NADAP is an agency that aims to assist individuals with their health and wellness goals, with a focus on medical, mental and social health issues. One of the programs at NADAP is Care Coordination, which has the primary purpose of aiding clients suffering from chronic medical conditions to effectively manage their diagnoses, such as, but not limited to, providing: assistance with medication and medical appointment adherence, access to all necessary health providers, ensuring basic social needs are met, and advocating on their behalf throughout their wellness journeys as needed. As such, it is the Care Coordinators’ reponsibility to ensure, to the best of their abilities, that the clients do not end up in the emergency room when it can, …show more content…
To think about this in reverse hierarchy fashion, from care coordinators to the Director, the closer the role is to the care coordinator, the more direct contact they will have with the clients.
While this systemic division of roles can be said to increase efficiency of the department, it is not without its faults. One of these liabilities entails the billing of Medicaid. Care coordinators are tasked with performing one “billable” service per client per month. This is an action care coordinators takes on behalf of clients that is then billed to Medicaid, allowing NADAP to sustain itself financially. Since care coordinators have large caseloads and therefore many billable services to achieve each month, clients are, at times, not receiving the care they need. Instead, the clients are often receiving the care that allows the care coordinators to check off the billable service box, not always considering the care only as it pertains to the client. Furthermore, since the care coordination program relies on Medicaid for financial support, it focuses attention to the billing of services as opposed to the services itself. Care coordinators’ performances are evaluated based on the successful completion of all the clients’ core services, and not on the success of their clients’ wellness goals per say. Consequently, the organization hires care
The culture prevalent at the hospital is based on the simple objectives associated with ethics that bring about the needed culture of ethical and responsible actions at the hospital (Schneider, B., Ehrhart, M. G., & Macey, W. H., 2013). The direction over decision making involves the senior levels of the hierarchy along with the middle level to incorporate ethical dilemma and making decisions in alignment with the mission of the community
M1- Discuss how policies and procedures help children, young people and their families whilst the child is being looked after.
Direct Care Providers work independently in clients home. Sheena has been able to carry out her job duties independently and thoroughly. Independently submits monthly billing and client Data Tracking Reports within the required timeframes. Consistently demonstrates adherence to client care standards.
One of the aims of the Patient Protection and Affordable Care Act (ACA) of 2010 is improved integration and coordination of services for primary patient care. The patient-centered medical home (PCMH) is one of the approaches by which improvements can be established. The patient-centered medical home model is particularly well-suited for people who have chronic illness. The design of the patient-centered medical home model departs substantively from traditional reimbursement policies, in that, the ACA provides for incentives and resources to enable care coordinators to be directly recognized and compensated for their care coordination work. Care coordinators are most often registered nurses who through their work that aligns with ACA engage in quality improvement work, cost-effectiveness measures, and patient advocacy. To bring the ACA model to a human scale, the authors present a case study of a care coordinator at a patient-centered medical home in rural Maine. The table provided below provides a basic textual analysis of the study as it is published in the professional nursing journal.
The maintenance and improvement of health is vital to every member of our society. Mental health, a person’s condition with regard to their psychological and emotional well-being, is one, if not the most important aspects to our health. Mental health has been viewed and treated in many different ways throughout history, but mostly has been misunderstood and feared worldwide. These individuals face discrimination, humiliation, and hate from many members of their community due to numerous misconceptions. The treatment and care for mentally disabled individuals have been inconsistent and underserved. As the United States moves forward with healthcare and public policies, mental health, should be a key focus due to its effects on the individual, health care providers, health care industry, families, and community collectively.
In my hometown state of Colorado, one of the piloting states who are implementing a new method of delivering and paying for Medicaid beneficiaries’ care to coordinate a broad range of health and social serves by shifting some of the financial risk for the costs and quality of care to providers. Colorado’s Accountable Care Collaborative Program is providing Medicaid beneficiaries care through an accountable care organization (ACO) delivery model. Medicaid contracts with one regional care collaborative organization (RCCO) that works with providers that are part of the Primary Care Medical Providers (PCMP). “Medicaid oversees that the regions get the medical management, admin support, while they seek to ensure care coordination to the Medicaid enrollees and integrate smoothly with the care in hospitals, with social services and specialist” (Ellis, Gifford, & Smith, 2014). Many of the ACA’s provisions affecting Medicaid eligibility and enrollment went into effect during 2014, most significantly the Medicaid expansion implemented as an option for states. All states were required to streamline Medicaid enrollment and renewal processes, transition to a uniform income eligibility standard and coordinate with the new marketplaces (Ellis, Gifford, & Smith, 2014). Colorado has also set out to integrate behavioral and clinical health care through incentives to providers. Colorado’s first annual report indicated progress and success for what the ACO set out to
Since the passage of the Affordable Care Act in 2010, the role and responsibilities of the nurse practitioners at the Healthcare Clinic has broadened. The current clinical model now allows the nurse practitioner to evaluate and treat both chronic and acute conditions affecting the elderly and the disabled, a step up from the previous years’ clinical model. The added clinic scope of service resulted to an influx of many clients, a significant percentage are uninsured. The clinics are staffed with one medical assistant and one nurse practitioner, with an off-site collaborating physician available 7 days a
Congress was the creator of Medicaid and continues to wield influence by originating and passing legislation to amend the staute(“Home Health Care Management Practice” Aug, 2009). The Centers for Medicare and Medicaid Services or CMS purpose is to guarantee that recipents receive state of the art health care and to support the staes efforts to provide quality and safety. In the CMS si the Center for Medicaid and state operations. They help Medicaid provide safe, effective, efficient, patient-centered, timely and equitable care. The Medicaid Integrity Program is there to eradicate fraud and abuse of Medicaid. These groups along with a variety of other agencies and facilities are there to coordinate and provide care to people with Medicaid. John should be able to get help from one or more of these agencies to make sure he is taken care of properly. They are in place to help people on the program. It might take some time for new policies or offices to be put in place but at least there will be hope for people to get the proper care without having to go out of their way to get it.
atisfaction (ANA, 2012). According to the ANA (2012), “Coordination of care is not a new concept to registered nurses. They understand that they are an essential component of the care coordination process to improve patients’ care outcomes, facilitate effective inter-professional collaboration, and decrease costs across patient populations and health care settings” (p. 1). As part of the Nurse of the Future Competencies, this ensures a successful outcome during the transition period from hospital to home (Massachusettes Department of Higher Education, 2010) because communication, professionalism, patient-centered care, and evidence-based practice are vital for the intervention to be successful. Part of the communication component is for nurses to educate patients thoroughly by assessing their health literacy capabilities upon discharge from the hospital. They should start
Initially, health policies are developed to address the specific to efficiently provide and receive service without any detrimental fabrications or alterations that lead to human related neglect concretely initiate health efforts to quickly prevent disease and further sickness, while not allowing services to be secretly held from the public that is in need, due to becoming poverty stricken or possibly trapped.
Each of the assigned articles defends the need for effective care coordination to help reduce escalating health care costs. Nurses are an important member of the health care team and have gained recognition among other professionals as effective care coordinators. According to Popejoy (2015), the American Nurses Association has identified registered nurses as a critical link in improving outcomes for all patient populations in the continuum of care. Care coordination increases client satisfaction, improves population health, and reduces per capita health care cost (Popejoy, 2015). Since, care coordination is delivered in a wide variety of approaches and in different settings it is difficult to fully realize the cost savings and benefits afforded by this type of care (Marek, et al., 2014). I agree that nurses are essential and that care coordination helps the patients navigate the complex health care system.
Care coordination within health care systems ensures the client of an effective and short stay. Care coordination refers to the coordination between and among professional teams that serve valuable roles involved in providing care to clients. Different disciplines of health care professionals include nursing, medicine, case management, pharmacy, nutrition, social work, and allied health professionals, such as speech therapists and physical therapists. They are found in all health care delivery systems and are extremely effective when the focus is strictly on the needs of the client. Interprofessional teams are valuable because each health care professional has specialized knowledge and skills so that health care plans are determined with
Abdominal pain or discomfort, especially in the area of your liver on your right side beneath your lower ribs
Approaching mental health as public health issue is a highly controversial matter, especially when the public is not educated or already have there own bias towards mental health. I feel that mental health is a public health issue and a major concern that should be addressed by local and state officials along with health care professionals and the community in general. Due to the limitations of mental health facilities and providers, most of these patients require hospitalization due to their illness, or end up in correctional facilities due to the behaviors related to there mental illness. Improving access to impatient and outpatient clinics is a concern for most patients who suffer from mental health issues. Most patients with mental health concerns are unable to keep up with job demands and tend to have no form of insurance, which leaves them with very limited resources for help or therapy. I have had the privilege of working with students within an inpatient facility for adults and children with mental health related disorders and one major concern for these patients was the stigma that came along with there condition.
The following report will introduce and then analyse the Victorian public health and wellbeing plan 2015-2019. Firstly, we will describe the primary concerns regarding the health and wellbeing of all Victorians. The Victorian public health and wellbeing plan identifies six main priority areas which include promoting healthier food and physical activity, reducing and ultimately eliminating tobacco use, a reduction in alcohol consumption and drug use, improvements in mental health, the reduction and prevention of domestic and family violence, and lastly the promotion of improved sexual and reproductive health. This report will analyse the priority area aimed at reducing harmful alcohol and drug use and then discuss two related