The American journal of managed care
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Accountable Care Organizations (ACOs) have potential to improve care for chronic conditions through incentives for better performance and bundled payments that promote care coordination. The Chronic Care Model (CCM) is a framework for providing health services for chronic conditions in primary care settings consistent with the organizational and financial goals of ACOs. ⋯ However, under the Medicare Shared Savings Program ACOs currently do not specify financial or organizational incentives for providing integrated mental health care through the CCM, leaving a missed opportunity to realize the full potential of ACOs to improve patient outcomes. We describe the rationale for incorporating mental health care into ACOs; how it can benefit consumers, providers, and ACOs; and what health care organizations can do to implement integrated mental health care.
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Targeted messaging that encourages consumers who are frequent users of the emergency department (ED) to contact their primary care physician in advance of an ED visit could reduce healthcare expenditures in select populations. However, such messaging has not been thoroughly evaluated. We used the input from consumers in a capitated plan to develop and test messaging designed to encourage primary care physician (PCP) contact prior to an ED visit. ⋯ A simple message that challenges consumers to think about whether the ED is truly more convenient and that provides a simple mechanism for finding out whether a trip to the ED is necessary (primary care practice contact) holds promise as a mechanism to reduce ED use for those who have ready access to primary care.
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To estimate the number of emergency department (ED) visits due to nonurgent problems and to describe the characteristics of those patients, as well as their reasons for presenting to the ED. ⋯ The results of our study corroborate the previous findings that inappropriate use of the ED is common. The prevalence of presentation for nonurgent problems was substantive between 6 PM and 6 AM. Gender, marital status, education, insurance, and day of the week had no association with nonurgent presentation.
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Screening can detect colorectal cancer (CRC) early, yet its uptake needs to be improved. Social determinants of health (SDOH) may be linked to CRC screening use but are not well understood. ⋯ Contextual factors including locality, primary care resources, and HMO membership are important determinants of CRC screening uptake; SES and segregation did not explain variation in screening behavior. More studies of contextual factors and varying geographic scales are needed to further elucidate their impact on CRC screening uptake.