing, including financial transactions that include company loans in risk of default. Often it is understood to include only downside risk, meaning the potential for financial loss and uncertainty about its extent. A science has evolved around managing market and financial risk under the general title of modern portfolio theory initiated by Dr. Harry Markowitz in 1952 with his article, "Portfolio Selection". In modern portfolio theory, the variance (or standard deviation) of a portfolio is used as the definition of risk. Types According to Bender and Panz (2021), financial risks can be sorted into five different categories. In their study, they apply an algorithm-based framework and identify 193 single financial risk types, which are sorted into the five categories market risk, liquidity risk, credit risk, business risk and investment risk. Market risk The four standard market risk factors are equity ri ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Case Management (USA Health System)
Case management is a managed care technique within the health care coverage system of the United States. It involves an integrated system that manages the delivery of comprehensive healthcare services for enrolled patients. Case managers are employed in almost every aspect of health care and these employ different approaches in the control of clinical actions. Definition The American Case Management Association (ACMA), a non-profit association dedicated to the support and development of the profession of case management through educational forums, networking opportunities, legislative advocacy and establishing the industry's Standards of Practice, defines case management as: Case management focuses on delivering personalized services to patients to improve their care, and involves four steps: # Referral of new patients (perhaps from another service if the client has relocated to a new area out of previous jurisdiction, or if client no longer meets the target of previous serv ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Nursing Process
The nursing process is a modified scientific method. Nursing practise was first described as a four-stage nursing process by Ida Jean Orlando in 1958. It should not be confused with nursing theories or health informatics. The diagnosis phase was added later. The nursing process uses clinical judgement to strike a balance of epistemology between personal interpretation and research evidence in which critical thinking may play a part to categorize the clients issue and course of action. Nursing offers diverse patterns of knowing. Nursing knowledge has embraced pluralism since the 1970s. Some authors refer to a mind map or abductive reasoning as a potential alternative strategy for organizing care. Intuition plays a part for experienced nurses. Phases The nursing process is goal-oriented method of caring that provides a framework to nursing care. It involves seven major steps: *A : Assess (what data is collected?) *D : Diagnose (what is the problem?) *O : Outcome Identificati ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Medical Case Management
Medical case management is a collaborative process that facilitates recommended treatment plans to assure the appropriate medical care is provided to disabled, ill or injured individuals. It is a role frequently overseen by patient advocates. It refers to the planning and coordination of health care services appropriate to achieve the goal of medical rehabilitation. Medical case management may include, but is not limited to, care assessment, including personal interview with the injured employee, and assistance in developing, implementing and coordinating a medical care plan with health care providers, as well as the employee and his/her family and evaluation of treatment results. Medical case management requires the evaluation of a medical condition, developing and implementing a plan of care, coordinating medical resources, communicated healthcare needs to the individual, monitors an individual's progress and promotes cost-effective care. The term also has usage in the USA he ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Managed Care
The term managed care or managed healthcare is used in the United States to describe a group of activities intended to reduce the cost of providing health care and providing American health insurance while improving the quality of that care ("managed care techniques"). It has become the predominant system of delivering and receiving American health care since its implementation in the early 1980s, and has been largely unaffected by the Affordable Care Act of 2010. ...intended to reduce unnecessary health care costs through a variety of mechanisms, including: economic incentives for physicians and patients to select less costly forms of care; programs for reviewing the medical necessity of specific services; increased beneficiary cost sharing; controls on inpatient admissions and lengths of stay; the establishment of cost-sharing incentives for outpatient surgery; selective contracting with health care providers; and the intensive management of high-cost health care cases. The p ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
