Primary Care spend in the State of Rhode island and its impact on overall cost trend a report worth reading for sure
Primary care Spend in RI went up from 47 million in 2008 to 67 million in 2013
BUT !!!
Total Spend went down from 823 Million in 2008 to 661 Million in 2013
Behavioral Health Industry Insights - 2016Duff & Phelps
This issue of Behavioral Health Insights details the impact of deinstitutionalization and the IMD Exclusion on the behavioral healthcare landscape. On April 25, 2016, the CMS issued a long-awaited official rule meaningfully changing the IMD Exclusion provisions in response to access concerns over inpatient psychiatric and substance use disorder services
hCentive Health Insurance Exchange PlatformAlisha North
Take advantage of hCentive's deep expertise in the healthcare insurance industry. Browse through or download our white papers to get an in-depth understanding of the industry.
Learn about 2016 trends in government and private healthcare spending, employer costs, and the patient-as-consumer movement that's spurring new provider models.
Population Health Management & Meaningful UsePhytel
The government’s EHR incentive program is designed to transform healthcare delivery and dovetails with other healthcare reform initiatives. Population health management, the goal of these initiatives, requires advanced forms of health IT.
How to Manage Population Health Effectively in Accountable Care OrganizationsPhytel
The Affordable Care Act authorized a Medicare shared-savings program for accountable care organizations, and private payers are also contracting with ACOs. To succeed, ACOs must learn how to manage population health effectively.
CBO’s work follows processes specified in the Congressional Budget and Impoundment Control Act of 1974 (which established the agency) or developed by the agency in concert with the House and Senate Budget Committees and the Congressional leadership.
CBO is strictly nonpartisan; conducts objective, impartial analysis; and hires its employees solely on the basis of professional competence, without regard to political affiliation. The agency does not make policy recommendations, and each report and cost estimate summarizes the methodology underlying the analysis.
Presentation by Keith Hall, CBO Director, at the 10th Annual Meeting of the OECD Network of Parliamentary Budget Officials and Independent Fiscal Institutions.
The Affordable Care Act and Its Impact on Workers’ CompensationCognizant
While the Affordable Care Act (ACA) is expected to reduce the number of uninsured and improve personal wellness in the U.S., the law's changes in workforce definitions will significantly impact workforce dynamics, employee hiring, employers' benefits strategies and wellness programs -- requiring a reevaluation of how workers' compensation is accounted for and delivered.
Behavioral Health Industry Insights - 2016Duff & Phelps
This issue of Behavioral Health Insights details the impact of deinstitutionalization and the IMD Exclusion on the behavioral healthcare landscape. On April 25, 2016, the CMS issued a long-awaited official rule meaningfully changing the IMD Exclusion provisions in response to access concerns over inpatient psychiatric and substance use disorder services
hCentive Health Insurance Exchange PlatformAlisha North
Take advantage of hCentive's deep expertise in the healthcare insurance industry. Browse through or download our white papers to get an in-depth understanding of the industry.
Learn about 2016 trends in government and private healthcare spending, employer costs, and the patient-as-consumer movement that's spurring new provider models.
Population Health Management & Meaningful UsePhytel
The government’s EHR incentive program is designed to transform healthcare delivery and dovetails with other healthcare reform initiatives. Population health management, the goal of these initiatives, requires advanced forms of health IT.
How to Manage Population Health Effectively in Accountable Care OrganizationsPhytel
The Affordable Care Act authorized a Medicare shared-savings program for accountable care organizations, and private payers are also contracting with ACOs. To succeed, ACOs must learn how to manage population health effectively.
CBO’s work follows processes specified in the Congressional Budget and Impoundment Control Act of 1974 (which established the agency) or developed by the agency in concert with the House and Senate Budget Committees and the Congressional leadership.
CBO is strictly nonpartisan; conducts objective, impartial analysis; and hires its employees solely on the basis of professional competence, without regard to political affiliation. The agency does not make policy recommendations, and each report and cost estimate summarizes the methodology underlying the analysis.
Presentation by Keith Hall, CBO Director, at the 10th Annual Meeting of the OECD Network of Parliamentary Budget Officials and Independent Fiscal Institutions.
The Affordable Care Act and Its Impact on Workers’ CompensationCognizant
While the Affordable Care Act (ACA) is expected to reduce the number of uninsured and improve personal wellness in the U.S., the law's changes in workforce definitions will significantly impact workforce dynamics, employee hiring, employers' benefits strategies and wellness programs -- requiring a reevaluation of how workers' compensation is accounted for and delivered.
A new report from PwC’s Health Research Institute predicts that insurance companies will be spending more to pay for prescription drugs starting next year, from around 3% to almost 6% by 2027. Here’s more forecasts on medical spending from the report:
•Generics: Almost half of the estimated sales from the top 100 brand-name drugs won’t be affected by generic competition for another three years.
•Specialty drugs: Spending on specialty drugs — such as biologics or rare disease treatments — has already been growing over the past five years, but by 2020 these drugs may make up more than half of all U.S. drug spending.
•Chronic disease: 85% of all employer-provided insurance spending is on chronic conditions, and obesity and diabetes will be the two top conditions that will account for spending in 2020.
Mercer Capital's Value Focus: Healthcare Facilities | Mid-Year 2014Mercer Capital
Mercer Capital's Healthcare Facilities Industry newsletter provides perspective on valuation issues. Each newsletter also includes a macroeconomic trends, industry trends, and guideline public company metrics.
Employer-sponsored insurance is the leading source of health insurance in America, covering about 149 million non-elderly people. To provide current information about the nature of employer-sponsored health benefits, the Kaiser Family Foundation (Kaiser) and the Health Research & Educational Trust (HRET) conduct an annual national survey of nonfederal private and public employers with three or more workers. This is the fourteenth Kaiser/HRET survey and reflects health benefitinformation for 2012.
The key findings from the survey,conducted from January through May 2012, include modest increases in the average single and family insurance premiums and little change in the premium contributions and cost sharing that workers face since last year. Enrollment in high deductible plans with a savings option, such as a health savings account or health reimbursement arrangement, did not increase significantly over the
previous year for the first time since 2009. The share of workers in a grandfathered
health plan decreased significantly from the previous year to 48% of covered
workers. Approximately 2.9 million adult children who were previously not eligible
for benefits now have health insurance coverage through their parents due to
the Affordable Care Act. In addition, the 2012 survey includes questions on
employer wellness programs, including the percentage of plans with financial rewards
or penalties for completing health programs or achieving biometric targets.
Authors: • Claxton G, Rae M, Panchal N, Damico A, Whitmore H, Bostick N, Kenward K
CFO Strategies for Balancing Fee-for-Service and ValuePhytel
Moving from fee-for-service to value-based care is not easy. However, leading health systems are all following a similar blueprint that enables the move to value-based care.
Download this whitepaper to learn how:
- Bon Secours Richmond - Closed 75,801 gaps in care within 12 months, generating $7 million in revenue for chronic & preventive care, while improving quality.
- Northeast Georgia Medical Center - Decreased HbA1C levels across uncontrolled diabetes by an average of 1.6 points within 120 days.
- Riverside Medical Center - Reduced unnecessary readmissions by 40% by using automation to reach and assess patients post discharge.
- Prevea Health - Increased care management productivity by 150% by automatically identifying high risk patients, and automating patient engagement.
Mercer Capital's Value Focus: Healthcare Facilities | Year-End 2015 | Sub-Sec...Mercer Capital
Mercer Capital's Healthcare Facilities Industry newsletter provides perspective on valuation issues. Each newsletter also includes a macroeconomic trends, industry trends, and guideline public company metrics.
Mercer Capital's Value Focus: Healthcare Facilities | Mid-Year 2015Mercer Capital
Mercer Capital's Healthcare Facilities Industry newsletter provides perspective on valuation issues. Each newsletter also includes a macroeconomic trends, industry trends, and guideline public company metrics.
This gives a good base knowledge of where the current insurance industry is, a timeline of when certain mandates go into effect and a simplified description of the mandats being launched on Sept 23, 2010.
Similar to Rhode island primary care spend final (20)
The Patient-Centered Medical Home in the Transformation From Healthcare to He...Paul Grundy
Surgeon General of the Navy VADM Matthew L. Nathan, MC USN
Fortunately, we have a way to address this crisis—the
Patient-Centered Medical Home (PCMH) model launched at Naval Hospital Pensacola and Walter Reed National Military Medical Center, Bethesda, Maryland (formerly the National Naval Medical Center) in 2008. It is now being implemented throughout the Military Health System (MHS) and carries great promise. It provides the clinical framework we need to meet our strategic objectives in terms of quality of care, impact on costs, population health, and readiness. One of the most significant benefits of the team-based, collaborative approach is that it allows us to embed within a primary care environment the psychologists, nutritionists, tobacco cessation specialists, mind-body medicine therapists, and health educators our patients need in order to develop and maintain mindful, healthy behaviors—along with the “mental armor,” our active duty military personnel need to increase their operational effectiveness and their resiliency in bouncing back from stressful situations. As we move ahead with this more comprehensive approach to health, we can begin to better address so many of our patients for whom we can find no specific reason for pain and discomfort. The PCMH model also provides a positive impact on our costs. Early data reporting from the PCMH clinics at Bethesda show reduced visits to the emergency room, lowered pharmacy costs, and significant per beneficiary per year savings and improved Healthcare Effectiveness Data and Information Set metrics, access, and patient satisfaction and trust. These positive impacts on the bottom line can be applied directly to improved costs or toward the reallocation of resources from reimbursing those who are sick to the population health-based programs that can make and keep our patients healthy.More significant, however, the PCMH environment allows us to go beyond mere collaboration and to a much more proactive approach to managing our patient populations. It is within the context of the medical home that we can begin to surround our patients with the tools and resources they need to move them from health care to health.
Patient-centered medical homes (PCMHs) are intended to actively provide effective care by physician-led teams, Where patients take a leading role and responsibility. Objective: To determine whether the Walter Reed PCMH has reduced costs while at least maintaining if not improving access to and quality of care, and to determine
whether access, quality, and cost impacts differ by chronic condition status. Design, setting, and patients: This study
conducted a retrospective analysis using a patient-level utilization database to determine the impact of the Walter Reed PCMH on utilization and cost metrics, and a survey of enrollees in the Walter Reed PCMH to address access to care and quality of care. Outcome measures: Inpatient and outpatient utilization, per member per quarter costs, Healthcare Effectiveness Data and Information Set metrics, and composite measures for access, patient satisfaction, provider communication, and customer service are included. Results: Costs were 11% lower for those with chronic conditions compared to 7% lower for those without. Since treating patients with chronic conditions is 4 times more costly than treating patients without such conditions, the vast majority of dollar savings are attributable to chronic care.
National Conference on Health and Domestic Violence. Plenary talk Paul Grundy
explaining how the Patient Centered Medical Home (PCMH) platform for healthcare deliver is more likely to support domestic violence prevention and creat a safer environment than the FFS episode of care system we are in now. The medical Home is a home for the data where the all the data goes and is held accountable this idea was first articulated by Dr. Calvin C.J. Sia, a Honolulu-based pediatrician in 1967.
This concept of the medical home was integrated with Ed Wagners Chronic disease Model and Thomas Bodenheimer Kevin Grumbach advanced/proactive primary care at the request of the Patient Centered Primary care Collaborative into a set of principles Know as the Joint principles of the Patient centered medical home.
The patient-centered medical home (PCMH), is a team based health care delivery set of principles led by a physician that provides comprehensive and continuous medical care to patients with the goal of obtaining maximized health outcomes. It is "an approach to providing comprehensive primary care for children, youth and adults" The provision PCMH medical homes allow better access to health care, increase satisfaction with care, and improve health. Joint principles that define a PCMH have been established through the cohesive efforts of the American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), American College of Physicians (ACP), and American Osteopathic Association (AOA).[10] Care coordination is an essential component of the PCMH. Care coordination requires additional resources such as health information technology, and appropriately trained staff to provide coordinated care through team-based models. Additionally, payment models that compensate PCMHs for their effort devoted to care coordination activities and patient-centered care management that fall outside the face-to-face patient encounter may help encourage coordination.
PCMH implementation, highly associated with important outcomes for both patients and providers. The rate of emergency department visits was significantly
lower in sites with more PCMH effective implementation. Efficient PCMH implementation favorably associated with patient satisfaction, staff burnout, quality of care, and use of health care services.
A systematic review of the challenges to implementation of the patient-centre...Paul Grundy
review the available literature to identify the major challenges and barriers to implementation and adoption of the patient-centred medical home (PCMH) model, topical in current Australian primary care reforms. documents the key challenges and barriers to implementing the PCMH model in United States family practice. It provides valuable
evidence for Australian clinicians, policymakers, and
organisations approaching adoption of PCMH elements
within reform initiatives in Australia.
"'I am proud that MaineCare has been working in partnership with other payers to advance payment reform through greater investment in primary care to both improve outcomes for patients and reduce preventable high cost spending in emergency departments and avoidable inpatient admissions.
– Mary C. Mayhew, Commissioner, Maine Department of Health & Human Services
Effective integration of specialty practices into medical neighborhoods is likely to require several important environmental precursors. First, a sound infrastructure
design can connect PCMHs to the spectrum of surrounding
specialty practices. An aligned information architecture
will be vital to adequate patient access, care coordination, and communication. Second, a patient centered
neighborhood will rely on an organizational culture that
supports shared learning and transparency of performance and cost data among participating practices. Third, payment incentives will have to be aligned around shared accountability for outcome and cost. Responsibility
for outcomes and total cost of care will have to rest not only with primary care clinicians, but also with specialists who perform(often expensive) procedures and specialty services.The launch of the NCQA’s PCSP recognition program is a sign of a new phase of delivery system reform
Summary -- Patient Centered Medical Home the Necessary Foundation for Accountable Care and Population Management.
In the next 10 years, we will be living in 1) mobile world 2) in the middle of an aging and chronic disease epidemic and 3) data. But , we will also have the ability to analyze data in a cognitive way this will do for doctors’ minds what X-ray and medical imaging have done for their vision. How? By turning data into actionable information. Take, for instance, IBM’s intelligent supercomputer, Watson. Watson can analyze the meaning and con-text of human language and quickly process vast amounts of information. With this in-formation, it can suggest options targeted to a patient’s specific circumstances.
We need the basic foundation to support this transformation a system integrator where data at the level of a patients flows and is held accountable and that model is the Patient Centered Medical Home. (PCMH) starts to happen when clinicians/ healers step up to comprehensive relationship based care empowered by tools to manage the data and communicate effectively. This move to PCMH level care requires the discipline of leading a team that delivers population health management, patent centered prevention, care that is coordination, comprehensive accessible 24/7 and integrated across a deliver system and all of that is power by data made into meaningful information.
But at its core it is a move toward integration of a healing relationship in primary care and population management all at the point of care with the tools to do just that.
The Patient-Centered Medical Home (PCMH) lies at the center of the effort to get at population health, integrated and coordinated care. PCMH is where the Primary care healer leads an organization that delivers clinician-led primary care, with comprehensive, accessible, holistic, coordinated, evidence-based coordination and management. In the USA this is now the standard in the US Veterans Administration and the US Military and under the ACA.
OVERVIEW -- Care by Design - Putting Care back into healthcare the University of Utah experience in building PCMH level care over the decade of 2001 to . 2011
Care by design magill lloyd successful turnaroundPaul Grundy
The University of Utah purchased a 100-clinician, 9-practice multispecialty primary care network in 1998. The university projected the network to earn a profit the first year of its ownership in a market with growing capitation; however, capitation declined and the network incurred up to a $21 million operating loss per year. This case study describes the financial turnaround of the network.
Care by design 2 bodenheimer teams 2 utah chapterPaul Grundy
Putting Care back into healthcare the University of Utah experience in building PCMH level care. this talks about the team base experice as written up in 2007 by Tom Bodenheimer.
New zealand cantabury timmins-ham-sept13Paul Grundy
This is a great example of a community in New Zealand of the interrogation of social services and healthcare. They are changing the demand curve and getting away from “we need more and more resources to see more patients”. The language we use, very deliberately, is “right care, right place, right time”. Once you start getting the whole
system to work as one system, it starts flushing out unnecessary expenditure. So you can do more and/or do it better.’ worth a read.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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Rhode island primary care spend final
1. Primary Care Spending in Rhode Island
Commercial Health Insurer Compliance
January 2014
2. ABOUT THE REPORT
Primary Care Spending & OHIC’s Affordability
Standards
This report details the actual and projected primary care
spending of Rhode Island’s three largest commercial
health insurers: Blue Cross Blue Shield of Rhode Island
(BCBSRI), United Healthcare (United), and Tufts Health
Plan (Tufts). The report compares each insurer’s
performance against targets established by the Office of
the Health Commissioner’s (OHIC) Affordability
Standards, analyzing both the relative portion of primary
care spending and the ways insurers invest their primary
care dollars.
The first Affordability Standard, which establishes targets
for total primary care spending and types of investments,
is a core element of OHIC’s strategy to facilitate delivery
reform in Rhode Island. It requires all insurers to
increase primary care’s share of total medical payments
by one percentage point per year from 2010 to 2014,
incrementally raising primary care’s share of total
commercial medical payments to a level comparable to
that seen in other states and high performing health care
systems. This spending cannot result in higher premiums
and cannot increase overall medical expenses; rather, it
must reflect a shift in issuers’ primary care payment
strategies away from the dominant FFS system.
The standard compliments OHIC’s commitment to
payment reform by ensuring the foundation of our health
care system remains a funding focus. It encourages
efficient, affordable health care through organizational
innovations in care delivery and payment reform.
1
Key
Findings
In
This
Report
Insurers
are
hitting
their
targets |
In
2012,
both
BCBSRI
and
UHC
met
or
exceeded
their
primary
spending
targets.
Though
Tufts
does
not
have
an
established
target,
they
spent
nearly
the
same
percentage
of
their
medical
spending
on
primary
care
as
United.
United
and
BCBSRI
predict
they
will
again
hit
their
targets
in
2013.
The Affordability Standards
Begun in 2010, the Affordability Standards ensure
health plans invest their premium dollars in structural
improvements to the healthcare system. OHIC directs
commercial health insurers to:
1. Expand and improve the primary care
infrastructure:
2. Spread the adoption of patient-centered
medical homes
3. Support CurrentCare, the state’s health
information exchange
4. Work toward comprehensive payment reform
across the health care system
About OHIC
The Office of the Health Insurance Commissioner
(OHIC) was established through legislation in 2004 to
broaden the accountability of health insurers operating
in Rhode Island. The Office is dedicated to:
1. Protecting consumers
2. Encouraging fair treatment of medical service
providers
3. Ensuring solvency of health insurers
4. Improving the health care system’s quality,
accessibility, and affordability
The Office sets and enforces standards for health
insurers in each of these four areas. It is the only state
agency in the country that specifically oversees health
insurance.
3
Non
fee-‐for-‐service
(non-‐FFS)
investments
continue
to
increase |
Insurers
continue
to
invest
in
non-‐FFS
methods,
particularly
Patient
Centered
Medical
Homes,
to
drive
their
primary
care
spending.
Insurers
predict
they
will
meet
OHIC’s
requirements
to
allocate
at
least
35%
of
their
total
primary
care
spending
to
non-‐FFS
investments
in
2013.
4
The
future
of
primary
care
in
Rhode
Island
looks
promising
|
Investments
in
both
fee
schedules
and
non-‐FFS
methods
bolster
the
state’s
primary
care
delivery
system.
OHIC
will
build
on
insurers’
commitment
to
innovative
supports
for
primary
care
by
updating
its
Affordability
Standards
in
2014.
2
Primary
care
spending
is
rising |
Spending
on
primary
care
grew
37%
from
2008
to
2012,
while
total
medical
spending
fell
14%.
In
2012,
the
market
spent
$7m
more
on
primary
care
than
it
did
in
2011.
3. MARKET TRENDS:
Primary Care’s Share of Total Medical Spend Grows Steadily
In 2012, insurers spent 9.1 cents of
every fully insured commercial medical
dollar on primary care services; this was
an increase of nearly 3.5 cents from
2008. The share of spending on primary
care is projected to rise to 10.1%
($67m) in 2013 and 10.5% ($73m) in
2014. If these projections are realized,
the share of primary care spending will
have grown by 84% between 2008 and
2014.
Figure 1: Primary Care Spending, Total and as Percent of Total
Spending 2009-2012 Actual | 2013-2014 Projections
12.0%
$80
Primary Care Spending
% of Total Spending
10.0%
$70
10.5%
8.0%
9.1%
$40
7.1%
6.3%
5.7%
$60
$50
8.0%
6.0%
4.0%
10.1%
$30
$20
2.0%
0.0%
$47
$50
$53
$58
$65
$67
$73
2008*
2009
2010
2011
2012
2013
(Proj)
2014
(Proj)
*BCBSRI &
United only
$10
$0
Total Primary Care Spending in
Millions
For all three commercial insures,
spending on primary care is rising. On
the right, Figure 1 shows annual primary
care spending in both dollars and as a
percent of total medical payments. The
2009-2012 data reflect actual spending,
while 2013 and 2014 show projected
spending based on data from the first
six months of 2013.
Each insurer reported its primary care and overall medical spending data to OHIC. These
figures were combined in the market trends listed throughout this report.
How Primary Care Differs by Company
Figure 2 below shows how each insurer contributes to the market results above. Each company has steadily
increased the portion of their premium dollars they dedicate to primary care since 2008. Tufts’ results are more
uneven than BCBSRI or UHC in part because of their small, but growing, membership in Rhode Island.
Figure 2: Primary Care Spending as Percent of Total Medical Spending by Company
12.0%
2008-2012 Actual | 2013 Projections
10.6%
11.0%
10.0%
9.4%
9.0%
8.2%
8.0%
8.0%
7.5%
7.0%
6.0%
5.0%
BCBSRI
6.4%
7.2%
5.8%
6.0%
8.2%
United
9.5%
8.5%
Tufts
7.9%
7.0%
6.5%
5.5%
4.0%
2008
2009
2010
2011
2012
2013
(Projected)
The first Affordability Standard requires
companies to increase primary care’s share
of total medical spending by one percentage
point, on average, per year from 2010 to
2014. Figure 2 demonstrates that both
commercial insurers with targets exceeded
their goals through 2012. From 2011 to
2012, BCBSRI’s spending on primary care
grew 1.2 percentage points, United’s by 1.0
and Tufts, a recent market entrant, by 1.4,
in line with the other insurers. Next year,
BCBSRI and United predict they will again
meet their cumulative primary care
spending target, dedicating 10.6% and 9.5%
respectively.
Tufts’ historically small market share in Rhode Island contributes to a relatively volatile claims experience that has
thus far been unsuitable for the same targets that BCBSRI and UHC are required to meet. Tufts is also the only
insurer to project a decline in the share of primary care spending for 2013. Due to rising non-primary care spending,
Tufts expects the share to fall from 8.2% in 2012 to 7.7% in 2014.
Office of the Health Insurance Commissioner
|
Primary Care Spending Report 2013
|
Page 3
4. ACTUAL, TARGET, and PROJECTED SPENDING:
Insurers are hitting their primary care spending targets
Insurers report their primary care spending and
projections to OHIC quarterly, which creates a
sustainable and transparent evaluation process towards
the targets. Each company employs its own strategy to
reach its target over the course of a year, monitoring its
evolving claims, utilization, enrollment and other factors
that affect the “denominator” of the primary care
spending equation.
11.0%
10.5%
10.5%
10.6%
10.0%
Tufts does not yet
have a primary care
spending target
9.5%
8.5%
Figure 3b: Primary Care’s Share
of Medical Spending versus OHIC
Standard (2013 Projected )
11.0%
Figure 3a: Primary Care’s Share
of Medical Spending versus
OHIC Standard (2012)
10.0%
9.0%
Figure 3a compares each insurer’s actual share of
primary care spending in 2012 against its target and
its previously reported spending projection for that
year, as of October 2012. Figure 3b shows
insurers’ projected share of primary care spending
against its projected target for 2013. Note that Tufts
does not have a specified spending target because of
its recent entry into the Rhode Island market and
low enrollment.
9.4%
9.5%
9.8%
9.5%
9.5%
Tufts does not
yet have a
primary care
spending target
9.0%
9.1%
8.8%
8.5% 8.5% 8.5%
8.0%
8.5%
8.5%
8.2%
8.0%
7.9%
7.5%
BCBSRI
Actual 2012
United
Target 2012
7.5%
Tufts
BCBSRI
United
Projection 2013
Reported 2012 Projection
Tufts
Target 2013
Highlights of Insurer Performance in 2012 and 2013 Projections
BCBSRI | BCBSRI’s actual spending (2012) and
projected spending (2013) on primary care met or
exceeded their Affordability Standard targets. In 2012,
BCBSRI committed 9.4% of its total medical spending
to primary care, surpassing both the target and its
previous projections. Next year, the company predicts
it will again exceed its target, due in part to lower than
expected total medical claims. About 40% of BCBSRI’s
2012 primary care spend went to non-FFS investments,
exceeding its previous projection of 37.6%. Patient
centered medical homes, particularly BCBSRI’s
proprietary program, led these investments, which are
further analyzed on page six.
UNITED | United met its target primary care share of
8.5% in 2012 and projects to meet its 2013 target of
9.5%. Similar to BCBSRI, United projects lower total
medical spending in 2013 and 2014 than in previous
years, though this change did not affect its projections
relative to actuals for either 2012 or 2013. UHC has
also shown significant growth in non-FFS spending
Office of the Health Insurance Commissioner
|
(detailed on page 6) and projects nearly half of
total primary care spend will support such
investments by 2014.
TUFTS | Tufts’ actual 2012 spending (8.2%) was
slightly lower than the company previously
projected for 2012 (8.5%). Tufts representatives
note the company’s recent market entrance and
relatively low but growing enrollment make
precise spending projections difficult. The
company projects the share primary care spending
to fall in 2013 due to rising spending in other
areas, particularly inpatient hospital care. Non-FFS
investments composed 12% of Tufts’ primary care
spending in 2012, lower than BCBSRI or United,
but more than double their 2009 percentage.
However, projections show primary care spending
as a percent of total medical spending will drop to
7.9% in 2013 due in part to a discontinued EMR
grant program.
Primary Care Spending Report 2013
|
Page 4
5. Primary Care Spending is Rising While Total Medical Spending is Falling
Figure 4: Total Medical Spending and Total Primary Care Spending
The Affordability Standards
prevent divestment in primary
$823
care when other areas of medical
$80
$900
$787
$749
$731
spending unexpectedly rise or
$707
$800
$70
$704
fall. Evidence of this principal is
$661
$700
$60
Total Medical Spending
seen in Figure 4: insurers have
$600
$50
spent more money on primary
$500
care even as their spending on all
$40
$400
other services has fallen. Annual
$30
primary care spending rose by
$300
$20
$18m from 2008 to 2012 while
$200
Primary Care Spending
annual total medical spending
$10
$100
$47
$50
$53
$58
$65
$67
$74
dropped $115m during the same
$$time. Projections indicate the
2008
2009
2010
2011
2012
2013
2014
(Proj)
(Proj)
commercial insurers will spend
an additional $8m dollars annually
on primary care during by 2014 while total medical spend in 2012 and 2014 will be about even.
Primary Care Spending
in Millions
Total Medical Spending
In Millions
2008-2012 Actual | 2013 & 2014 Projections
The decline in overall medical spending is the result of myriad factors including improved care coordination and
focus on primary care; the slow economic recovery in Rhode Island relative to the rest of the country; fewer
fully-insured commercial enrollees due to the market-wide growth in self-insured groups; and a falling population.
Tables 1a and 1b below show the changes in total primary care spending and total medical spending by insurer
from 2008 to 2012. As the annual growth rate from 2008 to 2012 shows, primary care spending is growing (8.2%
annually, on average) while total medical spending is falling (-3.7% annually).
Table 1a: Primary Care Spending by Insurer, 2008-2012, 2013 (Projected)
2008 (Actual)
BCBSRI
United
Tufts
(2009)
TOTAL
2012 (Actual)
2013 (Projected)
% Change 2008-2012
% Change 2008-2013 (Proj)
$38,094,327
$9,009,969
$49,359,059
$11,382,057
$51,049,096
29.6%
34.0%
$11,786,549
26.3%
28.8%
$2,355,556
$3,853,443
$4,211,018
63.8%
78.8%
$47,104,296
$64,594,559
$67,046,663
37.2%
42.3%
Annual Growth Rate: 8.2%
Annual Growth Rate: 7.3%
(BCBSRI & United)
Table 1b: Total Medical Spending by Insurer, 2008-2012, 2013 (Projected)
2008 (Actual)
2012 (Actual)
2013 (Projected)
% Change 2008-2012
% Change 2008-2013 (Proj)
BCBSRI
$657,952,445
$527,432,444
$483,872,012
-19.8%
-26.51%
United
Tufts
(2009)
$165,281,490
$133,505,554
$124,085,574
-19.2%
-24.9%
TOTAL
$36,797,475
$46,994,384
$53,258,046
25.0%
44.7%
$823,233,936
$707,932,382
$661,215,632
-14.1%
-19.7%
Annual Growth Rate: -3.7%
Annual Growth Rate: -4.3%
(BCBSRI & United)
Office of the Health Insurance Commissioner
|
Primary Care Spending Report 2013
|
Page 5
6. TYPES OF PRIMARY CARE INVESTMENT:
Prioritizing Non-FFS Types of Investment
Figure 5 at the left illustrates the proportion
of primary care spending that insurers
dedicated to non-FFS investments. OHIC’s
Affordability Standards requires insurers
allocate at least 35% of their total spending on
primary care to non-FFS payments in 2013
and 40% in 2014.
Figure 5: Percent of Primary Care Payments Dedicated to
Non-Fee for Service Investments
2008-2012 Actual | 2013-2014 Projected
50%
45%
40%
29.0%
30%
33.0%
23.6%
25%
Since 2008, insurers have increasingly invested
in structural, non fee-for-service (non-FFS)
projects. In a fee for service (FFS) system,
insurers pay for each service a provider
performs or orders separately, which rewards
the quantity, and not necessarily the quality, of
care. A value-based care system, however,
invests in structural improvements so doctors
are encouraged and able to keep people well
and avoid unnecessary treatment.
23.8%
20%
13.5%
13.9%
8.8%
10%
5%
BCBSRI
45.7%
41.2%
35%
15%
42.5%
39.6%
United
47.3%
5.9%
2.0%
0%
2008
Tufts
12.2%
12.5%
12.2%
10.3%
10.8%
2010
2011
2012
2013
(Proj)
2014
(Proj)
6.0%
2009
Of the $65m spent on primary care in 2012, nearly $22m (34%) funded non-FFS projects. BCBSRI’s proportion of
primary care spending dedicated to non-FFS investments is 3.5 times higher than it was in 2008. United’s 2012
investments in non-FFS is 15 times greater than it was in 2008. BCBSRI and UHC project non-FFS investments will
account for 45.7% and 47.3%, respectively, of primary care spending in 2014. Tufts, however, is the only insurer to
report a decrease in non-FFS investments, falling 0.3% from 2011 to 2012 and 1.8% in 2013.
Figure 6a: 2012 Spending on Non-FFS Investments
Understanding Shifts in non-FFS Investment Types
Total: $23,780,326
$434,319
HIT
Non-FFS investments include Health Information Technology
(HIT), Patient Centered Medical Homes (PCMHs),
CurrentCare (the state’s health information exchange),
incentives to providers, and other methods like investments
in loan forgiveness for training physicians, flu clinics, or
rewards for provider reporting.
Other
Incentive
Payment
Providers
$4,635,384
Current
Care
$3,805,000
Medical
Home
Figures 6a and 6b show the types of non-FFS investments
made in 2012 and 2013 (projected). While all insurers invest
in the state’s all payer medical home program, as required by
the second Affordability Standard, investments in the
companies’ own PCMHs account for nearly half of all 2012
non-FFS investments. All carriers expect to double their
payments to CSI in 2013 to account for the program’s
expansion.
CSI:
~$2m
$0
Other Medical Home:
About $10m
$2
$4
$6
$8
$10
$12
$14
Millions
Figure 6b: 2013 Projected Spending on Non-FFS Investments
Total: $26,991,640
Each insurer also contributes in some form to CurrentCare
in support of the third Standard. For instance, in 2013,
BCBSRI partnered with the Rhode Island Quality Institute to
reward providers that met enrollment targets for
CurrentCare.
$210,000
HIT
Other
In addition to Current Care and PCMHs, insurers also fund
incentive payment to providers. UHC, for instance,
dedicates over half (57%) of its non-FFS spending to these
payments. This coordinated investment in non-FFS initiatives
reflects market support for comprehensive payment reforms,
innovative care delivery models and a patient-centered
primary care system.
Office of the Health Insurance Commissioner
$2,750,255
|
$841,423
Incentive
Payment
Providers
$9,793,110
Current
Care
$3,869,116
Medical
Home
CSI:
~$3.7m
$0
$2
Other Medical Home:
About $8.5m
$4
$6
$8
$10
$12
$14
Millions
Primary Care Spending Report 2013
|
Page 6
7. POLICY IMPACT:
The Future of Primary Care Spending and Non-FFS Investments
Figure 7: Total Primary Care Spending in Millions
Baseline Scenario vs. Meeting Primary Care Target
Because of the Affordability
Standards, primary care has seen an
additional investment from the
commercial insurers of $64m since
2010 (relative to maintaining the same
contribution rate as 2010). Raising the
portion of premium dollars spent on
primary care supports the state’s
transition into a system of valuebased care.
These investments strengthen both
the primary care system and the
medical delivery system generally.
They help clinicians keep people well
and out of more intensive care. They
augment the state’s health IT system
and enable primary care practices to
coordinate the care their patients
receive from specialists, hospitals, and
home health care.
The aggregate value of these
investments is clear, though OHIC
continues to monitor whether the
Affordability Standards meet the
evolving market needs.
Key
Points
$64m in additional primary
care spending, 2011-2014
$24
$6
$14
Meeting
Spending
Targets
$20
Baseline
Scenario
$50
2009
$53
$52
$51
2010
2011
2012
$47
$50
2013 (Proj) 2014 (Proj)
v Insurers
are
meeting
their
primary
care
spending
targets
BCBSRI,
United,
and
Tufts
meet
the
requirements
established
by
the
first
Affordability
Standard
v The
rate
of
primary
care
spending
is
increasing
faster
than
total
medical
spending
is
falling
v Insurers
predict
medical
spending
to
fall
in
2013
and
recover
slightly
in
2014
v Insurers
are
focusing
on
non-‐FFS
investments
to
both
meet
the
standard’s
targets
and
evolving
market
direction
In
2014,
nearly
half
of
all
primary
care
spending
can
be
attributed
to
non-‐FFS
investments.
v Spending
on
medical
homes
dominate
non-‐FFS
investments
Approximately
17%
in
2012
and
30%
in
2013
of
medical
home
spending
was
spent
on
the
state’s
PCMH
(also
known
as
CSI-‐RI)
v Shifts
in
spending
and
infrastructure
have
implications
for
effective
policy
making
Understanding
insurers’
investments
in
primary
care
and
the
emerging
needs
of
a
value-‐
based
care
environment
will
guide
the
evolution
of
the
Affordability
Standards
in
coming
years
Office of the Health Insurance Commissioner
|
Primary Care Spending Report 2013
|
Page 7
8. APPENDIX
The tables included in the appendix show primary care spending for each insurer from 2008 through its 2014
projections. It is important to note that these tables therefore include data prior to the enactment of the Affordability
Standards in 2010. Each table includes the data on the following: (1) a comparison of each insurers actual spending on
primary care to its established target for each year; (2) a break-down of total primary care payment methods into FFS
or non-FFS components; (3) the dollar expenditures for each non-FFS category and the percentage contribution of
each category to total non-FFS expenditures for a given year.
The calculated percent change and average annual growth rate are based on the period of data used from 2008 to
2012 unless data from these years was not available. Particularly, all calculations for Tufts Health Plan are based off
Tufts’ 2009 data submissions since Tufts did not start selling insurance in Rhode Island until 2009.
Appendix Table 1
Appendix Table 2
Office of the Health Insurance Commissioner
|
Primary Care Spending Report 2013
|
Page 8
9. APPENDIX
The tables included in the appendix show primary care spending for each insurer from 2008 through its 2014
projections. It is important to note that these tables therefore include data prior to the enactment of the Affordability
Standards in 2010. Each table includes the data on the following: (1) a comparison of each insurers actual spending on
primary care to its established target for each year; (2) a break-down of total primary care payment methods into FFS
or non-FFS components; (3) the dollar expenditures for each non-FFS category and the percentage contribution of
each category to total non-FFS expenditures for a given year.
The calculated percent change and average annual growth rate are based on the period of data used from 2008 to
2012 unless data from these years was not available. Particularly, all calculations for Tufts Health Plan are based off
Tufts’ 2009 data submissions since Tufts did not start selling insurance in Rhode Island until 2009.
Appendix Table 3
Appendix Table 4
Office of the Health Insurance Commissioner
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Primary Care Spending Report 2013
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Page 9