Relevant bibliographies by topics / Managed care plans (Medical care) Australia

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Academic literature on the topic 'Managed care plans (Medical care) Australia'

Author: Grafiati
Published: 4 June 2021
Last updated: 19 February 2022

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Journal articles on the topic "Managed care plans (Medical care) Australia"

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Scott, Ian A., Clair Sullivan, and Andrew Staib. "Going digital: a checklist in preparing for hospital-wide electronic medical record implementation and digital transformation." Australian Health Review 43, no. 3 (2019): 302. http://dx.doi.org/10.1071/ah17153.

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Objective In an era of rapid digitisation of Australian hospitals, practical guidance is needed in how to successfully implement electronic medical records (EMRs) as both a technical innovation and a major transformative change in clinical care. The aim of the present study was to develop a checklist that clearly and comprehensively defines the steps that best prepare hospitals for EMR implementation and digital transformation. Methods The checklist was developed using a formal methodological framework comprised of: literature reviews of relevant issues; an interactive workshop involving a multidisciplinary group of digital leads from Queensland hospitals; a draft document based on literature and workshop proceedings; and a review and feedback from senior clinical leads. Results The final checklist comprised 19 questions, 13 related to EMR implementation and six to digital transformation. Questions related to the former included organisational considerations (leadership, governance, change leaders, implementation plan), technical considerations (vendor choice, information technology and project management teams, system and hardware alignment with clinician workflows, interoperability with legacy systems) and training (user training, post-go-live contingency plans, roll-out sequence, staff support at point of care). Questions related to digital transformation included cultural considerations (clinically focused vision statement and communication strategy, readiness for change surveys), management of digital disruption syndromes and plans for further improvement in patient care (post-go-live optimisation of digital system, quality and benefit evaluation, ongoing digital innovation). Conclusion This evidence-based, field-tested checklist provides guidance to hospitals planning EMR implementation and separates readiness for EMR from readiness for digital transformation. What is known about the topic? Many hospitals throughout Australia have implemented, or are planning to implement, hospital wide electronic medical records (EMRs) with varying degrees of functionality. Few hospitals have implemented a complete end-to-end digital system with the ability to bring about major transformation in clinical care. Although the many challenges in implementing EMRs have been well documented, they have not been incorporated into an evidence-based, field-tested checklist that can practically assist hospitals in preparing for EMR implementation as both a technical innovation and a vehicle for major digital transformation of care. What does this paper add? This paper outlines a 19-question checklist that was developed using a formal methodological framework comprising literature review of relevant issues, proceedings from an interactive workshop involving a multidisciplinary group of digital leads from hospitals throughout Queensland, including three hospitals undertaking EMR implementation and one hospital with complete end-to-end EMR, and review of a draft checklist by senior clinical leads within a statewide digital healthcare improvement network. The checklist distinguishes between issues pertaining to EMR as a technical innovation and EMR as a vehicle for digital transformation of patient care. What are the implications for practitioners? Successful implementation of a hospital-wide EMR requires senior managers, clinical leads, information technology teams and project management teams to fully address key operational and strategic issues. Using an issues checklist may help prevent any one issue being inadvertently overlooked or underemphasised in the planning and implementation stages, and ensure the EMR is fully adopted and optimally used by clinician users in an ongoing digital transformation of care.
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Ryan, Benjamin, Richard Franklin, Frederick Burkle, Erin Smith, Peter Aitken, and Peter Leggat. "Determining Key Influences on Patient Ability to Successfully Manage Noncommunicable Disease After Natural Disaster." Prehospital and Disaster Medicine 34, s1 (May 2019): s47—s48. http://dx.doi.org/10.1017/s1049023x19001122.

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Introduction:Natural disasters often damage the public health infrastructure required to maintain the wellbeing of people with noncommunicable diseases. This increases the risk of an acute exacerbation or complications, potentially leading to a worse long-term prognosis or even death. Disaster-related exacerbations of noncommunicable diseases will continue, if not increase, due to an increasing disease prevalence, sustained rise in the frequency and intensity of disasters, and rapid unsustainable urbanization in disaster-prone areas. However, the traditional focus of public health and disaster systems remains on communicable diseases, despite a low risk. There is now an urgent need to expand the public health response to include noncommunicable diseases.Aim:To explore the key influences on patient ability to successfully manage their noncommunicable disease after a natural disaster.Methods:A survey of people with noncommunicable diseases in Queensland, Australia, collected data on demographics, disease/condition, disaster experience, and primary concern post-disaster. Descriptive statistics and chi-square tests with Bonferroni-adjustment were used to analyze data.Results:There were 118 responses to the survey. Key influences on the ability to self-manage post-disaster were access to medication, medical services, water, treatment and care, power, and food. Managing disease-specific symptoms associated with cardiovascular disease, diabetes, mental health, and respiratory diseases were primary concerns following a disaster. Stress and anxiety, loss of sleep, weakness or fatigue and shortness of breath were common concerns for all noncommunicable diseases. Those dependent on care from others were most worried about shortness of breath and slow healing sores. Accessing medication and medical services were priorities for all patients post-disaster.Discussion:The key influences on successful self-management post disaster for people with noncommunicable diseases must be reflected in disaster plans and strategies. Achieving this will reduce exacerbations or complications of disease and decrease demand for emergency health care post-disaster.
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Ryan, Benjamin J., Richard C. Franklin, Frederick M. Burkle, Erin C. Smith, Peter Aitken, and Peter A. Leggat. "Determining Key Influences on Patient Ability to Successfully Manage Noncommunicable Disease After Natural Disaster." Prehospital and Disaster Medicine 34, no. 03 (May 13, 2019): 241–50. http://dx.doi.org/10.1017/s1049023x1900431x.

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AbstractIntroduction:Natural disasters often damage or destroy the protective public health service infrastructure (PHI) required to maintain the health and well-being of people with noncommunicable diseases (NCDs). This interruption increases the risk of an acute exacerbation or complication, potentially leading to a worse long-term prognosis or even death. Disaster-related exacerbations of NCDs will continue, if not increase, due to an increasing prevalence and sustained rise in the frequency and intensity of disasters, along with rapid unsustainable urbanization in flood plains and storm-prone coastal zones. Despite this, the focus of disaster and health systems preparedness and response remains on communicable diseases, even when the actual risk of disease outbreaks post-disaster is low, particularly in developed countries. There is now an urgent need to expand preparedness and response beyond communicable diseases to include people with NCDs.Hypothesis/Problem:The developing evidence-base describing the risk of disaster-related exacerbation of NCDs does not incorporate the perspectives, concerns, and challenges of people actually living with the conditions. To help address this gap, this research explored the key influences on patient ability to successfully manage their NCD after a natural disaster.Methods:A survey of people with NCDs in Queensland, Australia collected data on demographics, disease, disaster experience, and primary concern post-disaster. Descriptive statistics and chi-square tests with a Bonferroni-adjustment were used to analyze data.Results:There were 118 responses to the survey. Key influences on the ability to self-manage post-disaster were access to medication, medical services, water, treatment and care, power, and food. Managing disease-specific symptoms associated with cardiovascular disease, diabetes, mental health, and respiratory diseases were primary concerns following a disaster. Stress and anxiety, loss of sleep, weakness or fatigue, and shortness of breath were common concerns for all patients with NCDs. Those dependent on care from others were most worried about shortness of breath and slow healing sores. Accessing medication and medical services were priorities for all patients post-disaster.Conclusion:The key influences on successful self-management post-disaster for people with NCDs must be reflected in disaster plans and strategies. Achieving this will reduce exacerbations or complications of disease and decrease demand for emergency health care post-disaster.
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Marsden, Dianne Lesley, Kerry Boyle, Louise-Anne Jordan, Judith Anne Dunne, Jodi Shipp, Fiona Minett, Amanda Styles, et al. "Improving Assessment, Diagnosis, and Management of Urinary Incontinence and Lower Urinary Tract Symptoms on Acute and Rehabilitation Wards That Admit Adult Patients: Protocol for a Before-and-After Implementation Study." JMIR Research Protocols 10, no. 2 (February 4, 2021): e22902. http://dx.doi.org/10.2196/22902.

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Background Urinary incontinence (UI) and lower urinary tract symptoms (LUTS) are commonly experienced by adult patients in hospitals (inpatients). Although peak bodies recommend that health services have systems for optimal UI and LUTS care, they are often not delivered. For example, results from the 2017 Australian National Stroke Audit Acute Services indicated that of the one-third of acute stroke inpatients with UI, only 18% received a management plan. In the 2018 Australian National Stroke Audit Rehabilitation Services, half of the 41% of patients with UI received a management plan. There is little reporting of effective inpatient interventions to systematically deliver optimal UI/LUTS care. Objective This study aims to determine whether our UI/LUTS practice-change package is feasible and effective for delivering optimal UI/LUTS care in an inpatient setting. The package includes our intervention that has been synthesized from the best-available evidence on UI/LUTS care and a theoretically informed implementation strategy targeting identified barriers and enablers. The package is targeted at clinicians working in the participating wards. Methods This is a pragmatic, real-world, before- and after-implementation study conducted at 12 hospitals (15 wards: 7/15, 47% metropolitan, 8/15, 53% regional) in Australia. Data will be collected at 3 time points: before implementation (T0), immediately after the 6-month implementation period (T1), and again after a 6-month maintenance period (T2). We will undertake medical record audits to determine any change in the proportion of inpatients receiving optimal UI/LUTS care, including assessment, diagnosis, and management plans. Potential economic implications (cost and consequences) for hospitals implementing our intervention will be determined. Results This study was approved by the Hunter New England Human Research Ethics Committee (HNEHREC Reference No. 18/10/17/4.02). Preimplementation data collection (T0) was completed in March 2020. As of November 2020, 87% (13/15) wards have completed implementation and are undertaking postimplementation data collection (T1). Conclusions Our practice-change package is designed to reduce the current inpatient UI/LUTS evidence-based practice gap, such as those identified through national stroke audits. This study has been designed to provide clinicians, managers, and policy makers with the evidence needed to assess the potential benefit of further wide-scale implementation of our practice-change package. International Registered Report Identifier (IRRID) DERR1-10.2196/22902
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KANE, SISTER. "Hospital Strategies for Contracting with Managed Care Plans." AORN Journal 48, no. 2 (August 1988): 369–70. http://dx.doi.org/10.1016/s0001-2092(07)68859-0.

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Mozaffari, Essy, and Sean D. Sullivan. "Home care reimbursement for intravenous ganciclovir therapy." American Journal of Health-System Pharmacy 53, no. 2 (January 15, 1996): 161–63. http://dx.doi.org/10.1093/ajhp/53.2.161.

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Variability in reimbursement for home i.v. ganciclovir therapy among three types of payers was investigated. A survey was developed to estimate reimbursement for drug and medical supplies and nursing services associated with preparing i.v. ganciclovir and administering it to persons with cytomegalovirus (CMV)-associated retinitis in the home care setting. The questionnaire was mailed to 45 home health care agencies and 11 nursing agencies. Of the 56 surveys mailed, 26 (46%) were returned and considered usable. Of the 26 respondents, 22 were home health care companies, 4 were nursing ageiicies, 22 served patients covered by managed care or state assistance that reimbursed on a per diem trasis, and 9 did not provide care to fee-for-service patients. The mean total daily-reimbursement rate (for ganciclovir, supplies, and nursing services) from managed care per diem plans was $137.69 per patient, compared with $I29.18 from fee-for-service plans and $72.68 from state assistance per diem plans. The dissimilarity may have been due to geographic variations in reimbursement and different mechanisms of reimbursement. Providers of home i.v. ganciclovir therapy for persons with CMV retinitis received the highest tnean total daily reimbursement from managed care per diem plans, followed by fee-for-service plans and state assistance per diem plans.
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Havighurst, Clark C. "Vicarious Liability: Relocating Responsibility For The Quality Of Medical Care." American Journal of Law & Medicine 26, no. 1 (2000): 7–29. http://dx.doi.org/10.1017/s0098858800010807.

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AbstractManaged health care has recently generated a great deal of distrust, even anger, in the public mind. To be sure, much of this public reaction is based on anecdotal evidence and one-dimensional thinking. But many unbiased experts observing managed care today are themselves unhappy with the health care industry's performance. While these observers find little justification for the current political backlash against managed care, they are also disappointed that today's health plans have not made a more positive difference. Indeed, informed observers commonly regret that the new arrangements for the financing and delivery of care have done so little to get physicians to adopt truly efficient practices, achieving not only cost reductions but also substantial improvements in health status and patient outcomes— that is, in the quality of care. Although managed care has not demonstrably harmed the overall quality of health care in the United States, it has done little to improve it.
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Aledort, Louis M., and James Coates. "Can Health Care Plans Afford Hemophilia Costs? Yes." Blood 106, no. 11 (November 16, 2005): 5551. http://dx.doi.org/10.1182/blood.v106.11.5551.5551.

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Abstract Hemophilia care has high annual recurring costs. 80–90% of these costs are to cover replacement therapy. Managed care programs have, in general, not recruited specialists to help determine the guidelines of care, the use of hemophilia treatment centers (HTC) by their patients or the multiple sources and charges for acquiring these expensive biologics. Aetna has 700–750 hemophilia patients in a typical year whose medical costs are upward of $60 million. These patients represent only.005% of the total membership, and 0.198% of the health care dollars spent. A hemophilia specialist was asked to evaluate these patients vis-á-vis site of care, optimal treatment plan, and potential savings for covered members, payers and employers. Methods: working with the Aetna nurse case managers, individual patients were evaluated for the above issues. Results: From June 2004 to June 2005, 190 patient files were reviewed. Of these, 18% had lifetime caps, and 30% were not treated in an HTC. 16% of these patients decided to transfer to an HTC for either their care or product procurement. The remainder decided not to pursue this path. Table I Patients Issue 1) 4.5 % Altered regimen, product or product procurement 2) 3 % Contemplating altered regimen, product or product procurement 3) 17 % Physician contacted regarding optimal therapy 4) 9.5 % Prices of product negotiated downward 5) 12 % Product procurement switch to PHS pricing 6) 3 % Adhering to previous regimen Table II $ Savings (using above categories) Real Potential 1) 2,978,028 2) --- 353,972 3) 0 4) 1,157,504 5) 4,334,523 6) --- 1,904,360 Total 8,470,055 2,258,332 The potential savings represent those who are either contemplating change but, in the main, are physicians and/or patients who chose not to accept the recommendations made. Realized annualized savings of more than $8 million affect all aspects of the care system. It is particularly revelant to those with lifetime caps. If this model were expanded for other high cost disorders, medical expenses could diminish and premium inflation could eventually decrease. Hemophilia biologics have continued to increase in costs from cryoprecipitate in the 1960s to current recombinant products. Fostering access to HTCs substantially improves quality of care and reduces medical expenditures. In conclusion, we believe that by using this approach, hemophilia care and its costs can be appropriately managed.
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Furst, Daniel E. "Measuring the impact of managed care plans on the use of biologics." Arthritis & Rheumatism 53, no. 3 (2005): 318–19. http://dx.doi.org/10.1002/art.21168.

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Latham, Stephen R. "Regulation of Managed Care Incentive Payments to Physicians." American Journal of Law & Medicine 22, no. 4 (1996): 399–432. http://dx.doi.org/10.1017/s0098858800011904.

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A large and growing number of physicians in today’s managed care market are paid for their services according to incentive schemes that offer financial rewards for the provision of less, and less expensive, medical care. Such schemes typically reward physicians for reducing their own costs of care and reward primary care physicians for reducing the number and cost of referrals for inpatient and specialty care. Consumers, fearful that such schemes will prompt physicians to deny them medically necessary care, have protested the implementation of such incentive plans. Various states are considering bills to ban or to limit physician incentive payments.Federal policy with regard to incentive schemes has been confused and contradictory. On one hand, regulators concerned with controlling health care costs and limiting the provision of unnecessary care have encouraged such financial incentives. For example, federal Stark regulations, which ban referrals tied to physician compensation, include explicit exceptions for incentive schemes.
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Dissertations / Theses on the topic "Managed care plans (Medical care) Australia"

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Mills, David. "The role of goal setting in the diabetes case management of aboriginal and non-aboriginal populations in rural South Australia /." Title page, table of contents and abstract only, 2005. http://web4.library.adelaide.edu.au/theses/09MD/09mdm6571.pdf.

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Thesis (M.D.)--University of Adelaide, Dept. of General Practice, 2005.
Includes publications published as a result of ideas developed in this thesis, inserted at end. "April 2005" Includes bibliographical references (leaves 210-242).
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Armbruster, Susanne. "Versorgungsnetzwerke im französischen und deutschen Gesundheitswesen : eine vergleichende Studie unter Berücksichtigung rechts- und gesundheitswissenschaftlicher Aspekte /." Stuttgart : Ibidem-Verl, 2004. http://www.gbv.de/dms/sbb-berlin/46191977X.pdf.

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Levy, Elizabeth Giselle. "Therapeutic process in a managed care type setting : the working alliance, pre-treatment characteristics and outcome /." Digital version accessible at:, 1998. http://wwwlib.umi.com/cr/utexas/main.

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Beaubien, Jason Michael. "Effectiveness of recipient restriction programs in medicaid managed care organizations /." View online ; access limited to URI, 2005. http://0-wwwlib.umi.com.helin.uri.edu/dissertations/dlnow/3206244.

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Brudevold, Christine. "Assessment of capitated contract medicine arrangements in Hong Kong : an example of financial incentives and managed care in an unregulated environment /." Hong Kong : University of Hong Kong, 1999. http://sunzi.lib.hku.hk/hkuto/record.jsp?B20906791.

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Callister, Ronda Roberts. "Examining conflicts across organizational boundaries : managed care--provider interactions /." free to MU campus, to others for purchase, 1996. http://wwwlib.umi.com/cr/mo/fullcit?p9801628.

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Lindrooth, Richard C. "Selective contracting, cost sharing, and utilization management : a theoretical and empirical analysis of the market for health care /." Thesis, Connect to this title online; UW restricted, 1998. http://hdl.handle.net/1773/7463.

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Bornman, Magda. "Digital media as communication tools for health promotion in managed health care." Pretoria : [s.n.], 2000. http://upetd.up.ac.za/thesis/available/etd-07132006-105048/.

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Stein, Bradley D. "Drug and alcohol treatment services among privately insured individuals in managed behavioral health care." Santa Monica, CA : RAND, 2003. http://www.rand.org/publications/RGSD/RGSD170/RGSD170.pdf.

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Lei, Xiaoyan. "Public and private transfers essays on transfers to children and parents /." Diss., Restricted to subscribing institutions, 2007. http://proquest.umi.com/pqdweb?did=1467890571&sid=1&Fmt=2&clientId=1564&RQT=309&VName=PQD.

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Books on the topic "Managed care plans (Medical care) Australia"

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Fillingham, David. Managed care. Manchester: Health Services Management Unit, University of Manchester, 1997.

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Glied, Sherry. Managed care. Cambridge, MA: National Bureau of Economic Research, 1999.

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Weber, Gil. Managed care negotiations. Edited by Wilner Burton J and American Academy of Ophthalmology. San Francisco, CA (655 Beach St., P.O. Box 7424, San Francisco 94120-7424): American Academy of Ophthalmology, 1997.

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Cafferky, Michael E. Managed care & you. Los Angeles: Health Information Press, 1997.

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Senn, Deborah. Navigating managed care: A consumer's guide to managed care. [Olympia, Wash.]: Washington State Insurance Commissioner, 1998.

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Hooghiemstra, T. F. M. Privacy & managed care. 's-Gravenhage: Registratiekamer, 1998.

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Implementing managed health care. New York, NY: Conference Board, 1991.

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Mercurio, Carl. Managed care in the new millennium: New York managed care. New Rochelle, NY: Corporate Research Group, 2000.

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Mercurio, Carl. Managed care in the new millennium: New Jersey managed care. New Rochelle, NY: Corporate Research Group, 2000.

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Weber, Gil. Succeeding in managed care. Edited by Freund York, Lum Flora, Wilner Burton J, Weber Gil, and American Academy of Ophthalmology. San Francisco, CA (655 Beach St., P.O. Box 7424, San Francisco 94120-7424): American Academy of Ophthalmology, 1997.

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Book chapters on the topic "Managed care plans (Medical care) Australia"

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ENTHOVEN, ALAIN C. "‘GUILD FREE CHOICE’, ‘MARKET FREE CHOICE’ AND COMPETITIVE MEDICAL PLANS." In Theory and Practice of Managed Competition in Health Care Finance, 31–74. Elsevier, 1988. http://dx.doi.org/10.1016/b978-0-444-70359-0.50007-9.

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