Managed care quarterly
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Medicaid is a cornerstone of this country's health care system, covering over 50 million people and supplying one in five health care dollars in the United States. Medicaid is again a contested issue in state capitols, where states facing sluggish revenues target Medicaid since it is the second largest and fastest growing component of state spending. Managed care was the policy tool many states embraced in order to slow Medicaid spending, and while managed care has had some successes in improving Medicaid services, it has not met states' expectations for cost savings. This analysis explores several reasons why these savings have not been realized, and proposes policy reforms for state Medicaid programs that would make Medicaid coverage more stable, thereby increasing the ability of managed care plans and network providers to work with Medicaid beneficiaries to change patterns of care and realize real savings.
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Managed care quarterly · Jan 2003
Reducing pain and costs with innovative postoperative pain management.
Individual patient responses to some of the standard-of-care treatments for post operative pain management are unpredictable, but studies have shown undertreatment of acute post operative pain is common. There are new, innovative techniques for postoperative pain management that may improve a patients' recovery period. ⋯ Overall, the less time a patient is removed from normal day-to-day activity, the more satisfied they tend to be with their surgical experience. The following article addresses these and other issues surrounding the reduction of pain and cost after surgery.
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Managed care quarterly · Jan 2003
A test of the California competency-based differentiated role model.
To address the incongruence between the expectations of nursing service and education in California, the Education Industry Interface Task Force of the California Strategic Planning Committee for Nursing developed descriptions to assist employers and educators in clearly differentiating practice and educational competencies. The completion of the Competency-Based Role Differentiation Model resulted in the need to test the model for its utility in the service setting, in education, and for career planning for nurses. Three alpha demonstration sites were selected based on representative geographical regions of California. ⋯ New graduates are more likely to take on novice and competent care coordinator roles. The CBRDM may be useful for practice and education settings to evaluate student and nurse performance, to define role expectations, and to identify the preparation necessary for the roles. It is useful for all of nursing as it continues to define its levels of practice and their relationship to on-the-job performance, curriculum development, and carrier planning.
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This article examines the national standards for safeguarding the confidentiality, integrity, and availability of electronic protected health information under the final Privacy Rule of the Health Insurance Portability and Accountability Act (HIPAA). The standards require entities covered by the rule to implement basic safeguards to protect electronic protected health information from unauthorized access, alteration, deletion, and transmission. The final privacy rule applies to protected health information in any form.