Definition of serious and complex medical conditions / Carole A. Chrvala and Steven Sharfstein, editors ; Committee on Serious and Complex Medical Conditions, Division of Health Care Services, Institute of Medicine.

Format:

Book

Author/Creator:

Institute of Medicine (U.S.). Committee on Serious and Complex Medical Conditions.

Contributor:

Chrvala, Carole A.

Sharfstein, Steven S. (Steven Samuel), 1942-

Institute of Medicine (U.S.). Committee on Serious and Complex Medical Conditions.

Language:

English

Subjects (All):

Health insurance--United States.

Health insurance.

Critically ill--Medical care--United States.

Critically ill.

Catastrophic health insurance--United States.

Catastrophic health insurance.

Physical Description:

vi, 116 p.

Edition:

1st ed.

Other Title:

Serious and complex medical conditions

Place of Publication:

Washington, DC : National Academy Press, c1999.

Language Note:

English

Summary:

In response to a request by the Health Care Financing Administration (HCFA), the Institute of Medicine proposed a study to examine definitions of serious or complex medical conditions and related issues. A seven-member committee was appointed to address these issues. Throughout the course of this study, the committee has been aware of the fact that the topic addressed by this report concerns one of the most critical issues confronting HCFA, health care plans and providers, and patients today. The Medicare+Choice regulations focus on the most vulnerable populations in need of medical care and other services-those with serious or complex medical conditions. Caring for these highly vulnerable populations poses a number of challenges. The committee believes, however, that the current state of clinical and research literature does not adequately address all of the challenges and issues relevant to the identification and care of these patients.

Contents:

Definition of Serious and Complex Medical Conditions

Copyright

Acknowledgments

Contents

Executive Summary

CONCLUSIONS

1 Introduction

CHARGE TO THE INSTITUTE OF MEDICINE

SCOPE AND ORGANIZATION OF THIS REPORT

DEFINITIONS OF SERIOUS AND COMPLEX MEDICAL CONDITIONS: ALTERNATIVES AND IMPLICATIONS

Background

Conceptual Overview-Serious and Complex Conditions

Potential Operational Definitions and Criteria

Disease Code Definitions

ICD-9 Codes Alone

2 Challenges in Health Care Delivery for Patients with Serious and Complex Medical Conditions

QUALITY OF HEALTH CARE

Patient Characteristics

Provider Characteristics

Patient Volume

Health Care Delivery System

ACCESS TO CARE

HEALTH CARE COST CONTAINMENT

Medicare and Medicaid

Utilization Review and Management

Care Management

Screening and Risk Assessment

Alternative Strategies for Cost Containment

3 Conclusions and Recommendations

INTRODUCTION

References

Appendix A Workshop to Define Serious or Complex Medical Conditions

CLINICAL IMPLICATIONS OF DEFINING SERIOUS OR COMPLEX MEDICAL CONDITIONS

Disabled Populations

Complexities of Patients with Cancer

Serious and Complex Chronic Illness at the End of Life

Example of a Population-Based Screening Intervention for Care Delivery Integration

HEALTH CARE POLICY AND INSURANCE IMPLICATIONS OF DEFINING SERIOUS OR COMPLEX MEDICAL CONDITIONS

Managed Care and Approaches to Regulation

Implementation Strategies for the Medicare+Choice Regulations Concerning Serious or Complex Medical Care

Serious or Complex Medical Conditions: Insurance Issues

Appendix B Speakers Biographies

Appendix C Workshop Agenda

Appendix D Workshop Participants

Appendix E Committee Biographies.

Notes:

Based on a workshop convened on June 14, 1999.

Includes bibliographical references (p. 55-63).

ISBN:

9786610185726

9780309172608

0309172608

9781280185724

1280185724

9780309557139

0309557135

9780585155524

0585155526

OCLC:

923267467