管理式医疗的经验教训。

J B Burl
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引用次数: 0

摘要

竞争、医疗保险费的降低、医疗成本的上升、人口老龄化和技术进步是为管理式医疗组织(mco)带来挑战和机遇的几个因素。在降低成本的同时,不断提高护理质量和操作效率的要求是激励组织不断努力重新考虑其护理提供过程的驱动因素。最具成本效益的方案是保持其健康计划成员在社区中活跃,远离机构环境。这是最佳实现通过一个可访问的和全面的门诊实践。在急症、亚急性和长期护理领域的创新和实践模式的改变使我们能够显著地影响这些昂贵领域的质量和利用率,同时为MCO初级保健从业人员腾出额外的时间来关注他们的社区患者。MCO初级保健提供者不仅支持而且欢迎其组织中的这些变化,认识到这些创新是有效服务患者所需的连续医疗保健的一个组成部分。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Lessons learned in managed care.

Competition, reduction in health care premiums, rising health care costs, aging of the population, and technologic advances are several factors that create both challenges and opportunities for managed care organizations (MCOs). The demands to constantly improve quality of care and efficiency of operation while holding down costs are drivers meant to stimulate organizations to constantly strive to rethink their process of care provision. The most cost-effective program is one that maintains its health plan members who are active in the community and away from the institutional setting. This is optimally achieved through an accessible and comprehensive ambulatory practice. Innovation and paradigms of practice change in the acute, subacute, and long-term care arenas have allowed us to dramatically impact quality and utilization in these expensive areas, while at the same time freeing up additional time for MCO primary care practitioners to focus on their community-based patients. MCO primary care providers have not only supported but welcomed these changes in their organization, recognizing that these innovations represent a component of the continuum of health care needed to effectively serve their patients.

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