When coupled with management of care, implementation of parity in insurance benefits for behavioral health care can improve insurance protection without increasing total costs.
Fee-for-service payment is blamed for many of the problems observed in the US health care system. One of the leading alternative payment models proposed in the Affordable Care Act of 2010 is bundled payment, which provides payment for all of the care a patient needs over the course of a defined clinical episode, instead of paying for each discrete service. We evaluated the initial "road test" of PROMETHEUS Payment, one of several bundled payment pilot projects. The project has faced substantial implementation challenges, and none of the three pilot sites had executed contracts or made bundled payments as of May 2011. The pilots have taken longer to set up than expected, primarily because of the complexity of the payment model and the fact that it builds on the existing fee-for-service payment system and other complexities of health care. Participants continue to see promise and value in the bundled payment model, but the pilot results suggest that the desired benefits of this and other payment reforms may take time and considerable effort to materialize.
Successful implementation of the elements of the ABCDE bundle can result in significant improvements in ICU patient care. The results of this study highlight specific structural and cultural elements of ICUs and hospitals that can positively and negatively influence the implementation of complex care bundles like the ABCDE bundle. Further research is needed to assess the influence of these contextual factors across a broader variety of ICUs and hospitals.
The extent of change in the performance of local mental health authorities (LMHAs) and in the development of community support systems (CSSs) is assessed for nine demonstration cities that participated in the RWJF Program on Chronic Mental Illness and one comparison site. Parallel measures of LMHA and CSS performance were obtained from two data sources (key informant and interorganizational network surveys) conducted at each site at two times during the demonstration: 1989 and 1991. Findings indicate that the LMHAs were successfully implemented at most demonstration sites, but changes in the CSSs lagged behind LMHA performance levels. The amount of system change tended to be greater when estimated from network versus key informant data.
With funding support from the federal grant mentioned earlier, John Talbott convened a 15-member multidisciplinary task force at the University of Maryland to examine key issues related to research and treatment for young adults impaired with the dual disorders of chronic mental illness and substance abuse. A first step in that
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