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By identifying patients with potentially catastrophic illnesses, contacting them and actively coordinating their care, plans can reduce expenses and improve the medical care they receive. Examples include identifying high-risk pregnancies in order to ensure appropriate pre-natal care and watching for dialysis claims to identify patients who are ...
For Medicaid benefits, beneficiaries generally enroll in their state's Medicaid FFS program or a Medicaid managed care plan administered by an MCO under contract with the state. Recently, Congress and CMS have placed greater emphasis on the coordination and integration of Medicare and Medicaid benefits for dual-eligible beneficiaries.
By increasing care coordination, ACOs were proposed to reduce unnecessary medical care and improve health outcomes, reducing utilization of acute care services. [16] According to CMS estimates, ACO implementation as described in the Affordable Care Act was estimated to lead to an estimated median savings of $470 million from 2012 to 2015.
You can see any doctor or seek care in any U.S. hospital that accepts Medicare patients. Also, you can apply earlier for Medicare if you have a disability or other conditions. Medicare has four parts:
It includes logistical arrangements, education of the patient and family, and coordination among the health professionals involved in the transition. Transitional care, which encompasses both the sending and the receiving aspects of the transfer, is essential for persons with complex care needs.
Since then, HEW, has been reorganized as the Department of Health and Human Services (HHS) in 1980. This consequently brought Medicare and Medicaid under the jurisdiction of the HHS. [8] In March 1977, the Health Care Financing Administration (HCFA) was established under HEW. [9] HCFA became responsible for the coordination of Medicare and ...
The medical home, [1] also known as the patient-centered medical home or primary care medical home (PCMH), is a team-based health care delivery model led by a health care provider [2] to provide comprehensive and continuous medical care to patients with a goal to obtain maximal health outcomes.
In the United States, disease management is a large industry with many vendors. Major disease management organizations based on revenues and other criteria [5] [6] include Accordant (a subsidiary of Caremark), Alere (now including ParadigmHealth and Matria Healthcare), [7] Caremark (excluding its Accordant subsidiary), Evercare, Health Dialog, Healthways, LifeMasters (now part of StayWell ...