NATIONAL HEALTH usa

reliably  effective  &  justly  efficient

H E A L T H   S E C U R I T Y   c e r t i f i c a t i o n

INTRODUCTION

For insurance, a group of individuals may decide to protect themselves from the financial obligations of certain possible events in the future.  Insurance becomes more efficient as the insured events are more predictable and definable among the subscribing participants.  For healthcare, the cost of healthcare for Basic Health Needs is much less predictable and definable as compared to the cost of healthcare for Complex Health Needs.  Therein lies the current crisis in the payment and benefit structure of our nation’s healthcare.  Primary Healthcare has not evolved to correct the actuarial problems associated with its traditional model of healthcare.  In addition, many other institutional and social issues aggravate and complicate the insurance disparities between the health care for Basic Healthcare Needs and the health care for Complex Healthcare Needs.

Without a means to standardize the character of our nation’s Primary Healthcare, the necessary improvements in the efficiency of our nation’s entire healthcare industry have not occurred and are, for now, unlikely to occur in the future.  By defining the character of the Primary Healthcare work environment, the sources of payment for healthcare will experience an improved ability of Primary Healthcare to serve the Basic Health Needs of their citizens and responsively limit their involvement in the wants and desires of these citizens that are not insurable.  This is not intended to ignore the legitimate worries and concerns by anyone about their  HEALTH. 

The  new strategy  for healthcare reform describes a means to stabilize the character of Primary Healthcare as a means to improve its ability to improve the cost and quality of healthcare for Complex Healthcare Needs.  Any criteria for certified Primary Healthcare should support the character of health care offered to any citizen regarding their worries and concerns as a basis for coordinating their Basic Healthcare Needs with any Complex Healthcare Needs they may have.  It is important that the criteria chosen for a clinic’s  HEALTH SECURITY  certification promotes the responsibility of the Primary Healthcare Team to support the  autonomy  of each citizen by coordinating the  beneficence  and the occurrence of  futility  for the health care offered to each citizen, especially for Complex Healthcare Needs.

Elsewhere on the  Initiative  Page and its Sub-Pages, I have expressed my belief that the importance of certification may not be enough to improve efficiency.  It is likely that each source of payment for healthcare will need to explore alternate models for reimbursement.  One of these should involve a standard allocation of the premium dollar that represents the cost of Basic Health Needs, in a sense, a prepaid expense.  With an allocation representing  30-35%  of the total premiums for a group of insured citizens, an individual Primary Healthcare clinic should be at  100%  risk for the cost of Basic Health Needs.  If implemented slowly with stop-loss provisions, any Primary Physician group should be able to achieve confidence in their ability to manage the costs of Basic Health Needs for their patient panel.  With a mindful attention to efficiency for Basic Health Needs, a Primary Physician would then have an improved ability to influence, secondarily, the efficiency of healthcare for Complex Health Needs, particularly the choice of providers for these needs. 

HEALTH  SECURITY  certification    

A. Criteria for any clinic offering Primary Healthcare to be certified as  HEALTH  SECURITY  qualified.

            For CERTIFICATION, the criteria are: 150-250 points for year one, 170-250 points for year two,

            190-250 points for year three, 210-250 points for year four, 230-250 points for year five and thereafter.  

            This process is based on a five-year development process. The Board of Trustees and 

            the Regional Councils will develop a plan involving each District Coalition or other sources

            to verify the  HEALTH SECURITY  status of any applicant for Certification

            including unannounced reviews. The  CLIA / VFC  certification, as managed by each State

            for these two Federally sponsored programs might be a source of collaboration.  They already have

            collaborative relationships with many Primary Healthcare clinics.

[ COMMENT: The criteria identified below are very preliminary.  During the first five years of  HEALTH  SECURITY  certification, it is likely that the 5 year probationary period will change to a shorter interval.  In addition, the certification criteria will evolve to account for new concepts, special populations being offered health care and the financing of Primary Healthcare. ]

            1. ORGANIZE  SYSTEMS      ( 40 points out of 250 total )

                  a. Corporate entity – 34

                        i. Ownership (one of the below) – 24 

                              I). Profit  

                                    A)  Employees own  100%  of all voting stock not owned

                                          by a 501C3 qualified non-profit Corporation.

                                    B)  A 501C3 Corporation may own up to 40% of the voting stock  OR

                                          if the voting stock is divided into CLASS A with voting privileges

                                          restricted to appointing 1/3 of the Board of Directors or

                                          dissolution of the Corporation with ownership this Class only

                                          by a 501C3 Corporation  and CLASS B  ownership only

                                          by employees

                                    C)  No individual who is not an employee may own stock    

                              II) Non-profit or Profit (but operated as a non-profit)

                                    A) 501C3 non-profit ownership of at least 60% of any voting Stock 

                        ii. Risk-management – 2 

                              I) A Policy regarding Catastrophic Risk Management exists

                                    that is reviewed and revised annually by the Board of Directors. 

                              II) The Catastrophic Risk Management Policy includes 

                                    appropriate insurance coverage for the corporation 

                                    and a relocation plan in case of a natural disaster  

                        iii. General Operating Principles – 4 

                              I) A Policy regarding General Operating Principals exists

                                    that is reviewed and revised annually by the Board of Directors.  

                              II) A Policy regarding the establishment of Policy and Procedures  

                                    exists and is reviewed and revised annually by the 

                                    Board of Directors.

                        iv. Strategic Projects Plan – 4  

                              I) A Policy regarding a Strategic Projects Plan exists that is  

                                    reviewed and revised annually by the Board of Directors  

                              II) The Strategic Projects Plan is used by the Board of Directors 

                                    to evaluate the performance of the Corporation’s Chief Executive Officer

                  b. Information systems –  6       

                        i.  Document Management – 3   

                              I) A Policy regarding Document Management exists and 

                                    includes the definition of active or inactive status,

                                    storage, and ultimate destruction for any document

                                    or folder of documents.  

                              II) Applicable Federal and State standards are identified and 

                                    followed in the Document Management Policy. 

                        ii. Personal Health Record (PHR) – 3

                              I) Each patient’s PHR contains a Process List of inactive and

                                    active health issues that either have previously or 

                                    currently require active healthcare supervision.  

                              II) Each patient’s PHR contains a summary of their

                                    Past Medical History, Social History,

                                    Family History, and Review of Systems that can be easily revised.

                              III) Each patient’s PHR contains at least a Routine

                                    Health Maintenance flow sheet along with any

                                    treatment flow sheet as necessary to

                                    document the use of multiple medications or 

                                    related healthcare follow-up. 

            2. PURSUE   V I S I O N      (90 point)

                  a. Triage – 20 points

                        i. Phone answered by a licensed registered nurse (R.N.) during office hours – 15    

                        ii. Failed appointments immediately reviewed – 1

                        iii. Waiting times are routinely monitored – 1

                        iv. Appointments can be made a year into the future -1

                        v. Automatic call forwarding to a medical answering service after hours – 2 

                  b. Professional Capacity – 60 points

                        i. All licensed health care personnel have BLS certification by the Red Cross – 2

                        ii. Each physician employee who is on-call after hours is scheduled

                              for at least 20 hours of appointment time during a regular

                              work week – 9

                        iii. 70% of physician encounter visits are with providers who take

                              after hours call – 9

                        iv. On-call schedule is limited to 2-6 physicians – 9

                        v. Physicians are Board Certified – 25

                              ( 20 if 75-99%, 10 if less than 75%, 0 if less than 50%)

                        vi. The Vaccines for Children inventory is maintained using

                              NESSIS. – 3

                        vii. The laboratory services are CLIA certified. – 3

                 c. Technical capacity – 10

                        i. Located <½ block from a mass transit stop if urban location or 

                              widely identifiable intersection if suburban or rural location – 4

                        ii. No steps between the parking lot and an exam room – 2

                        iii. Active medical records are continuously available – 2

                        iv. An easily accessible list of  HYPERSENSITIVITY  reactions to medications

                              or other health care interventions exist on each patient’s,

                              medical record Process List and Data Base – 2

            3. BUILD  TRADITION      (40 points)