Personal Health Budgets for Patients with Complex Needs

O'Shea, Luke; Bindman, Andrew B.

doi:10.1056/nejmp1606040

Cited by 21 publications

(21 citation statements)

References 3 publications

(4 reference statements)

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“…Improved equity and quality of home health care delivery has received relatively little policy attention, with virtually no focus on children. 63 There are some interesting policies being described (eg, families selfdirecting how to use home health funding), 64,65 but these have not been widely adopted. Another key driver of health care use is highcost pharmaceuticals, 66 whose affordability for the many rare, complex pediatric conditions likely will continue to be a policy challenge, particularly in the emerging era of personalized medicine.…”

Section: The Underemphasized Role Of Nonhospital Components Of Carementioning

confidence: 99%

Status Complexicus? The Emergence of Pediatric Complex Care

et al. 2018

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Discourse about childhood chronic conditions has transitioned in the last decade from focusing primarily on broad groups of children with special health care needs to concentrating in large part on smaller groups of children with medical complexity (CMC). Although a variety of definitions have been applied, the term CMC has most commonly been defined as children and youth with serious chronic conditions, substantial functional limitations, increased health and other service needs, and increased health care costs. The increasing attention paid to CMC has occurred because these children are growing in impact, represent a disproportionate share of health system costs, and require policy and programmatic interventions that differ in many ways from broader groups of children with special health care needs. But will this change in focus lead to meaningful changes in outcomes for children with serious chronic diseases, or is the pediatric community simply adopting terminology with resonance in adult-focused health systems? In this article, we will explore the implications of the rapid emergence of pediatric complex care in child health services practice and research. As an emerging field, pediatric care systems should thoughtfully and rapidly develop evidence-based solutions to the new challenges of caring for CMC, including (1) clearer definitions of the target population, (2) a more appropriate incorporation of components of care that occur outside of hospitals, and (3) a more comprehensive outcomes measurement framework, including the recognition of potential limitations of cost containment as a target for improved care for CMC.

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Section: The Underemphasized Role Of Nonhospital Components Of Carementioning

confidence: 99%

Status Complexicus? The Emergence of Pediatric Complex Care

et al. 2018

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“…56 As a result, even health systems that bear full financial risk for their population may be limited in the services they can offer HNHC patients. 57 Better integration of medical, behavioral health, and social service delivery, such as the models currently being tested as part of state waivers for managing dualeligible populations, 58 the Centers for Medicare & Medicaid Services Accountable Health Communities demonstration, 59 and the British Bpersonal health budgets^program, 60 could bolster the ability of health care delivery systems, and primary care clinicians in particular, to meet the needs of HNHC patients. 61 A final challenge for improving care for HNHC populations is that, with a handful of exceptions (some of which were noted in this essay), there are few rigorous studies of HNHC programs.…”

Section: Policy Changes To Improve Care For High-needs High-cost Patmentioning

confidence: 99%

Disruptive Models in Primary Care: Caring for High-Needs, High-Cost Populations

Hochman

Asch

2017

J GEN INTERN MED

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Starfield and colleagues have suggested four overarching attributes of good primary care: Bfirst-contact access for each need; long-term person-(not disease) focused care; comprehensive care for most health needs; and coordinated care when it must be sought elsewhere.^As this series on reinventing primary care highlights, there is a compelling need for new care delivery models that would advance these objectives. This need is particularly urgent for highneeds, high-cost (HNHC) populations. By definition, HNHC patients require extensive attention and consume a disproportionate share of resources, and as a result they strain traditional office-based primary care practices. In this essay, we offer a clinical vignette highlighting the challenges of caring for HNHC populations. We then describe two categories of primary care-based approaches for managing HNHC populations: complex case management, and specialized clinics focused on HNHC patients. Although complex case management programs can be incorporated into or superimposed on the traditional primary care system, such efforts often fail to engage primary care clinicians and HNHC patients, and proven benefits have been modest to date. In contrast, specialized clinics for HNHC populations are more disruptive, as care for HNHC patients must be transferred to a multidisciplinary team that can offer enhanced care coordination and other support. Such specialized clinics may produce more substantial benefits, though rigorous evaluation of these programs is needed. We conclude by suggesting policy reforms to improve care for HNHC populations.

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“…Examples include initiation of the roles of physician assistants, nurse practitioners and advanced care pharmacists, as well as minute clinics and dispensing robots. However, there is limited uptake of more disruptive reforms, such as virtual health care using technologies that are taken for granted in the daily management of personal finances, the use of public or insurance funds by people with disabilities to purchase their own support and health services, the instigation of person‐directed end‐of‐life care as a norm, and the tagging of funding to people with high health needs and the directing of that funding to follow the decisions such users make . The health workforce for these models is uncertain and many current workers are both reluctant and have limited ability to operate in such ‘disrupted’ environments …”

Section: Background To the Literature Review And Analysismentioning

confidence: 99%

“…30,32,89 This will lead to recognition of provider types and skills that add value. 32,90 Alternatively, if consumers purchase health care, 38 or if money allocated to their health care follows the choices they make, then the provision of public information to enable such choices is essential. 32,89,91 This information will need to be co-developed with consumers, providers and funders, and to be both contextually meaningful and trustworthy.…”

Section: Allowing Health Workforces To Evolve Naturallymentioning

confidence: 99%

Matching the production of doctors with national needs

Gorman

2017

Med Educ

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Context Matching the supply of health workers to need is necessary if a health system is to be sustainable, affordable and fit for purpose. On the 30th anniversary of the 1988 Edinburgh Declaration of the World Federation for Medical Education, levels of compliance with the 10th recommendation, ‘Ensure admission policies that match the numbers of students trained with national needs for doctors’, warrant review. There are two domains to such a review, concerning, respectively, how well these health needs are known, and whether workforce supply is well matched. Methods This is a literature review‐based analysis of extant health system planning, which underpins current understanding of national health needs and of the consequent alignment of student selection processes. Results The core finding is that national need for doctors, and any other health workers, is not confidently known for any jurisdiction. Consequently, validation of student selection processes is impossible against this endpoint and data to validate these processes against the alternative endpoint of a positive impact on health outcomes do not exist. Data do exist to suggest some student selection processes result in desirable career and career location uptakes.

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Personal Health Budgets for Patients with Complex Needs

Cited by 21 publications

References 3 publications

Status Complexicus? The Emergence of Pediatric Complex Care

Status Complexicus? The Emergence of Pediatric Complex Care

Disruptive Models in Primary Care: Caring for High-Needs, High-Cost Populations

Matching the production of doctors with national needs

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