Population Health Care

With its prevention based programs and educational outreach, “achieving these targets will result in lives saved and suffering avoided and will contribute to cost containment. Reform of the medical care system per se, however, will not make this vision a reality” (“Health Care Reform and Public Health”, 397). In order to enact change, it must come from the population level because good habits among groups of people can spread while medical care can get some individuals better but not all. But many of these groups are unaffected because of health disparities and back “In 2000, the CDC identified ten public health challenges for the nation” with one of them being “Eliminate health disparities among racial and ethnic groups” (Shore, 3). Many populations are being discriminated and treated poorly because of their socioeconomic status, race, and where they live. Some may be getting the preventative care needed, but the role of public health is to maintain health for the population and not the individual. America is growing; growing with more ethnically diverse people, and just because of who they are and where they come from, should not be a deterrent for the necessary and adequate care

The health care system must change to improve our nation’s health and takes strong steps to address the unsustainable growth of health care costs in America. We still have a long way to go before our health system become effective. We still have population that do not have insurance, have difficulties accessing their health care, or their needs are not met within the healthcare system. It is an investment in prevention and wellness and increasing access to primary care physician.

There are two main distribution principle regarding health care in the United States. The first being social justice, and the second being market justice. The delivery system has continued to undergo periodic changes, mainly in response to concerns with cost, access, and

Since the advent of health insurance in the 1950s, there have been many models of care that are come to the scene in an attempt to both control cost of care and improve quality of care. Insurance models came into being because the fee for service model used until then was proving to increase cost of healthcare without any measure of quality of services and care provided. Health insurance models have evolved from the basic hospital offered insurance to employer sponsored coverage plans. The US health system is broken both financially and quality wise with more than 20% of gross domestic product being spent on healthcare (Blackstone, 2016).

Health care spending grew 3.7 percent in 2012 and the traditional way medicine was practiced had to change (Edlin, Goldman & Leive, 2014). The Affordable Care Act and Population Health was designed based on the concept of “The Triple Aim” to foster change in patient care by providing better care for individuals, better health for populations and decrease the cost of health through improved care (Perez, 2014). As a result, population management has moved to the front by linking services, reducing hospital admission, risk stratification, pursing preventive medicine, ensuring medication review and lowering health care cost. Several organizations have follow in the pursuit of population management by forming Accountable Care Organizations

The patient- centered medical home is designed to improve quality of care through a team-bases coordination of care, which would treat the majority of a patients needs at once by increasing access to care and empowering patients to be a part of their own care (U.S Department of Health and Human Services, 2014). In order for these homes to work, the authors suggest that specialists might be the best candidates to certain conditions, however for these specialist to function in the capacity that is needed in these medical homes, they would have to have interest and proficiency to manage other conditions that fall outside of their

The United States is an incredibly diverse country. This diversity possesses significant strain particularly on the healthcare system. According to the Agency for Healthcare Research and Quality access to healthcare is defined as “the timely use of personal health services to achieve the best health outcomes” (Chapter 9 Access). Therefore, access of healthcare begins once an individual enters the system. Entry can be compromised if there are not enough necessary facilities, employees, or an individual is unable to afford care. Secondly, there needs to be sufficient facilities that offer services that are a necessity of the community.

As healthcare reform initiatives progress organizations have focused on balancing the triple aim of access, cost, and quality to improve outcomes for patients while decreasing the overall cost of care. This focus has resulted in increased technology innovation as well as the development of new care delivery models. Population health management programs (PHM) supported by patient engagement innovations such as wearable's, remote monitoring and telehealth are facilitating the shift from episodic care to the comprehensive management of patient healthcare. The population health market is expected to grow from about 12 billion in 2013 to 40 billion by 2018 representing a compound average growth rate of 26%1. Along with population health management

Disparities in access to health services affect people and lead to unmet health needs, preventive medical services, and poor health. Low-income people are less able to afford the out-of-pocket costs of care, even if they have health insurance coverage. Public health insurance programs have expanded coverage for the poor and not enough to close the disparity gap. In order to improve health care services, we must make sure that the District 17 communities have usual and ongoing source of care as people with a usual source of care have better health outcomes. District Council 17 needs increased access to quality care regardless of their ability to pay, insurance status, or other potential barriers to

The Patient-centered Medical Home (PCMH) will be assessed to evaluate the effectiveness of other health care organizations (HCOs) to compare and contrast values and mission. In addition, program cost-effectiveness will be examined considering health insurance providers and HCO. As a health care administrator, it is beneficial to truly understand the basis and goals of the PCMH to effectively execute the medical home model and successfully provide the best care for each patient.

The medical home concept is not new, as it is built on health care practice innovations that have arisen over the past 40 years (Kilo & Wasson, 2010). From these principles, a multitude of medical home projects and demonstrations across the United States have grown (PCPCC, 2011). Given the unique characteristics of each of the numerous projects promoting the PCMH model, it is difficult to obtain generalizable evidence of the effectiveness of the model (van Hasselt, et. al., 2015). However, the most fundamental aspect of the medical home model—the primary care provider – can be the source of the effective functioning of the model, and its direct benefit to the Medicare-eligible population. The role of primary care within a health care system has been tied to health services’ costs, with some evidence supporting the idea that health care delivery systems that place an emphasis on primary care have lower overall health costs (Starfield & Shi, 2004). Although the medical home model is not just about primary care, it places a priority on this type of care as a critical aspect of patient care. As a result, evidence of the success of primary care can carry through to the PCMH model.

The United States has a unique system of healthcare delivery, it is complex and massive. Twenty-five years ago; American citizens had guaranteed insurance, meaning the patient could see any physician and the insurance companies and patients would share the cost. But today, 187.4 million Americans have private health insurance coverage (Medicaid, 2014). The subsystems of American health care delivery are Managed care, military, vulnerable populations and integrated delivery

in primary care settings. (9) For the entire population, the greatest indicators for such diseases are: smoking, obesity, hypertension, poor diet, and low levels of physical activity. (8) Due to the lack of preventative measure for people with MHD and or SUD, these certain individuals experience greater health burden and are at risk of premature death. (10) The team care model will not only help with medical needs but, also social services and spiritual needs.

The creation of Affordable care act was one of the steps taken to make sure everyone had access to insurance. Cost was removed as a barrier to preventable services. Although there are challenges of not having a collaborated healthcare system, opportunities to overcome these challenges were broadly underlined. The public health is bending towards transforming health care by improving population health outcomes and to integrate data sets to have a population health data, involve a multisector collaboration between all sectors.

For patients with multiple health concerns and medical challenges it can be disheartening to have to keep up with all of the trouble surrounding the maintenance of health care. There is a specialist for each diagnosis, along with visits to the primary care physician, several insurances, sharing paperwork and lab results. As if the health condition itself is not tough enough to live with, it is more complicated for the patient to have to be the middleman between all the individuals in charge of his care. For example, Jim has diabetes, and as a result of his diabetes not being properly maintained he has lost his leg to amputation. In addition to Jim’s diabetes he has high blood pressure and chronic asthma. Jim too has some other mental health concerns. Therefore, Jim has to see at least 4 physicians he receive wound care for his amputation and he needs breathing treatments for his asthma. This is why the future of managed care if important. Like other transformative healthcare initiatives, patient-centered medical home (PCMH) implementation requires substantial investments of time and resources.