Chapter 11; Health Insurance and Healthcare Systems Flashcards
(86 cards)
1
Q
In the United States, there is no comprehensive right to health care
A
yes
2
Q
in the US, the ability to access most health care is dependent on having health insurance.
A
yes
3
Q
the United States spends approximately $4 [..] per year on health care. that represents nearly 20% of the gross domestic product (GDP), or well over $10,000 per person per year. dollars spent have been growing [faster or slower] than inflation for over 50 years.
A
trillion
growing
4
Q
excessive healthcare costs take money from other activities, which makes it more [..] for the US to compete globally or have multiple resources to spend
A
difficult
side note; other developed countries, such as Canada, the United Kingdom, France, Germany, Japan, and Australia, generally spend less than half as much per person - that is, 10% or less of their GDP - on health care
5
Q
much of the money spent on healthcare, whether by individuals, businesses, or government, pays for [..] coverage. the majority of the remaining funds are spent to fill in the holes in insurance coverage through [..] payments by patients called out of pocket expenses.
A
insurance
direct
6
Q
basic types of insurance availability in the US;
government financed insurance
employment based insurance
health insurance exchanges
A
7
Q
important insurance terms, Cap;
a [..] on the total amount that the insurance will pay for a service per year, per benefit period, or per lifetime.
A
limit
8
Q
important insurance terms, Copayment;
a dollar amount that the insured is responsible for paying even when the service is [..] by the insurance
A
covered
9
Q
important insurance terms, coinsurance;
in contrast to copayment, the [..] of the charges that the insured is responsible for paying
A
percentage
10
Q
important insurance terms, covered service;
a service for which health insurance will provide payment or coverage if the individual is [..] - in other words, any [..] has already been paid
A
eligible
deductible
11
Q
important insurance terms, customary, prevailing, and reasonable;
these standards were used in the past by many insurance plans to determine the [..] that would be paid to the [..] of services. under many employer based plans, the provider may bill patients above and beyond this amount. this is known as balance billing
A
amount
provider
12
Q
important insurance terms, deductible;
the amount that an individual or family is responsible for paying [..] being eligible for health insurance coverage
A
before
13
Q
important insurance terms, eligible;
an individual may need to meet certain criteria to be able to enroll in a health insurance plan. these may include an [..] level for Medicaid, [..] and [..] in the social security system for medicare, or specific employment requirements for employer based insurance
A
income, age, enrollment
14
Q
important insurance terms, entitlement program;
a general term indicating that the insurance or other governmental program is available to all those who are eligible without the need for yearly [..] authorizations
A
budget
15
Q
important insurance terms, medical loss ratio;
the [..] of benefit payments paid to premiums collected - indicating the proportion of the premiums [..] - indicating the proportion of the premiums [..] on health services. [greater or lower] medical loss ratios imply that a larger amount of the premium is retained by the insurance company for administrative costs, marketing, and/or profit
A
ratio
collected, spent
lower
16
Q
important insurance terms, out of pocket expenses;
the cost of health care that is [..] covered by insurance and is the responsibility of the insured. these costs may be due to deductibles, copayments/ coinsurance, and/or balance billing
A
not
17
Q
important insurance terms, portability;
the ability to continue employer based health insurance after [..] a job - usually by paying the [..] cost of the insurance. a federal law known as the Consolidated Omnibus Budget Reconciliation Act (COBRA), generally ensures employees 18 months of portability but requires the employee to pay the entire cost of the covered insurance
A
leaving , full
18
Q
important insurance terms, premium; the price paid by the purchaser for the insurance policy on a [..] or [..] basis
A
monthly
yearly
19
Q
the two largest government programs of insurance are [..] and [..]. both programs began in the mid -1960s, but they have very different funding sources, coverage, and populations served
A
medicare
medicaid
20
Q
medicare began as a program for persons [..] and older. it was expanded to include [..] persons eligible of social security disability benefits and those with end stage renal disease.
A
65
disabled
21
Q
when medicare began, it was designed primarily to cover [..] services and [..] services . it did not cover drugs, most preventive services, or nursing home care. drugs are now covered by part [..] of medicare. covered preventive services have [..] in recent years. skilled nursing or rehabilitative care, but not nursing home (i.e. custodial) care, is covered by Medicare. dentistry and eyeglasses, among the most important medical needs of the elderly, are not generally covered by medicare
A
hospital
doctors’
expanded
22
Q
medicare is a [..] government program, which means that eligibility and benefits are consistent throughout the United States. Medicare is primarily funded by a payroll [..] of 1.45% from employees and 1.45% from employers. there is no [..] limit on this tax. self employed individuals pay the employer as well as the employee share
A
federal
tax
income
23
Q
medicare is a complicated entitlement program because there are four different parts: A, B, C, and D.
A
24
Q
Part A of medicare;
covers hospital care, skilled nursing care, and home health care after a hospitalization, as well as hospice care. it is paid for primarily by the payroll [..], and no premium is required. a small annual [..] is required before receiving payments
A
tax, deductible
25
part B of medicare;
voluntary supplementary insurance that covers a [..] range of [..] and [..] services provided by physicians and other clinicians, emergency departments, and other outpatient services.for most people, about 75% of the cost of part B is funded by [..] tax revenues and about 25% by a monthly premium , which starts at more than $100 per month. those with higher incomes pay [..] premiums, up to a maximum of 85% of the total cost of Part B. those covered by Part B are still responsible for copayments of 20% for most services. there is also a small deductible. health insurance policies called medical policies, which are offered by private insurance companies, are often obtained by individuals to cover all or most of the 20% copayment
wide
diagnostic, therapeutic
general , higher
26
part C of medicare;
Medicare Advantage is a special program designed to [..] Medicare beneficiaries to enroll in prepaid health plans which limit services to those provided within the medicare advantage insurance system. to learn more about medicare advantage
encourage
27
Part D of medicare;
is the prescription [..] coverage plan. it is a complicated plan that is open to those who are enrolled in parts [..] and [..] of medicare. it requires a monthly premium, with increases for higher income groups. for those in part D plans, legislation has limited the cost of covered drugs to [..] per Medicare recipient
drug
A and B
$2,000
28
medicaid is a [..] plus [..] entitlement program that is designed to pay for health services for specific categories of [..] people and other designated categories of individuals. it is now the largest federal health insurance system, covering nearly 50% of [..] in the US, nearly 40% of children, and well over half of all custodial nursing home care
federal , state
poor
births
29
medicaid; in the basic program, the federal government pays a variable amount of the cost ranging from [..]% to [..]%, depending on the per capita income of the state. these funds are designed to match the funds provided by a state based on the states medicaid formula. all states have chosen to be part of the basic program and therefore must provide [..] for such groups as the disabled, children, and pregnant women based on the federal poverty level. the federal poverty level for a family of four is currently approximately $30,000 per year. thus, there have been a substantial number of poor and near poor individuals who have not been eligible for the basic medicaid program
50% to 83%
benefits
30
medicaid; states, at their discretion, may include and receive federal matching funds for other categories of "medically needy" and may also increase the eligible income level up to 185% of the federal poverty level. most states cover custodial care in nursing homes for eligible individuals who have limited financial resources. as a result, medicaid has become the largest source of insurance funds for custodial nursing homes.
31
Medicare part C - Medicare Advantage is an alternative to the original Medicare. it has grown rapidly in recent years and currently is the medicare choice of approximately half of medicare recipients. large numbers of medicare advantage plans are being enoucrages in many metropolitan areas in an effort to promote competition. the details of plans differ and require medicare recipients to carefully research their options
Medicare Advantage plans are allowed, but not required, to include a wide range of additional services from basic dental care, vision, and hearing aids as well as transportation to medical visits, gym memberships, and a wide range of other additional services. Medicare Advantage often bundles the Part D drug benefit into the plan. Medicare Advantage plans are required to offer the same range of services provided by the original Medicare. Beyond that they have considerable flexibility and may require the 20% coinsurance as well as an additional premium.
(medicare advantage plans have greatly increased the choices for medicare recipients and have also greatly increased the complexity of these choices)
32
in order to obtain federal matching funding through Medicaid, states that administer the program must provide basic services that include most [..] and [..] services, including preventive services. states may choose to offer other services, and the federal government will provide matching funds for a wide range of services including [..] and other services that address the social determinants of health. thus, for those who are eligible for medicaid, the coverage is usually quite comprehensive. however, the reimbursement rates to clinicians are often comparatively [high or low], and clinicians often choose not to participate in the Medicaid program.
inpatient , outpatient
transportation
low
33
a program begun in the late 1990s called the State Child Health Insurance Program (SCHIP) provides [..] funds that states may use to enhance the health care of [..]. this may include raising the [..] level for Medicaid eligibility, starting eligibility more rapidly, and ensuring longer periods of eligibility. in recent years, congress has expanded and made this program more flexible, utilizing funds from an increase in the tax on [..]
additional , children
raising , income
cigarettes
34
medicaid now covers over 70 million individuals, about half of whom are [..]. funds spent on the elderly, including those in custodial nursing homes who constitute less than 10% of Medicaid beneficiaries, exceed those spent on children. the rising costs and increasing number of individuals eligible for the medicaid enrollees become members of a Medicaid-managed care in an effort to [..] costs and [..] continuity of care
children
reduced , improve
35
employment based insurance is the largest single category of insurance coverage in the US. nearly 50% of all Americans have the option to [..] some form of employment based insurance
purchase
36
employment based insurance is in large part an [..] of history. during World War II, employment were prohibited from raising wage . instead they offered [..] benefits. employment based insurance grew rapidly in the 1950s and 1960s based on a principle known as community rating , which implied that the cost of insurance was the same regardless of the health status of a particular group of employees. community rating has since been replaced by what is called experience rating or medical underwriting. this concept means that employers and employees pay based on their groups' [..] of services in previous years
accident
healthcare
use
37
in the 1950s and 1960s, and in many arts of the country, well into the 1990s, employment based insurance provided payments to [..] and [..] based almost entirely on fee for service payments, often using the customary, prevailing, and reasonable criteria.
clinicians , hospitals
38
fee for service, as its name implies , consists of charges [..] for specific services provided, and as a payment system, it encourages the provision of as many services as possible. thus, this system has been accused of [increasing or decreasing] healthcare costs through over use of services `
paid
increasing
39
in 1973, the federal government began to encourage an alternative approach to employment-based insurance originally called HMOs. traditionally, HMOs charge patients a [..] fee designed to cover a comprehensive package of services.
monthly
40
In HMOs clinicians or their organizations are paid based upon the [..] of individual that enroll in their practice. their compensation is based on what is called capitation, which is a [..] number of dollars per month to provide services to an enrolled member regardless of the number of services provided. HMOs are traditionally "staff model" HMOs, like Kaiser Permanents, that directly or indirectly provide the [..] package of services
number
fixed
entire
41
capitation, as opposed to fee for service, has the potential for [..] of services in an effort to reduce [..]. HMOs, in contrast to a fee for service system, traditionally cover preventive services and thus argue that that they do a better job of keeping people healthy
underuse
costs
42
fee for service systems often evolved into what are called preferred provider organizations (PPOs). staff model HMOs developed options for what are called point of service plans (POSs). PPOs imply that the fee for service insurance system decides to work with only a [..] number of clinicians, called preferred providers. these providers, who form the plan's network, agree to a set of conditions that usually includes reduced payment and other conditions. patients may choose to use other clinicians in what is called out of network care, but if they do so, they typically will pay [..] out of pocket.
limited
more
43
POS plans imply that patients in an HMO may choose to receive their care [..] the system provided by the health plan. like a PPO patient who goes out of network, patients, who choose the POS option must expect to pay [..] out of pocket .
outside
more
44
PPOs and POSs are today the most common forms of employment based insurance. they now come in a variety of forms and together can be called mixed models. an employer may offer its employees a number of complicated mixed model choices, as well ones that are closer to the classic fee for service, HMO staff model, or class HMO
45
health insurance exchanges provide a mechanism to obtain health insurance for those who are not eligible for [..] forms of comprehensive health insurance, including the self employed and those who work for small employers that often do not offer comprehensive health insurance. undocumented individuals are not eligible to [..] in the exchanges. health insurance exchanges provide an online [..] - a service available in every state that helps individuals, families, and small businesses shop for and enroll in health insurance
affordable
participate
marketplace
46
the aim of health insurance exchanges to provide [..] to health insurance, at times subsidized by the federal government, for citizens, and legal residents of the US. the aim is to create a competitive marketplace to help increase access and control the [..] of health insurance. access to the exchanges, subsidizes for health insurance, types of health insurance offered, and the competitive nature of the health insurance offered and have all been contentious issues in the national health insurance debate
access
costs
47
despite the multiple insurance system sin the US, a substantial percentage of the population remains uninsured or underinsured
48
until 2010, over 15% of all Americans did not have any form of health insurance, and at least half of that number, or another 7.5% were considered underinsured, often facing [..] when faced with major medical expenses
bankruptcy
49
in the years after the passage of the Affordable Care Act (ACA) in 2010, the percentage of uninsured was [..] to approximately 10%. the number of underinsured has officially been reduced by requiring most insurance plans to provide comprehensive insurance that by definition covers all the Essential Health Benefits. However, out of pocket expenses still threaten the finances of many Americans, implying a continuing problem of underinsurance
reduced (made smaller)
50
Essential Health Benefits include the following 10 categories of health services
- ambulatory patient services (outpatient services)
- emergency services
- hospitalization
- pregnancy, maternity, and newborn care
- mental health and substance use disorder services, including behavioral health treatment,
- prescription drugs
- rehabilitative and habilitative services (those that help patients acquire, maintain, or improve skills necessary for daily functioning) and devices
- laboratory services
- preventive and wellness services and chronic disease management
- pediatric services, including oral and vision care
51
The uninsured before passage of the ACA could be classified into the following quite different groups:
* [..], often [..], individuals who choose not to purchase health insurance through their employer
* poor or near-poor individuals who do not [..] for Medicaid
* Self-employed persons who did not have [..] to affordable health insurance and employees of small companies who were not offered affordable insurance
healthy, young
qualify
access
the ACA attempted to address the needs of each of these groups using different approaches;
- young individuals were allowed to stay on their parents' insurance until age 26 and were allowed to purchase "catastrophic coverage" with limited covered primary care services until age 30
- the states were provided substantial funding and initially were required to expand eligibility for medicaid to better provide insurance for the poor and near poor (the Supreme Court rules this requirement unconstitutional, making it an option for the states whether or not to expand their medicaid program)
- self employed individuals and those who worked for companies that did not provide comprehensive health insurance were permitted to purchase insurance through the health insurance exchanges, often subsidized for low and middle income participants
52
under the ACA, all individuals were [..] to purchase comprehensive health insurance that included the Essential Health Benefits or pay a substantial fine. the fine was removed during the Trump Administration
required
53
Harms of being uninsured to individuals and families;
- they receive less preventive care, are diagnosed at more advanced stages of disease, and receive less treatment once diagnosed
- they are much less likely to have a usual source of health care and more likely to use the emergency department for routine care
- they have an increased mortality rate, with an estimated 20,000 excess deaths per year
54
Those without insurance can and often do use an emergency department to obtain care. Emergency departments are [..] to provide care for life-threatening emergencies. However, after stabilizing an individual with a life-threatening emergency, an emergency department is not required to [..] the patient or provide any [..] care. The emergency department may transfer the patient to another facility that provides care for those without insurance.
required
hospitalized, continuing
55
When these individuals fail to pay their bills, the costs are often picked up by other patients with insurance, thus [..] the costs of health care for all those who purchase health insurance.
raising
56
A complex system of federal and state programs are available for those who are injured on the job or have a disabling condition. These programs can be categorized as:
* Workers' compensation and federal programs for workers
* Social Security Disability Insurance (SSDI) and Social Security Income (SSI)
these programs are not designed to replace health insurance but do provide some assistance to those who are disabled, including those injured on the job.
57
Workers' compensation or "workers' comp" programs are [..] programs in the vast majority of the states that have existed since early in the 20th century when industrial-era jobs became increasingly dangerous. [..]-term assistance for traumatic injuries is covered by all workers' compensation programs, but coverage of other conditions, long-term disability coverage, and coverage of off-the-job injuries [..] from state to state.
state
short, varies
58
Congress has also added disability assistance to cover specific populations and specific conditions.
Federal workers are eligible for coverage for occupational injury and illness. The Department of Labor manages several employment-focused disability programs including those for energy employees, long-shore and harbor workers, and coal miners who suffer from black lung disease.
59
The Social Security Administration manages two sources of disability payments called SSDI and SSl, both of which are designed to assist those with [..]-term disabilities preventing them from working. SSDI is designed for those who have paid into the Social Security system and their children. it requires [..] months' disability before applicants are eligible to apply and requires a complex disability determination process. Medicare is provided [..] years after the individual is determined to be eligible for SSDI. SSI provides payments for disabled [..] and [..] who meet income levels for eligibility regardless of their prior contributions of the Social Security system. applicants have [..] waiting periods before being eligible to receive benefits and are enrolled in Medicaid immediately upon a determination of disability
long, 12
2
adults, children
shorter
60
SSDI recipients receive payments comparable to other social security recipients, while SSI recipients receive [..] payments, often in the range of half of that received by SSDI recipients. Disability applications grew rapidly during the "Great Recession" to over 2 million applications, with nearly 1 million accepted claims per year, making it a part of the safety net. in recent years, the number of applicants has fallen as employment has [..]
lower
increased
61
One approach to describing healthcare systems is to define their characteristics using the follows categories:
* Method of financing
* Method of insurance and reimbursement
Methods for delivering services
* Comprehensiveness of insurance
* Cost and cost containment
* Degree of patient choice
* Administrative costs
62
the following distinguish the US healthcare system to only from that of Canada and the United Kingdom, bust also from the healthcare systems of most other developed countries;
- the US spends considerably more per person and as a percentage of GDP
- the US continues to have a high percentage of uninsured individuals
- the US healthcare system is more complex for patients and providers of care and costs far more to administer
- US hospitals are more high tech oriented and emphasize shorter lengths of stay
- the US healthcare system places more emphasis on specialized physicians and on nurse practitioners and physician associates to provides primary care
- The US encourages rapid adoption of technology, especially for diagnosis and treatment when covered by insurance
- the US places greater emphasis on giving patients a wider choices of clinicians, though cost containment efforts often reduce choice of clinicians
- clinicians, especially physicians, generally earn higher incomes in the US
- the US has a more complex system for ensuring quality and a unique system of malpractice law
63
cost charing is out of pocket expenses including deductibles, copayments, and coinsurance
64
it can be argued that the US relies most heavily on market justice, while the UK places the greatest emphasis on social justice. Canada lies somewhere in between
65
While the U.S. scores favorably on use of technology, success in reducing cigarette smoking, and access to elective surgery, its considerably higher costs, somewhat poorer health outcomes, and lower patient satisfaction imply a need for improvement.
66
factors increasing costs in most developed countries;
- the aging population
- technological innovations have greatly expanded treatment options
- successes of medical care over the last half century have raised expectations of patients
(Nearly all developed countries face these forces to a greater or lesser extent. Many countries in Europe, as well as Japan, face an even more rapidy aging population than the United States. How the healthcare systems respond to these challenges it. determine in large part the overall costs of health care in each country.)
- aging population; The success of public health and healthcare efforts over the last century has produced a population that is living longer. Longer life is strongly associated with the development of chronic diseases, many of which require expensive care over many years or decades.
- technology; A wide range of interventions is now possible, some of which can have dramatic impacts on longevity and the quality of life. However, many others produce very modest improvements at high costs. It may be difficult to distinguish these different types of results.
- expectations; Greater expectations for access to technology, preventve interventions, individualized care, rapid access to care, rapid access to medical records, privacy and protection of confidentiality are now all possible, but often are quite expensive.
67
category of excess costs of health care;
- unnecessary services and overuse (210 billion)
- discretionary use beyond benchmarks
- unnecessary choice of higher cost services
68
category of excess cots of health care;
inefficiently delivered services (130 billion)
- mistakes - errors, preventable complications
- care fragmentation
- unnecessary use of higher cost providers
- operational inefficients at care delivery sites
69
category of excess cots of health care;
- excess administrative costs
(190 billion)
- insurance paperwork costs
- insurers administrative inefficients
- inefficiencies due to care documentation requirements
70
category of excess cots of health care;
- prices that are too high
(105 billion)
- service prices beyond competitive bench marks
- product prices beyond competitive benchmarks
71
category of excess cots of health care; - missed prevention opportunities
(55 billion)
- primary prevention
- secondary prevention
- tertiary prevention
72
category of excess cots of health care;
fraud (75 billion)
- all sources - payers, clinicians, patients
73
Together, these excess costs were approximately 25% of the dollars the United States spent on health care. Efforts to reduce these costs provide great opportunities for controlling healthcare costs without jeopardizing quality or access.
74
There are two basic approaches that are being increasingly implemented in the US to reduce the costs of the US health system while maintaining or increasing quality . these approaches that may be used alone or together have been called:
- competition
- population health management
75
one key features of a well functioning market,
- *informed purchaser*
- purchasing power
- multiple competing providers
- negotiation
- informed; the employer often serves an intermediary role in selecting the health plans from which their employees may choose (cost information is now widely available to both employees and employers + quality measures (accreditation standards))
76
one key features of a well functioning market,
- informed purchaser
- *purchasing power*
- multiple competing providers
- negotiation
- purchasing; the ability of those who need the product to have the purchasing power to obtain it. the subsidies that are available for health insurance purchased through the exchanges as well as government health insurance including medicare and medicaid are designed to provide purchasing power to a wide range of previously uninsured and underinsured consumers
77
one key features of a well functioning market,
- informed purchaser
- purchasing power
- *multiple competing providers*
- negotiation
give purchasers a choice of service providers. consumers' choices then generally favor providers who offer the services at reduced costs and/or increased quality. the availability of choices for employed individuals has increased in some but not all areas in recent years, especially for those who employers pay a substantial portion of the premiums. employees of some large firms and organizations may have a range of choices and can choose their health plan based on criteria inducing cost, quality, and/or convenience
78
one key features of a well functioning market,
- informed purchaser
- purchasing power
- multiple competing providers
- *negotiation*
the key to putting information, purchasing power, and competition together. these negotiations increasingly take place through the employer. however, labor unions are becoming moe involved in issues related to health benefits as well because health insurance constiteus an increasing percentage of employees current, as well as future, benefits. the individual employee often has little negotiating power and needs to rely on their employer and/or their union to successfully participate in negotiation for healthcare
79
Population health management is an effort to organize systems of health care focused on both patients and populations. Success is judged in population health management not only by what happens to any one patient, or by those who seek health services, but by the results for the population being served as a whole. therefore it can be viewed as a public health approach to the delivery of health care and has the potential to better connect the healthcare and public health systems
80
the goals of population health management have been called the "triple aim" and include:
- improving access to care
- improving the quality of care
- reducing the per person cost of care
in addition, two other potential goals are increasingly being discussed
- increasing provider engagement in improving health care
- working with public health to achieve community health and achieve health equity
81
key elements that are essential to the success of any population health management organization;
- *value based payments*
- comprehensive data system
- comprehensive scope of services
- organizational engagement in quality
- collaboration with public health and the community
value; central to the development of population health management is a system of financial reimburse that rewards improvements in quality as well as reductions in per person costs rather than the traditional fee for service system. this risk sharing approach allows financial returns to the organization for successes and potential reductions in reimbursement for failures to reach specific quality and cost targets
82
key elements that are essential to the success of any population health management organization;
- value based payments
- *comprehensive data system
- comprehensive scope of services*
- organizational engagement in quality
- collaboration with public health and the community
data; the competes of a population health management data system myst talk to each other - that is, they use be inter-operative - and be comprehensive, reaching every aspect of the organization. population health management organizations need a data system that serves as the center of planning, implementation, and evaluation of the success of the organization
83
key elements that are essential to the success of any population health management organization;
- value based payments
- comprehensive data system
- *comprehensive scope of services *
- organizational engagement in quality
- collaboration with public health and the community
services; the 10 essential health benefits defined by and required by the ACA are the starting point for services provided through a population health management organization. by integrating the delivery of these services, the population health management organization has the potential to removed many of the disconnects that exist in US health care. this allows for better coordination between clinicians, healthcare delivery institutions, payment systems, and coordination with public health. additional services such as dental and vision as well as services designed to addresses the social determinants of health are likely be added to the list of covered services by population health management organizations
84
key elements that are essential to the success of any population health management organization;
- value based payments
- comprehensive data system
- comprehensive scope of services
- *organizational engagement in quality *
- collaboration with public health and the community
quality;
engagement of the entire workforce with continuous quality improvement is an important prerequiriste for success of a population health management organization. patient safety efforts often are used to initiate this type of engagement. success requires organization wide involvement including organizational leadership, encouragement of confidential reporting, and timely and dependable responses. reducing provider "burn out" is increasingly viewed as an important goal
85
key elements that are essential to the success of any population health management organization;
- value based payments
- comprehensive data system
- comprehensive scope of services
- organizational engagement in quality
- *collaboration with public health and the community*
a formal collaboration between a population health management organization and public health department(s) is essential for identifying and addressing health needs and health problems in a community being served. these assessments require direct participation of the community served and the development of health improvement plans. these efforts are increasingly being tied to initiatives to increase health equity
86
