Resource management and allocation strategies

Management of Continuum of Care Services

As the new director appointed for the Medicare and Medicaid Services (CMS), I realize the climbing costs of payments of these two programs and have met with the other members to come up with a plan of that will help enforce the strategies and guidelines in the state of North Carolina that can help us follow a budget that will assist the overall national requirements for persistent care. In doing so fellow board members have met with me to look at the Medicare Modernization Act (MMA), Administration on Aging (AoA), and other parts of the medical services to help come up with an arrangement that will help us reduce costs in our particular area that will assist the national healthcare problems that we currently face.

After looking at the problems within our own area we have decided to enforce the guidelines of the current healthcare coverage to the people that are eligible and already receiving Medicaid and Medicare services first because it will get the attention of healthcare providers and their patients they will have to follow. While other measures are being adjusted and determined, we can start enforcing these care services to create a more seamless continuum of care by regulations and physicians in the area can be easily informed of the changes. For starters, physicians who are treating new and established Medicaid and Medicare patients have been asked to supply a certain number (a percentage from their office) of sample and starter kit medications instead writing prescriptions for any medicine that is not covered by Medicare and Medicaid. Currently, physicians are not aware of medications some medications that are not approved and will be contacted by CMS to discuss the reason for prescribing it.

Next, there will be reinforcement to physicians and patients that receive Medicaid and Medicare services there is no bypassing their regular family physicians and enforcement to keep appointments made if they do have a doctor's appointment. All participants must have a written referral from their regular family doctor in order to make an appointment with a specialist. We feel some specialists are unnecessary and requires the patients to have more expensive co-pays and office visits that Medicaid and Medicare is responsible to when the family physician can handle some of the care themselves without the patient being charged extra. Patients who make appointments are required to show up for any doctor's appointment because if they do not show or follow cancelation policies they may still charge them and CMS has to pay for the appointment regardless. Patients are being informed when they make any appointment in the future of their requirements to follow these procedures or it results in not being able to reschedule and more time untreated.

Now, the members of our services also want to look at the Administration on Aging (AoA) who continue to provide low cost services to the senior population and improve independent living of the elderly in their own homes as long as they choose. The long-term health care will involve affordable living assistance services and assistance to remain at home and decrease the number of readmissions, provide transportation to and from doctor visits, preparation of meals, and other daily living needs. There was a decrease in using the base of one-time, special funding for the Senior Community Service that will transfer to the Administration on Aging from the Department of Labor (Department of Health).

The Medicare Modernization Act (MMA) is a part of Medicare Part D that was added to help improve the cost of prescription drugs to participants and they should continue to have support through their state and national governments. All Medicaid and Medicare patients are also eligible for these benefits that will help reduce the costs of the CMS and assist the nation in a seamless continuous of care and expand coverage to mental retardation institutions and inpatient psychiatric hospitals. CMS is able to contract with plans that are private to give participants the benefits and to cover more regions throughout the nation which promotes market competition and negotiations between Medicare and drug corporations that are excluded. The benefits of the Part D is cost sharing because it entails significant impact on "minimizing the federal deficit with monthly premiums, deductibles, tiered co-payment, formulary control" and basic coverage must "provide alternative plans such as: zero co-pay for generic drugs, reducing deductibles, and changes to reduce tiered co-payments" as well quoted Reyering (2007).

Part D Plans prior enrollments has reached their goals and continue to look at weak populations and provide the best healthcare services and at least two drugs in every category to assist the mental health population according to the United States Pharmacopoeia. These medications will be for patients that need assistance mental health conditions such as dementia, depression, bipolar and mood disorders, and schizophrenia. However, Part D Plans will be excluding drugs such as weight control, fertility and cosmetic medications, drugs that are covered by A and B, and other drugs that are covered currently by other plans. By providing a wider range of services and combining with private institutions the plan will continue to produce positive results and success in recovering patients (Reyering, 2007).