IOM (Institute of Medicine) six outcomes for new healthcare

- Safe

- Effective

- Efficient

- Patient-centered

- Timely

- Equitable

1999- To ERR is Human – states that too many mistakes were made that 

could have been prevented; focused on human safety

Health Care should be:

- Affordable

- Accessible

- Quality and safety

Continuously Learning

-through science, public reports and patient-clinician partnerships

IOM’s 4-tiered strategy to prevent medical errors:

1. Establish a national focus to create research and protocols to enhance our 

knowledge on safety

2. Identify and learn from errors by developing a nationwide public reporting 

system

3. Raising performance standards and have them be overlooked by higher 

authorities in health care professionals

4. Implement safety systems to ensure safe practice

Pay Per Performance

-DSRIP (delivery system reform incentive payment program)

Goal: to reduce hospital readmissions by 25%

Gives incentive to hospitals by giving them a monetary rewards

Fined if they can’t do it

PPACA (patient protection and affordable care act)

Goal: to decrease number of uninsured, control healthcare costs and improve 

healthcare delivery system

Provide a new way to get health insurance: The Health Insurance Marketplace

AHRQ- Agency for Health Care Research and Quality

Levels of Health Care

1. Preventive- focuses on educating to prevent future health problems

2. Primary- treatment of common health problems

a. Physicals once a year

3. Secondary- treatment of problems requiring more specialized clinical 

experience

a. More than routine ex/diabetes

4. Tertiary- management of rare and complex disorders

a. Chronic illnesses/no cure

U.S. is a multipayer system:

-Government funded (Medicaid = poor / Medicare = old)

-Military = champus/tricare

-Private plans

1. Traditional insurances

2. MCOs- Managed care organizations- quality care designed to control costs 

3. PPOs- Preferred provider organizations- clients choose from a list of providers

4. EPOs- Exclusive provider organizations- clients choose from a list of providers 

within a contracted organization

5. Long term insurance

DRGs – diagnosis related grouping

-When you go into the hospital it refers to the length of stay they believe you 

should have according to what it wrong with you or what procedure you are 

getting done.