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Health Care Systems/Medicaid & Medicare

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Medicaid/Medicare Services
Stella Williams
Harrison College
Medicaid/Medicare Services
Develop a plan for the center by using clinical quality measures, or CQMs, which are tools to help track and measure the quality of health care serviced that are provided by eligible professionals, eligible hospitals that are within the health care system. These would be measures to use data that is associated with providers that are able to provide high quality care or relate to long term goals for health care. The measures would be the many aspects of patient care including: * Health outcomes * Patient safety * Clinical processes * Efficient use of health care resources * Population and public health * Adherence to clinical guidelines * Patient engagements * Care coordination
By reporting and measuring CQMs in a three month or 90 day reporting period will help to ensure that the health care system is safe, efficient, effective, patient centered, timely care and equitable. According to the EHR Incentive Programs the need to report the measures will demonstrate meaningful use and receive an incentive payment so the CQMs may be reported electronically or via attestation. The CQMs are identified into core sets and they are highly recommended so the focus can be on conditions that contribute to the morbidity and mortality of most Medicare and Medicaid beneficiaries with some factors that would be recommended, the Center would have to have certain conditions that would contribute to most of Medicaid and Medicare beneficiaries like the health disparities, conditions that disproportionately drive health care costs and could improve with better quality measurement, measures that would enable CMS, States, and the provider community to measure quality of care in new dimensions, with a stronger focus on parsimonious measurement and that would include patient and/or caregiver engagement. The Center would need to take steps to submission: * Determine reporting method and which measures apply * Verify the EHR system is 2015 edition certified * Document patient information in the EHR system * Register for an IACS account (only required for Portal CQM submission) by requesting the EHR Submitter Role when registering for the IACS account/and Refer to the IACS EHR Submitter Role Quick Reference Guide * Submit 2015 CQM Data: by reporting through the Registration & Attestation system, review the Attestation User Guides/and review the Quality Net PQRS submission User Guide.
There are so many Incentive Programs that provide financial incentives for the use of certified EHR technology to improve patient and by taking part the Center can receive incentive payments for certain Medicaid health care and can receive up to a maximum of $63,750 over six years participation. Although to qualify we must have a minimum 30% of Medicaid patient volume and a practice predominantly in a Federally Qualified Health Center and have a minimum 30% patient volume attributable to needy individuals.
Developing ways to accurately measure the efficiency and quality of care for older Americans for the long term care and holistic care that includes both medical services and social support is necessary for assessing the effectiveness of current care and payment models so the policy directions should include: EHR and increased data analytic capacity to better coordinate care and improve the value of patient care, new integrated care delivery strategies which would include community based services to provide insights to target improvements for specific high risk and high cost patient populations and methods of payment that would incentivize the delivery of high value care and guarantee that the quality of improvements are sustained over time.
Implementing reforms and reinforcing reforms will have the greatest impact on the growth rate of health care spending and the improvements of quality of care provided to the older Americans. ARRA has provided financing by authorizing $17.2 billion for the Centers for Medicare and Medicaid Services to assist providers that are eligible. Utilizing the multiple programs that are out there like (PACE) Programs for All Inclusive Care for the Elderly which funds services for individuals 55 years or older that require nursing home care and will meet all the needs of medical and supportive services across the continuum of care so they are able to maintain their independence. The Care Transitions program is a four week program that would need a coach to provide complex needs and this program will also use a transitional nurse to coordinate patients moving from their home to the hospital giving the family an assessment of the patient’s disposition so they are able to care for the patient at home.
To best meet the needs of the aging population and to improve older adults with their health is very critical, that’s why training future nurses and staff with expertise in geriatric care will maintain the quality of life and dignity for older adults in various care settings that will have a high quality of care and support from family members and friends.

Works Cited (n.d.). Retrieved from Centers for Medicare & Medicaid Services:
Fowler, W. (08, August). Responding to the Challenges of Long-Term Care. Retrieved from
Lee, M. E. (2013, October). The Strategy That Will Fix Health Care. Retrieved from Harvard Business Review: (n.d.). U.S. Department of Helath & Human Services.

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