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To understand the evolution of U.S. healthcare

Classmate 1: by David stewart

Health informatics looks at the health care system as a game of chess. Every piece on the chess board has a roll to play. Health informatics looks at the game through a mathematical and a scientific point of view to see how this industry runs, and how efficient can it run. When looking back at the traditional healthcare systems, where all the records were kept in a file and stored away in giant file cabinets. That led to much slower patient care in the hospitals. Later on led to many errors and unnecessary tests which raised the prices for healthcare in America. According to Mark L. Braunstone, MD states in his book, “ the Institute of Medicine attempt to summarize shows 30 percent of the $2.5 trillion the United States spends each year on healthcare represents unnecessary, wasteful, fraudulent, or overpriced services”(Braunstone, 2014, p. 8).

To understand the evolution of U.S. healthcare, you have to look at the morbidity rate in the United States. Before World War II, many people died of infectious diseases due to lack of antibiotic medications, vaccinations, and poor sanitation. Since the improvement of technology people are living healthy and the technology improved, the demand for quality care increased as well. By the demand of care the institutions had to provide led to many professional organizations to build technologies and educational programs to meet the ever-growing demand for healthcare.    

One of the ways the invention of technology helped with the demand brought on in healthcare   industry was the Electronic Medical Records (EMR) “The core application using patient specific information is the electronic medical record (EMR). The paper based medical record has its tradition and virtues; however, research has shown it can be illegible, incomplete, difficult to access in more than one place, and insecure from unauthorized uses and users” (Hersh, 2002, p. 1955).  As hospitals started adopting and using the EMR systems, the records show that patients were getting better care and more efficient results of their illnesses. Another organization called Health maintenance organizations ( HMOs) work hand in hand with the providers to take more expensive forms of care to less expensive by allowing more clinics to  see patients rather than hospitals. The HMO is simply put as managed care. (Braunstein, p. 13).  The HMO model is designed to help with lowering the cost of healthcare yet up holding high quality care. Braunstein states, “ Incentives are different in any HMO for both patient and their providers. In most HMO models, the patient must seek care from physicians who are employed by the HMO (staff model) or are in the contracted HMO network. If patients go elsewhere, they may need to pay for the care themselves. A comprehensive study of HMO suggests that increasing HMO enrollment growth has led to substantial reductions in hospital and other healthcare cost” (Braunstein, 2014, p. 14). The automation of the healthcare system proves that overall there is less human err, and improved quality medical care and record keeping. An article titled Improving Patient Care did a study on health information technology on quality, efficiency, and costs of medical care. They concluded, “Studies form 4 benchmark leaders demonstrate that implementing a multifunctional system can yield real benefits in terms of increased delivery of care based on guidelines, enhanced monitoring and surveillance activities, reduction of medication errors, and decreased rates of utilization for potentially redundant or inappropriate care” (Chadhry, 2006, p. 748). When looking back in the early days of the U.S. healthcare system, it is clear to see the statistical improvement across the board in this industry, where treating patients has never been so easy.

Classmate two: by Kimberely schenck

HIE Models Run at the State Level

Braunstein (2014) states, “Health Information Exchange (HIE)  is the key component of health informatics through wich information from various electronic record systems is shared and is potentially transformative for the healthcare system.”  He goes on further to say that “as the U.S. moves towards  Accountable Care Organizations (ACOs) and other outcomes based reinbursement systems, HIE is the way that patients can be managed at the population level and providers can be managed as a group at an outcomes measure to determine reimbursement for services. .”(Braunstein, 2014, p. 55).   

According to, The Innovation Center develops new payment and service delivery models in accordance with the requirements of section 1115A of the Social Security Act and publishes an interactive dashboard to display areas all over the United States the programs that health care systems and facilities are participating in and what awards/grants they have received to participate in such programs. (“Where Innovation is Happening | Center for Medicare & Medicaid Innovation,” 2018).  In my home state of Florida, there is currently a total of 12 healthcare systems participating in programs at the state level.  Of those 12 participating, they are broken down further by types of awards:  Healthcare Innovation Awards  (total 7), Healthcare Innovation Awards Round 2 (total 3), and Transforming Clinical Practices Initiative  (total 2) (“Where Innovation is Happening | Center for Medicare & Medicaid Innovation,” 2018). 

Healthcare Innovation Awards are funded up to $1 billion in awards to organizations that implement the most compelling new ideas to deliver better health, improved care, and lower costs to people enrolled in Medicaid, Medicare, and Children’s Health Insurance Program (CHIP) (“Health Care Innovation Awards | Center for Medicare & Medicaid Innovation,” 2018).  The first round of award recipients was announced on May 8, 2012 and a second set on June 15, 2012 and the funding for these projects was to last for three years (“Health Care Innovation Awards | Center for Medicare & Medicaid Innovation,” 2018). 

Initially, there were 3,000 applicants in total and 700 were found to not meet the criteria which left 2, 260 applications that met eligibility criteria.  It took 190 review panels of independent contractors to get through and evaluate all the applications.  Once that process was completed, they further grouped the applicants into 166 portfolio groups that were to create a balance of range of interventions and geographic diversity (“Health Care Innovation Awards | Center for Medicare & Medicaid Innovation,” 2018).  Florida and several other states participated in several of these groups from the University of Miami to the University of Alabama at Birmingham to the University of North Texas Health Science Center to mention a few.  States were grouped together in various ways, some from Maine to Oregon and others located closer geographically:  Florida, Georgia, Alabama, Mississippi and Tennessee (“Health Care Innovation Awards | Center for Medicare & Medicaid Innovation,” 2018). 

The Healthcare Innovation Awards went on for Round Two by announcing the receipiants on May 22, 2014 and the second batch on July 9, 2014.  There were a cumulative 39 awards being implemented in 27 states with a wide range of patient populations across the entire contiuum of care (“Health Care Innovation Awards Round Two | Center for Medicare & Medicaid Innovation,” 2018).  Florida had a total of 3 participants awarded and this time 2 were systems were only in the state of Florida, The National Association of Children’s Hospitals and Related Institutions and Children’s Home Society of Florida and the last, had just Florida and Wisconsin with the American College of Cardiology Foundation (“Where Innovation is Happening | Center for Medicare & Medicaid Innovation,” 2018). 

Health Innovation Awards Round Two (2018) was differnet from the first awards in that it had four distinctive characteristics:

1. Models are designed to reduced Medicare, Medicaid, and CHIP costs

2. Models are to improve care for populations with special needs

3. Models that test approaches for specific types of providers to transform their financial and clinical models

4. Models improved the health of populations with wellness programs and comprehensive care for chronic diseases that extend beyond the clinical service delivery setting

The final awards ranged from $2 million to $23.8 million over a three-year period with monitoring for measurable improvement in quality of care and cost savings. 

 The final award system that the state of Florida particpates in is the Transforming Clinical Practice Initiative (TCPI).  There were only 2 who reached this level of awards:  VHA/UHC Alliance Newco, Inc which included 6 other states and Florida and Community Health Center Association of Connecticut, Inc which includes centers from all 50 states (“Where Innovation is Happening | Center for Medicare & Medicaid Innovation,” 2018). 

This initiative was designed to assist clinicians achieve “large-scale health transformation” by further adapting their programs for comprehensive quality improvement to be in line with the strategies outlined in the Affordable Care Act (ACA) which was launched September 29, 2016 (“Transforming Clinical Practice Initiative | Center for Medicare & Medicaid Innovation,” 2018).  TCPI (2018) states that this opportunity provides up to $10 million over three years and continues to grow to this day.  With the current political climate and the recent changes to the ACA, it is uncertain if these programs will continue to grow and flourish. 

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