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![An Exploration of Care Coordination and Management for the Medicaid HIV Population within Upstate New York Health Homes için kapak resmi An Exploration of Care Coordination and Management for the Medicaid HIV Population within Upstate New York Health Homes için kapak resmi](/client/assets/d79c3e4af2b6d196/ctx/images/no_image.png)
An Exploration of Care Coordination and Management for the Medicaid HIV Population within Upstate New York Health Homes
Başlık:
An Exploration of Care Coordination and Management for the Medicaid HIV Population within Upstate New York Health Homes
Yazar:
Oghenejobo, Esemikelu B., author.
ISBN:
9780438075191
Yazar Ek Girişi:
Fiziksel Tanımlama:
1 electronic resource (326 pages)
Genel Not:
Source: Dissertation Abstracts International, Volume: 79-10(E), Section: B.
Advisors: Wendy Weller Committee members: Brenda Kirkwood; Patricia Strach.
Özet:
Within the U.S. healthcare system, there has been a renewed focus to improve the delivery of care services, to increase the quality of care, and to decrease costs. The Affordable Care Act introduced the health home (HH) model to serve vulnerable, Medicaid populations who are experiencing difficulty managing their care and navigating complex healthcare systems. The HH was a voluntary state option; of which New York State (NYS) chose to participate. Additionally, NYS was granted a Medicaid 1115 waiver to fully implement an ambitious re-design of NYS's Medicaid program. NYS invested in the HH as a key model to address targeted sub-groups within the Medicaid population, such as the HIV population, who disproportionately use health services and contribute to the highest healthcare costs in NYS.
While HHs have existed since 2012, providers and the community at large still have very limited understanding of HHs. Early evaluations of HHs showed that more education is needed on HHs. Previous literature also shows that there is limited knowledge on the impact of HHs on targeted sub-populations. The purpose of this study was to increase understanding of upstate New York HHs and the HHs' care coordination and management approaches to the HIV sub-population in NYS. NYS has the highest prevalence of persons living with HIV (PLWH) and has been a leader in the country with addressing HIV and care services and also implementing Medicaid reform initiatives. Along with its Medicaid redesign initiatives, NYS also set an ambitious blueprint called Ending the Epidemic (EtE), an initiative focused on ending the HIV/AIDS epidemic. NYS is invested in the HH model to positively impact PLWH; thus, making the HH an ideal model to explore in aiding PLWH.
A qualitative design was used to explore the organizational infrastructure of the service- level lead and care management agencies (LAs and CMAs respectively) within upstate New York HHs, the roles of providers, the HHs' core services to the HIV population, and facilitators and barriers specifically related to coordinating and managing care for the HIV population. Six Upstate New York HHs were examined as case studies through qualitative instruments of: semi-structured key informant interviews, participant observation via an upstate HHs provider meeting (CMAs only), and HHs' document analyses. Guided by Nadler and Tushman's Organizational Design Framework, this study described the different methods HHs used to organize their organizations and care teams, in addition to the identification of coordinating mechanisms that HHs used to implement core services to their HIV populations.
Overall, study findings showed that the HH goal of seamless integration of physical health, behavioral health, and social services has not yet been realized in HHs due to structural and functional deficiencies. HHs experienced steep learning curves serving additional populations outside of their primary areas of expertise. However, the inclusion of legacy COBRA providers directly benefitted PLWH in HHs, due to care management staff's HIV expertise and additional supportive services provided to PLWH. The implementation of HHs represented a vast difference from traditional, targeted case management (TCM) legacy programs; but, LAs and CMAs welcomed the transition from TCM models to HHs because of its focus on empowerment, independence, and comprehensive care for the HH member. However, LAs and CMAs were frustrated with unclear guidelines, the lack of bi-directional information sharing, deficiencies in HIT, loss of HIV quality data measurements, and barriers to obtaining resources for their HH members. Despite the ever-changing HH environment, LAs and CMA staff showed great resiliency and commitment to implementing processes that could positively impact their HH members. LAs and CMAs were learning best practices for their sub-populations within HHs as they worked and were invested in the success of the HH model. As HHs evolve, it will be advantageous to incrementally target complex populations, provide standardized policies and procedures, and implement key quality measures that HHs should work to achieve. State health departments, managed care organizations, providers, HHs, and communities will need to work together to improve care coordination and management.
Notlar:
School code: 0668
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Yer Numarası | Demirbaş Numarası | Shelf Location | Lokasyon / Statüsü / İade Tarihi |
---|---|---|---|
XX(680834.1) | 680834-1001 | Proquest E-Tez Koleksiyonu | Arıyor... |
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