policy
C O M M U N I T Y H E A L T H F O R U M
15 pages — 15 —
INTRODUCTION
“I’ve learned that people will forget what you said,
people will forget what you did,
but people will never forget how you made them feel.”
Maya Angelou ( 1928 – 2014 )
The heritage of our nation has promoted a healthcare industry that lacks a means to uniformly assure that Primary Healthcare is equitably available by each resident person, community by community. Unfortunately, our nation’s scientific mandate for highly technical healthcare, most applicable to Complex Healthcare Needs, has succeeded to the detriment of our nation’s humanitarian mandate for deeply caring healthcare, most applicable to Basic Healthcare Needs. The humanitarian mandate begins and ends with a caring relationship. As cited above, Maya Angelou calls us to a renewed focus for improving each person’s HEALTH with sustained caring relationships from within their Family as well as their health care.
PURPOSE
The NATIONAL HEALTH Proposal begins with four national projects and proceeds with a new strategy to enhance the skills, priorities, and commitments that already exist among the resident persons within every community. The new strategy has a focus to promote “Stable HEALTH For Each Resident Person” with an emphasis on their Basic Healthcare Needs. The rejuvenation of Primary Healthcare must lead the way to attain justly efficient and dependably effective healthcare. The intent of this Operational Statement is to eventually balance our nation’s commitment to Complex Healthcare Needs with an augmented commitment to the Basic Healthcare Needs of each resident person, community by community. In the future, these Basic Healthcare Needs will require a renewed understanding of its community-based dimensions.
The Board of Trustees, as tentatively proposed, for NATIONAL HEALTH would have the authority to establish this Operational Statement for providing technical support to a Community HEALTH Forum for each citizen’s community. As described by this Page, its Operational Statement would propose that communities encompassing, on average, 400,000 citizens would represent an economically stable unit for assessing and improving the local efficiency and effectiveness of its healthcare. With three national projects to support the improvement of our nation’s Primary Healthcare, each Forum would apply the local expertise and resources available to assess the equitable availability of Primary Healthcare that is offered to each resident person within their community.
This new strategy represents the fundamental basis for improving the efficiency and effectiveness of our nation’s entire healthcare industry. Using various forms of collective action as the basis for informing each community’s responsible stakeholders, a host of other factors would be considered by each Forum as a means to improve the overall Stable HEALTH of their own community, especially its contribution to our nation’s social cohesion.
Briefly stated, starting a Forum represents a community’s spontaneously mobilized prevalence of trust, cooperation, and reciprocity. The resultant enhancement of the community’s social capital then allows it to moderate various forms of collective action to mitigate the adversities that many citizens endure daily as they encounter the social dilemmas occurring within their community’s municipal life. With a community-directed strategy to energize its level of social capital, there is validated research to support its importance for “downloading” their community’s ecological and cultural determinants of Unstable HEALTH.
A combination of monitoring data as gathered by the healthcare systems and a broadly endorsed community “conversation,” neighborhood by neighborhood, then initiates the basis for locally-driven healthcare reform and its combined humanitarian and scientific mandates. The monitoring data would develop a process for the healthcare systems within the community’s Survival Commons to achieve an augmented focus on its community’s population HEALTH.
NATIONAL HEALTH — a new Proposal for the future
Ultimately, each of nine Regional Councils, in collaboration with their own 9 associated District Coalitions, would have the authority to approve their own Procedures and associated protocols required to implement this Policy within each community. The initial level of diversity among the Forums would be profound. But, this early phase and its high level of local diversity may be the only means to eventually define the range of “best practices” for all of the Forums. The words of Senator Robert F. Kennedy from 1968 apply to this new strategy: “…surely we can begin to work a little harder to bind up the wounds among us and begin to become in our hearts, brothers and sisters, compatriots once again.”
Think about healthcare reform at the level of nearly 800 equitably defined communities, each with the leadership of 9 local Advocates for a total of 7,200 Forum Advocates. With the 7,200 Advocates collaborating with one national VISION, assuring equitably available Primary Healthcare may be the best initial project for eventually improving the community HEALTH needs of many other health conditions. So, what might be the ultimate impact of this new strategy for healthcare reform over 10-20 years?
Is it possible that this new strategy for healthcare reform will improve the level of commitment to shared priorities, community by community? And, could this new strategy for healthcare reform reverse the pervasive resignation and stagnation now afflicting our nation? For the future of our nation, the ultimate benefit of this Policy may be its ability to re-ignite our languishing sense of communityship and to renew our connections as “…brothers and sisters, compatriots once again.” The improvement of our nation’s social cohesion may be most recognizable by the resultant improvement of our Nation’s maternal mortality, childhood obesity, adolescent suicide/homicide, substance addiction, homelessness, mass shootings, mid-life depression/disability, and stagnant longevity at birth since 2014.
METROPOLITAN OMAHA — Community HEALTH Forum
As of 2018, there was no nationally recognized strategy for healthcare reform with any hope for significant improvement within our nation’s healthcare industry. Obamacare Revised, the Accountable Care Organizations, the Medical Home models, or even the fundamental payment reforms by Medicare have all been significant efforts to solve the problems underlying the cost and quality of our nation’s healthcare. None have demonstrated any hope to achieve big-picture success. Many have been tried previously by the National Health System in England, and eventually given-up as fruitless. Even the 30-day hospital readmission strategy, although effective, was associated with a paradoxical increase in our nation’s heart failure mortality rate. Without a clear direction for healthcare reform, it is likely that its over-riding problems will still be high cost and variable quality. This will be aggravated by a doubling of the Medicare-eligible citizens between 2000 and 2030.
For Nebraska, the continuing increase in the demand for hospital healthcare by our resident persons may eventually require a state-wide, hospital expansion process. Remember that a hospital bed may require the expenditure of nearly $2+ million in construction costs per bed given an entirely new hospital. Remember also that our nation’s excess health spending was nearly $3,200 per citizen in 2018, as compared to the health spending per citizen among the OECD (Organization for Economic Co-Operation and Development) nations of the world. The high cost of our healthcare industry has a dramatic drag on the economic stability of each resident person and their employers as well as our nation’s city, county, state, and federal levels of government. The excess health spending by the Federal government during 2018 was equal to 57% of its entire deficit of $779 Billion for 2018.
STARTING NOW
Given this scenario, it is time to recognize that the ultimate improvement of our nation’s healthcare will only occur when it’s promoted from within each community. We really can’t wait any longer to see if the national leadership for healthcare reform will be able to formulate a successful healthcare reform strategy. The proposal for the NATIONAL HEALTH Initiative is only one possible scenario. In the absence of a nationally sanctioned institution for the leadership process to guide each community’s efforts, it is time to consider the spontaneous formation of a local Community HEALTH Forum within Metropolitan Omaha.
At a minimum, the excess spending for the healthcare of Metropolitan Omaha citizens was at least $3,000 per citizen in 2018. The extra healthcare spending for these citizens represented at least $2.5 Billion in 2018. Assuming that 2/3 of this excess was funded by our Federal and State government, then nearly $800 million of the excess spending in 2018 originated from within the Metropolitan Omaha area. In the future, the over-all need to conserve our locally-driven resources will be profound. Keep in mind that the Omaha Metropolitan area is in the midst of rapid growth in the total number of its resident persons.
As a means to improve the efficient use of our local healthcare resources, I propose the eventual formation of a Community HEALTH Forum as a broadly supported project for decreasing the use of hospital days by the citizens of the 5-county community representing Metropolitan Omaha. Over-all, the role of the Forum would be to promote investment in the Omaha area’s social capital asset. This investment would focus on the prevalence of caring relationships among our community’s social networks as augmented by each resident person’s Family, their Extended Family, and their micro-social networks.
The investment in the social capital of the Metropolitan Omaha area would be carefully defined to support the healthcare already offered throughout the community. The disruptive processes that cause Unstable HEALTH affect almost every person every day. To achieve stable population HEALTH, we must simultaneously improve the norms of trust, cooperation, and reciprocity that each person applies for resolving the social dilemmas they encounter every day.
The hospital utilization rate, based on the total number of Douglas County residents, and reported monthly would be the simplest overall measurement to monitor the improvement of the HEALTH by our entire urban, suburban, and rural citizens. Having access to timely reported data will represent the first step for triggering a monthly, community-wide conversation among the resident persons about their knowledge and obligations for preventing, mitigating, and ameliorating each other’s need for hospital-level healthcare. Promoting a combined involvement by the micro-social networks that interact with each person’s Family will be necessary.
A monthly, theme, and variation schedule as moderated by the community’s occurrence of unexpected events could be planned. Each person’s Stable HEALTH needs will require a shift each year based on weather and a large number of associated disruptive processes. The entire monitoring and social capital investment project would be planned by a Community HEALTH Forum for the Omaha Metropolitan Area. It would be funded locally and purposely planned to encourage the relationships, creativity, and principles that are currently prevalent among the resident persons and institutions of Douglas county and its 4 surrounding counties.
Promoting equitably available Primary Healthcare within Douglas county would account for the first major project by the Community HEALTH Forum. This is not intended to achieve ownership or management of any healthcare. It is an effort to bring community needs to the forefront of a leadership collaboration among the local institutions responsible for serving the Basic Healthcare Needs of each citizen by their Primary Healthcare. This project could eventually include provisions for special populations such as veterans, active-duty military personnel, Native American populations, the homeless, and institutionalized populations (group homes, penitentiaries, nursing homes) throughout the Omaha Metropolitan area. It is likely to be a multi-year project but should start now, for Douglas county. It should represent a collaborative commitment to achieve community-sponsored healthcare reform to assure that equitably available Primary Healthcare is offered to each resident person.
Given early progress, the formation of one Forum for the Omaha Metropolitan Area could serve as the basis to eventually promote 4 other Forums across Nebraska. Based on travel distances and population density, the 5 statewide Forums for its 1,932,000 citizens (2019 US Census estimate) could be divided into:
* METROPOLITAN OMAHA Nebraska with a home office in Omaha for its 5 counties and a population of 822,000 [ comprised as two divisions — Douglas County with a 561,000 population and Sarpy/Dodge/Saunders/Washington Counties with a combined 261,000 population ];
* METROPOLITAN LINCOLN Nebraska for Lancaster County with a home office in Lincoln and a population of 314,000;
* NORTHEAST Nebraska, north of the Platte River, for 33 counties with a home office in Norfolk and a population of 312,000 not including Washington, Dodge, Sarpy, Dawson, and Buffalo Counties as well as the WEST Nebraska counties marked south and west by Cherry County;
* SOUTHEAST Nebraska, south of the Platte River, for 28 counties with a home office in Hastings and a population of 320,000 with the exception of Saunders, Lancaster, and Hall counties as well as the West Nebraska counties marked south and west by Cherry County; AND
* WEST Nebraska, Cherry county plus the counties directly south and west, for 27 counties with a home office in Ogallala and a population of 164,000.
Implemented initially by the Metropolitan OMAHA Forum, the commitment would represent the most immediately possible strategy for promoting statewide healthcare reform. This new strategy for assuring equitably available Primary Healthcare for each resident person includes a monitoring tool for its progress. This Forum’s initial priority would eventually be followed by a phase devoted to promoting neighborhood awareness of community-wide social capital investment for each resident person’s Stable HEALTH. In short, this campaign would focus on a mutually sustained awareness for helping each other achieve self-sustained Stable HEALTH. This is not an effort to by-pass the normal use of health care. Instead, it’s an effort to augment the caring relationships occurring throughout the community as a basis for everyone’s better HEALTH.
The reform proposal represents the simplest model for using various forms of collective action as a means to achieve improved Primary Healthcare for the Basic Healthcare Needs of each Nebraska resident person. The improved health care for Basic Healthcare Needs and the community based, collective action strategies would represent the initial stage for the new strategy. Eventually, each community will have formed a new local heritage for resolving the gaps occurring within their own Survival Commons.
TASKS
I. ORGANIZE SYSTEMS
A. Accept the following definitions of HEALTH and Person by each Forum:
HEALTH may be postulated for a Nation’s resident persons as
each person’s daily experience of Well-Being which
occurs when each person’s lifelong survival has been initially
^
A. Endowed by the prenatal, generational Family Traditions
of both parents for sustaining the occurrence of a fetal conception, that
when recognized, begins to intensify the ‘shared intentionality’
among the caring relationships of the parental Extended Family for
mentoring the maternally-nurtured synergy of the fetal person’s
innate temperament and its baseline homeostasis to achieve sufficient
resilience for the fetal person’s survival immediately after birth and
vitality thereafter from a parent-originated, Personal Survival Plan
as a happy ‘Dependent Person’;
^
B. Nurtured by the person’s caring relationships that originate
from within the person’s Family, their Extended Family, and
their Home’s close neighborhood 1) during Early Childhood
with a goal to enrich the person’s search for the
broadest portrayal of their uniquely-endowed Human Capability
while becoming a joyful ‘dependent person’ AND 2) during
Late Childhood and Adolescence with a goal to mentor
the person’s cultural social-cognition for the broadest portrayal
of their uniquely-endowed Human Capability while becoming
a courageous and sustainably self-sufficient ‘Independent Person’
within their Home’s community after adolescence;
^
C. Challenged by the person’s daily encounters with a disruptive process
involving discordant social interactions that begin before birth,
occur as interacting combinations and patterns, and
cause variably-reversible beneficent and maleficent changes
to the adaptive resilience of the person’s Quantum Signaling Brain
as variously prevented, mitigated, and ameliorated lifelong
by their Family Traditions, by the courageous
caring relationships originating from within the person’s Family^
their Extended Family^ and their Home’s close neighborhood,
by their Personal Survival Plan, as well as
by the Survival Commons of their Home’s community;
^
D. Matured by the person’s episodic encounters with a disruptive process
involving diversely-complex traumatic events that begin before birth,
occur as interacting combinations and patterns, and cause
variably-irreversible and maleficent changes to the adaptive resilience
of the person’s uniquely-endowed Human Capability including
its innate temperament and baseline homeostasis as prevented,
mitigated, and ameliorated lifelong by their Family Traditions,
by the courageous caring relationships originating from within
the person’s Family^ their Extended Family^ and their Home’s
close neighborhood, by their Personal Survival Plan, as well as
by the Survival Commons of their Home’s community; AND
^
E. Sustained by the person’s Family Traditions,
by the hopeful caring relationships originating from
within their Family^ their Extended Family^ and
their Home’s close neighborhood,
by their Personal Survival Plan, as well as
by the Survival Commons of their Home’s community
until eventually the entropy-ladened, resilience of the person’s
uniquely-endowed Human Capability is no longer sufficient
to maintain the person’s survival as a result of their lifelong
encounters with a disruptive process.
PERSON may be postulated as
^
a Human Fetus that had become prenatally viable; survives
its birth to become a joyful ‘Dependent Person’ within their Family;
develops an awareness of the nurturing caring relationships that
originated before and during Childhood from within their Family,
their Extended Family, and their Home’s neighborhood
for promoting the broadest expression of the person’s
uniquely-endowed Human Capability; encounters the daily
occurrence of a disruptive process involving diverse combinations
of discordant social interactions and lasting traumatic effects
to their innate temperament and its baseline homeostasis beginning
before birth for which survival depended on their Family’s
caring relationships, their Family Traditions, their parent-originated
Personal Survival Plan, and their community’s Survival Commons
to become a courageous, self-sufficient ‘Independent Person’
with a uniquely-endowed Human Capability after Adolescence.
B. Define the geographic boundaries for each of at least nine Forums of @400,000 citizens within each District Coalition representing, on average, 4,000,000 citizens based on:
1. respect for the county and state borders within a District Coalition,
[ COMMENT: The geographic border of each Forum should represent one OR more contiguous counties within the same State. Two or more Forums may be identified within one county using widely recognizable divisions such as zip codes or transportation routes. ]
2. where appropriate, the presence of a dominant referral pattern for the healthcare of Complex Healthcare Needs,
[ COMMENT: These have been defined by Medicare as “Hospital Referral Regions (CMS).” For Nebraska, its counties north of the Platter River represent a referral pattern that is connected to Omaha and the counties south of the Platter River represent a referral pattern that is connected to Lincoln.]
3. where possible, a recognition of the immigration or migration trends substantially contributing to the original ethnic or cultural heritage of a Forum,
4. where possible, the geographic size of a Forum represents an intent to limit the travel time to 1 hour or less for 2/3 of the citizens who might travel to the center of their Forum, as adjusted for the population density of the Forum,
5. where possible, the number of citizens associated with the seven most populated Forums of a District vary as little as possible between 200,000 – 600,000 citizens and no Forum possibly having more than 700,000 citizens at the next census, and
6. one extra Forum for a District Coalition may be necessary based a) on an assessment of future population changes of 100,000 – 300,000 citizens over the next 5 – 7 years or b) one or two Forums with a very low population density while at least five or more Forums having substantially more than 350,000 citizens;
C. Define the initial and continuing selection processes applicable to the nine Advocates of each Forum;
D. Define the disclosure criteria for the educational preparation, employment, conflicts of interest, and expertise contributed by each Advocate to the affairs of a Forum;
E. Define the scheduling process for the Regular or Special Meetings of each Forum along with any applicable quorum or voting requirements for its Community HEALTH Plan;
F. Define the basis for nominating an Advocate to be a Member of its associated District Coalition; AND
G. Certify each Forum annually based on the content and progress achieved by its Community HEALTH Plan to improve the HEALTH of their community and to collaboratively maintain its affairs with its associated District Coalition.
II. PURSUE ‘ V I S I O N ‘
A. Accept the following ‘V I S I O N’ for each Forum:
“Stable HEALTH For Each Resident Person”
B. Recognize the following definition of a caring relationship as the basis for implementing equitably available and ecologically accessible Primary Healthcare for each resident person within a community.
Caring Relationship may be postulated for HEALTH as
^
a dyadic social interaction with a Human Dignity scenario that
begins by expressing beneficent respect for each other’s autonomy,
thrives when each person steadily renews their adaptive skills, and
flourishes from a timely intent to communicate ‘in harmony’ with
warmth, non-critical acceptance, congruence, and empathy.
AND
C. Define the implementation process required to assist each Forum as they promote a Community HEALTH Plan to achieve the V I S I O N of NATIONAL HEALTH, including the general provisions for the Plan’s annual revision to:
1. Monitor the equitable availability of Primary Healthcare within the Forum’s boundaries —
a. monitor patterns by census tract, zip code, or another locally recognizable boundary,
b. consider any special community priorities for the equitable availability of Primary Healthcare, especially for a group of resident persons living at a remote residential location — such as urban/rural, farmland/forest, coastal/island, mountainous/desert, or swamp/tundra locations, and
c. identify the community resources for the collaborative commitments intended to resolve current and future deficits of equitably available Primary Healthcare;
2. Monitor the most prominent, social determinants of Unstable HEALTH for the resident persons of their Forum including the current collective action projects in place or planned for their prevention, mitigation, or amelioration, such as:
a. infant mortality, early childhood education, or foster care;
[ COMMENT: As of 1-1-19, there were 21 national Educare facilities, including 3 in Nebraska. These are nationally certified, local collective action efforts to offer advanced early childhood education to families whose children may be at risk for a poor start in Primary education from kindergarten through 3rd or 4th grade.
See http://www.educareschools.org ]
b. adolescent health as in suicide/homicide, sexually transmitted infection (STI), or teenage pregnancy;
c. a community-wide chronic pain covenant,
[ COMMENT: Opiate prescription medication is increasingly implicated for overdose deaths, intentional, and non-intentional. A widely respected institution, that is locally instituted, would have the social standing for sponsoring the evolution of a local protocol to the limit the use of outpatient prescribing by physicians other than a Primary Physician, or designee. This now is managed in Nebraska by its ability to monitor each physician’s controlled substance prescribing patterns by the State’s mandated prescription database. ]
d. homelessness including a community’s current Strategic Plan for Ending Homelessness,
e. a list of any other relevant and currently active collective action projects for improving the community’s Survival Commons beginning with social mobility, and
f. a current analysis of possible newly identifiable, adverse social determinants of Unstable HEALTH worthy of a collective action strategy, especially for social mobility and social isolation; AND
3. Monitor and revise the community’s Master Disaster Mitigation Strategy, annually – including any recent, significant disaster history:
a. Local Governmental Plans – current status including predictable disasters considered (especially, an influenza pandemic), their last governmental review, any mitigation exercises/preparedness, and responsible Manager/phone;
b. Connection with regional and State disaster preparedness; and
c. Connection with Federal preparedness.
III. BUILD COMMUNITY
A. Accept the following “MISSION” for each Forum:
“To improve our nation’s population HEALTH and its healthcare
with a continuously renewed understanding of our nation’s
Resources, Knowledge, and Human Dignity.”
B. Accept the following definition for a community by each Forum:
^
a social interaction involving a cluster of three or more persons
with certain uniformly identifiable attributes, most typically recognized
as the persons residing within a geographically defined municipality,
who share a valued awareness about their interconnected identity
that is borne out of the cluster’s daily social interactions and each person’s
association of these social interactions with certain memories
of their own ethnographic traditions.
C. Accept the following definition for social capital by each Forum:
^
the spontaneity occurring among a community’s resident persons
for using the norms of trust, cooperation, and reciprocity
to resolve the social dilemmas they encounter daily
that becomes more readily expressed by the community’s resident persons
when multi-generational caring relationships
increasingly permeate the community’s social networks.
D. Accept the following definition of Social Cohesion by each Forum:
^
a general expectation among the resident persons of a nation’s communities
that the resident persons of each other’s community are trustworthy and
that the prevalence of these trustworthy persons improves when
every community of their nation persistently collaborates with their adjacent communities
to support each other’s Survival Commons with mutual contributions of social capital.
E. Monitor the total hospital days used monthly by a community’s resident persons whose primary residence is located within a Forum’s boundary as a means to monitor the effectiveness of a Forum’s Community HEALTH Plan.
AND
F. Accept citizen reports of deficiencies in the availability of Primary Healthcare by their District Coalition for the purpose of evaluating the opportunities for collective action as a basis to promote each Forum’s Community HEALTH Plan.
IV. MANAGE RESOURCES
A. Arrange technical support for each Forum by its sanctioning District Coalition;
B. Accept voluntary, in-kind, support for a Forum from any locally functioning healthcare institution that has a historically significant, connection with Basic Healthcare Needs; AND
C. Accept direct financial support for a Forum from any institution, as long as, 1) there is a locally based, non-profit institution to manage the financial accountability of these funds and 2) this local, non-profit institution is 501(c)(3) qualified by the Federal Internal Revenue Service.
V. DEVELOP SKILLS
A. Recognize the following PRINCIPLES by each Forum:
Altruism . Trust . Cooperation . Reciprocity . Excellence
[ COMMENT: These would be defined and periodically revised by the Board of Trustees for NATIONAL HEALTH. ]
B. Identify opportunities for assisting each Primary Healthcare clinic located within the respective Forum’s boundaries to become and remain HEALTH SECURITY certified;
C. Improve the skills associated with a collective action process given the goal of each Forum to promote the efficiency and effectiveness of our nation’s healthcare industry;
[ COMMENT: The most common variant for community-based collective action strategy is widely known as a collective impact strategy. ]
D. Prepare an analysis of the annually revised Professional Achievement Plan by the combined Advocates of each Forum as a basis for their continued recognition as an official Community HEALTH Forum;
AND
E. Monitor the performance of each Forum periodically, offer assistance based on the PRINCIPLES of NATIONAL HEALTH and, with inappropriate conflicts-of-interest or an under-performing Community HEALTH Plan, terminate the certification of the Forum by notification of its Advocates through certified mail and public notice.
S U B P A G E S
ADVOCATE selection To emphasize the importance of each community’s autonomy, the initial ADVOCATES should represent a locally acknowledged, publicly supported representation of the community’s prominent HEALTH stakeholder groups. The ADVOCATES would not have an employment relationship with NATIONAL HEALTH.
It is reasonable to have a NATIONAL HEALTH vested interest with this group, especially its performance over time. As a result, the essential involvement of NATIONAL HEALTH is limited to technical assistance and training opportunities for the community’s connection with the other Regional Councils and their District Coalition affiliated Community HEALTH Forums. It continues to be recognized as an affiliate of NATIONAL HEALTH as long as it functions to support the progress of all Community HEALTH Forums.
ADVOCATE Panel Each Forum would be formed, i.e. franchised, according to the OPERATIONAL STATEMENTS of NATIONAL HEALTH and its Regional Councils. The designation as a participating Forum would initially encompass, on average, approximately 400,000 resident persons based substantially on population density and each State’s county-defined geographic borders.
PERSONAL SURVIVAL PLAN The three National Projects and new strategy for achieving “Stable HEALTH For Each Resident Person” is connected with a contemporary, expanded definition of HEALTH for understanding its expression during a person’s lifetime. One benefit of NATIONAL HEALTH will be its ability to promote a social capital investment within each community based on promoting a common understanding of HEALTH. The improvement of each community’s Social Capital will be most measurable by how well the community’s resident persons take care of each other and the resident person’s located within their adjacent communities. These caring relationships imply a basic obligation throughout their community to support the Survival Commons of their own community as well as their adjacent communities.
RESOURCE MONITOR The initial affairs of each Forum will focus on the equitable availability of their community’s Primary Healthcare for each citizen. Meanwhile, each Forum will need a measurement tool for assessing any progress achieved for improving the equitable efficiency and reliable effectiveness of its overall healthcare. The NATIONAL HEALTH Initiative proposes one specific measurement tool with real-time validity as a measure of progress. There will likely be many more eventually.
AGREEMENTS To measure the total number of hospital days required by any resident person within a community will require a unique connection among the community’s hospital institutions. For these institutions, this Sub-Page represents only one person’s concept for honoring the PRINCIPLES of NATIONAL HEALTH as a basis to improve the Survival Commons of a community.
PHc EFFICACY MODEL Primary Healthcare (PHc) by necessity should offer healthcare for a resident person’s needs as well as appropriately acknowledging their preferences. With this in mind, enhanced Primary Healthcare would offer an ethnographically resilient level of medical TRIAGE during and after office hours, viz. 24/7. This level of Primary Healthcare would also offer a life-time process for screening and preventive healthcare in conjunction with the formation of a comprehensive healthcare plan based on the person’s Complex Healthcare Needs.
Given the above character of Primary Healthcare, some of it is actuarially reimbursable by fee-for-service and some is not. Thus, another model partially based on fee for service reimbursement as supplemented with capitation based on a portion of premium revenue would be necessary. After the adjustment of risk-pool and stop-loss protective measures, Primary Healthcare would develop an improved level of confidence in their ability to manage the risk management process in conjunction with their referral sources for Complex Healthcare Needs. This Sub-Chapter offers a template to report a 1 year, rolling-average report prepared every three months by each payer for each HEALTH SECURITY certified Primary Healthcare Clinic.
It is likely that the improved levels of trust, cooperation, and reciprocity could also accentuate their community’s commitment to reduce the upstream determinants of Unstable HEALTH. Our nation’s currently stagnant level of improving “longevity-at-birth,” since 2010, will require both enhanced Primary Healthcare as well as invigorated levels of community-wide Social Capital to improve our nation’s population HEALTH and it’s healthcare.
C
This page has the following sub pages.