User:Uargueta/sandbox

Healthcare Reform in the United States

 * There is heavy debate on the talk page about whether or not to delete a large chunk of the information on the ACA as the ACA itself is now a part of healthcare policy and has thus moved out of the realm of "reform."
 * Under the section on "Insurance cost and availability," more information could be added, specifically in regards to health inequities. Additional information should also be added to the overall "Movtivation" section, for instance, adding another section that corresponds and discusses the idea of health as a human right.
 * There seems to be an overall lack of information about healthcare reform in the US in reference to the Trump administration. In fact, the subsection "Trump administration efforts" is only a paragraph long and has no actual citations to back up the information stated.
 * In the subsection "alternatives and research directions" there is a mention of the work Centers for Medicare and Medicaid does, but there is o further elaboration on the topic in the rest of the subsection.
 * The article seems for the most part to be neutral in tone, however, there does seem to be an over representation of liberal views on reform and a lack of reform initiatives or thoughts from conservatives

Health Promotion

 * Too much of a focus on the 1986 Ottawa Charter in synthesizing a definition of "health promotion." The term was supplemented by the WHO Ottawa Charter, but there is other literature on it as well that should be incorporated in creating a comprehensive definition of the term.
 * The "Scope" subsection is too broad and only provides a one sided perspective from the WHO. The sentence "health literacy can be developed in schools, while aspects of health promotion such as breastfeeding promotion can depend on laws and rules of public spaces" seems out of place in the paragraph it is written in and should be part of a larger paragraph or subsection that provides a closer look at different examples of health promotion. Or perhaps, the "Scope" subsection should be further divided into sections that cover health promotion in the public and private sector (e.g. public policy, NGOs, etc.)
 * I found the subsection on "Workplace Setting" to be an awkward addition to the flow of the article as a whole, as there is no mention of "health promotion" in other settings like schools, clinics, etc. One of two solutions is possible, either the subsection remains and there is further expansion on health promotion in other sectors or the section is reduced and the large chunk of the information could be moved to the main article Workplace Health Promotion.
 * There seems to be an absence of policies that have been implemented that involve Health promotion.
 * Some links lead to unavailable pages and should be fixed. Most of the links do come from scholarly sources.
 * There hasn't been much activity on the Talk Page since 2007. The activity in 2007 involved debate about which category the article should be placed in, with one person arguing that it should be moved to a more general health category rather than being placed in WikiProject Nursing and WikiProject Occupational Safety and Health.

Trump Administration Efforts
I would like to add more information to this subsection as the current information lacks any citations

I would like to add developments in Trump's healthcare agenda

Alternatives and research directions
I would like to add more information about initiatives that are occurring in healthcare that could possibly translate to health policy change.

I would like to expand on the information on the Centers for Medicare and Medicaid Services. It was briefly mentioned and never followed up with in the rest of the article.

Consider the possibility of adding the addition I currently have to the ACA section instead because this is actual work currently being conducted by the US government rather than a theoretical framework that is currently being debated. Also, make sure to add that in spite of the push back by the Trump Administration, CMS is still pushing through with its work. Also mention the limitations and methods associated with the screening tool (which is essentially a survey).

Social Impact (new subsection)
I want to add a section that addresses the social impact social programs have had on patients in reference to developing methods of service delivery that keeps in mind the dignity of the patient.

Consider the possibility of maybe just adding the addition to the impact section without the creation of a new subsection. Also, frame the draft so that it is neutral while still providing evidence for the pro-welfare state argument. The drafting should start off maybe, "for those in favor of the pro-welfare state" without actually articulating it in this manner. The draft should highlight the importance of how the welfare state has changed its approach to enrolling people, by providing dignity to them.

Area
This paper published by the National Academy of Medicine discusses how the Centers for Medicare & Medicaid Services (CMS) Accountable Health Communities (AHC) Model, tested by the Center for Medicare and Medicaid Innovation, addresses the critical gap between clinical care and community services in the current health care delivery system by testing whether systematically identifying and addressing the health-related social needs of Medicare and Medicaid beneficiaries through the use of a screening questionnaire impacts their total health care costs and improves health. The paper argues that applying this tool in the AHC Model will help CMS to evaluate the impact of local partnerships among health care providers and community service organizations—working toward common goals and empowered by shared data and tools—in advancing the aims of addressing the cost and quality of health care across all settings, and safeguarding the health of the nation. I found this article to be particularly helpful in better understanding my organization, as we utilize a screening tool very similar to the example that was provided in this paper. I hope to use this article to further expand on what the CMS has done to try to address social determinants of health.

This article identified that there are are growing number of initiatives to address social determinants of health within and outside of the healthcare system. Focusing on those initiatives within healthcare, there are multi-payer federal and state initiatives as well as Medicaid-specific initiatives focused on addressing social needs. These include models under the Center for Medicare and Medicaid and Innovation, Medicaid delivery system and payment reform initiatives, and options under Medicaid. Managed care plans and providers also are engaged in activities to identify and address social needs. Prior to finding this article, I did not know that there were actual federally-led initiatives in place that were working to incorporate social needs as a part of standard healthcare, I was under the impression that this type of work was only being done by NGOs. I found the section that mentions how new directions pursued by the Trump Administration could limit resources and initiatives focused on the work being done to address social determinants of health to be of possible help when drafting my addition to the “Alternatives & Research Direction” in the “Healthcare Reform in the United States” article. This section could aid in explaining how these types of programs would fair in today’s political climate. This article also provides various examples of programs that have been implemented across the country that all in one way or another touch on addressing social determinants of health within healthcare. It demonstrates examples how some clinics/hospitals are working to address social determinants that goes beyond the realm of only conducting social screens on high risk patients, with most working with local stakeholders from multiple sectors to determine priorities in their respective communities. Including various approaches different clinics have taken to tackle social determinants would add more depth to the article as well as provide insight as to how these programs are being funded and how future nationwide initiatives could possibly be funded and managed as well.

This literature review was written to explore the various screening tools that are available to identify social risk, examine the impact that screening for social determinants has on health and social outcomes, and identify factors that promote the uptake of screening in routine clinical care. The study found that there is increasing traction within the medical field for improving social history taking and integrating more formal screening for social determinants of health within clinical practice as well a growing number of high-quality evidence-based reviews that identify interventions that are effective in promoting health equity at the individual patient level, and at broader community and structural levels. I found that this review’s findings the relative lack of literature on the association between social screening and patient health outcomes to be a bit disheartening, as the few studies that have been conducted have, in fact, found that social screenings does lead to improved health outcomes. I would like to use this article to add to a new subsection under the “Alternatives & Research Directions” section which will be talking about government agencies and programs that have begun to test if integrating the process of addressing social determinants of health as a part of traditional healthcare could possibly improve patients’ health outcomes. I feel that this article also supports the concept of multidimensional screening for social risk rather than single social risk theme, which is right on par with that Health Leads does.

Sector
The main research question in this study seeks to address how social workers construct the helping process to help the client restore her/his dignity, specifically by uncovering the elements of the social worker’s support process that help to restore human dignity. The findings of this study highlighted that in situations, when people lose their feeling of dignity within social exclusion then they experience the self-deprecating. In the process of social help a main role is played by social workers professional communication with the client, as the social worker stimulates the maintenance and restoration of client’s dignity by applying the principle of acting together. I found this article to be very insightful on the more intimate aspects of social work, revealing some of the more worker-client interactions that are often overlooked. I think this piece would be very helpful in my addition to the “Social Impact” subsection as it deals with topics such as moral values, reciprocal responsibility, mutual respect, sincerity, confidentiality and empathy. These components create a trustful environment where, by sustaining clients’ free choice and a right of decision, the possibility to achieve client’s openness emerges.

This article analyzes the teachings of German philosopher Axel Honneth about the human condition, the prerequisites for personal identity and, most importantly, human flourishing. The author emphasizes that Honneth’s work can be applied to the realm of social work particularly “identity formation” namely recognition in terms of care, rights, and strengths. With an improved understanding of the impact of shame, social workers are better equipped conceptually to empower service users to make the link between misrecognition and acts of resistance or contestation. I found this article to be very insightful on the processes social workers could take in order to address feelings of guilt and shame they may encounter when asking for assistance with within social programs. I would like to incorporate this piece into the subsection “Social Impact” in order to explain the role social workers have in the lives of their clients. The role of the social worker in the lives of their clients’ goes beyond providing services and making referrals but includes helping individuals in their attainment of pride and feelings of social well being. By regaining some sense of pride, service users are better placed to take action for empowerment – seeking the lost recognition they deserved without having to also deal with the debilitating effects of shame hampering the empowerment process.

This article published in the Journal of Sociology & Social Welfare talks about shifting the current welfare state paradigm and makes suggestions on what a new welfare state paradigm should look like. The author argues that in order to capitalize on such public sentiment, however, proponents of the welfare state must get beyond the intuitive response of defending programs grounded in the New Deal, and begin to re-conceptualize social programs so that they reflect the social, political, and economic imperatives of contemporary American culture. In the article there is mention that workers in the welfare state should be penalized should they be found to “show pattern of discriminatory practice against certain people seeking and eligible for care” (137); prior to reading this I had been under the assumption that penalties or repercussion were already in place to punish people who denied individuals access to social programs, but currently they do not. I would like to use the previously mentioned information in my addition to the subsection “Social Impact” in the Wikipedia article “Social Programs in the United States” in order to demonstrate that not all people working within social welfare programs do the work with the intention of promoting the well-being of others and in their negligence often harm people seeking out these services. The recommendation the author makes about penalizing welfare workers could be interesting to include in my addition to the article as it provides a possible solution to ensure that people seeking social assistance are treated with dignity and respect by those working the system.

Other Possible Sources (unfinished)

 * "success with value-based reimbursement will also depend more on keeping patients healthy and out of the physician's office. Capitation payments, accountable care organizations (ACOs) and other alternative payment models require population health management and strategies for reducing utilization. Addressing SDOH is becoming increasingly important for providers seeking greater efficiency and lower costs."Malnourished patients cost nearly twice as much as their well-nourished peers because they experience prolonged hospitalizations and higher readmission rates, the Health Care Cost and Utilization Project reported in 2016."
 * Transforming Complex Care - multi-site demonstration aimed at refining and spreading effective care models that address the complex medical and social needs of high-need, high-cost patients. Currently 6 orgs that are enhancing
 * CMMI released an accountable Health Communities (AHC) screening tool that was tested by a panel of experts to identify patients’ unmet needs.10 In 2014, the Institute of Medicine’s (IOM) Committee on the Recommended Social and Behavioral Domains and Measures for Electronic Health Records recommended that at minimum, 10 patient-reported social and behavioral domains and one neighborhood/community-level domain should be documented in EHR. The recommendations established a much-needed benchmark for prioritizing SDOH categories for patient assessments.
 * On May 30, 2017, CMMI released the core questions from the CMS Health-Related Social Needs Screening Tool that will be used in the Accountable Health Communities model. As described in this National Academies of Medicine paper (CMS Core Health-Related Social Needs Screening Tool), the tool uses 10 questions to assess needs in five domains: housing instability (including homelessness and housing quality), food insecurity, transportation needs, utility needs, and interpersonal safety.
 * On May 30, 2017, CMMI released the core questions from the CMS Health-Related Social Needs Screening Tool that will be used in the Accountable Health Communities model. As described in this National Academies of Medicine paper (CMS Core Health-Related Social Needs Screening Tool), the tool uses 10 questions to assess needs in five domains: housing instability (including homelessness and housing quality), food insecurity, transportation needs, utility needs, and interpersonal safety.

Webpages to check out

 * https://www.chcs.org/resource/bridging-community-based-human-services-health-care-case-studies/
 * https://www.chcs.org/topics/social-determinants-of-health/
 * https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health/interventions-resources

Healthcare Reform in the United States
Healthcare reform through addressing social determinants in the healthcare system through various programs and initiatives in order to reduce healthcare expenditures and improve health outcomes.

Programs and initiatives recognizing and addressing non-medical social needs have sprung from various sectors within healthcare, with emerging efforts made by multi-payer federal and state initiatives, medicaid initiatives led by states, or by health plans, as well as provider level actions.State and federal initiatives, primarily sponsored CMMI (Center for Medicare and Medicaid Innovation) a division of CMS, seek to address basic social needs within the context of the healthcare delivery system. CMMI initiatives like the 2016 "Accountable Heath Communities" (AHC) model have been created to focus on connecting Medicare and Medicaid beneficiaries with community services to address health-related social needs, while providing funds to organizations so that they can systematically identify and address the health-related social needs of Medicare and Medicaid recipients through screening, referral, and community navigation services. The model was officially implemented in 2017 and will be evaluated for its ability to affect cost of healthcare spending and reduce inpatient/outpatient utilization in 2022. Under the AHC model, funds have been allocated towards developing a 10-item screening tool to identify 5 different patient need domains that can be addressed through community resources (housing instability, food insecurity, transportation difficulties, utility assistance needs, and interpersonal safety). Increasing bodies of evidence suggest that addressing social needs can help stop their damaging health effects, but screening for social needs is not yet standard clinical practice. Applying this tool in the AHC model will help CMS evaluate the impact of local partnerships between healthcare providers and community organizations in advancing the aims of addressing the cost and quality of health care across all settings. National recommendations around multi-dimension screening for social risk are not yet available since the evidence base to support such recommendations is highly under-developed at present. More research is still needed in this area to be able to demonstrate whether screening for social risk, and especially for multiple domains of social risk, will succeed in meeting the Wilson and Jungner screening criteria.

Health plan specific initiatives

Due to how new CMMI initiatives are, evidence supporting the effectiveness of its various initiatives of reducing healthcare spending and improving health outcomes of patients is relatively small, but is expected to grow within the coming years as many of CMMI's programs and initiatives will be due for their programmatic performance evaluation. However, it remains that there is more evidence of smaller scale initiatives in individual health plans/hospitals/clinics, as several health plans, hospitals, and clinics have sought out to address social determinants of health within their scope of care. .

Transportation

Transportation is a key social determinant impacting patient outcomes with approximately 3.6 million individuals unable to receive the necessary medical care due to transportation barrier, according to recent study. In addition, these 3.6 million experience multiple conditions at a much higher rate than those who have stable access to transportation. Many conditions that they face, however, can be managed if appropriate care is made available. For some conditions, this care is cost-effective and results in health care cost savings that outweigh added transportation costs. without access to reliable, affordable, and convenient transportation, patients miss appointments and end up costing clinics money. According to a cross-study analysis, missed appointments and care delays cost the healthcare industry $150 billion each year. Patients without transportation are also less likely to take medications as directed. One study found that 65 percent of patients felt transportation assistance would enable them to fill prescriptions as directed after discharge. According to a recent article published in the Journal of the American Medical Association, ridesharing services such as Lyft and Uber can improve that healthcare disparity and cut down on the $2.7 million the federal government spends each year on non-emergency medical transportation services. To recover revenue and improve care quality, some health systems like MedStar Health and Denver Health Medical Center are teaming up with Uber, Lyft, and other ridesharing companies to connect patients with transportation.

Housing

The University of Illinois Hospital, part of the University of Illinois Hospital & Health Sciences System, identified that large portion of the individuals with high rates of emergency department were also chronically homeless, and that these individuals were in the 10th decile for patient cost, with annual per patient expenses ranging from $51,000 to $533,000. The University of Illinois partnered with a community group called the Center for Housing and Health to initiate the Better Health Through Housing initiative in 2015, an initiative that connected chronically homeless individuals with transitional housing and case managers. In partnering with the Center for Housing and Health, the University of Illinois Hospital saw participant healthcare costs fall 42 percent, and more recent studies have found that costs dropped by 61 percent. The hospital's emergency department reported a 35% reduction in use.

Malnutrition

Some health plans have chosen to address some SDOH within their own means by establishing programs that directly deal with a single risk factor. Studies show that malnutrition can lead to higher costs of care and extended hospital states with the average hospital stay costing nearly $2,000 per day. Advocate Health Care, an accountable care organization in Chicago, Illinois, implemented a nutrition care program at four of its Chicago area hospitals, an initiative that resulted in more than $4.8 million in cost savings within 6 months due to shorter hospital states and lower readmission rates (reduced 30 day readmission rates by 27% and the average hospital stay by nearly two days)

Social Impact
Complaints of mistreatment in navigating the welfare state are commonplace, with most unpleasant encounters arising from interactions between welfare recipients and social workers. The dominant approach to social work was casework which emphasized the personal characteristics or moral deficiencies of the recipient rather than social reform. In some cases the said deficiency was grounds for denying assistance. Casework fostered a paternalistic and demeaning relationship between social workers and clients. Caseworkers are the persons who have the post opportunity for showing respect or disrespect to the welfare client. Attitudes of welfare clients toward their caseworkers are described not as much in terms of what they receive in their checks but rather in terms of the relationship that they have with their caseworker; a study found that the way in which a client was shown respect was often more important to the client than what the provider in the situation did to solve the client’s problems.

As such, there has been work in the private and public sector to target the relationships between social worker and welfare recipients as a way to improve access to social provisions and ease the transition from welfare to work. In a study conducted of the association between the relationship held between people with mental health illnesses who are arrested and sent to mental health court with the mental health court (MHC) caseworker assigned to their case and outcomes, researchers found that perceived conflict with caseworkers was higher amount of participants who were terminated or missing from MHC. Participant who reported less conflict with assigned caseworker utilized more services and spent fewer days in jail. The study shows the importance a perceived bond has on a participant's use of services, with less perceived conflict resulting in an increase of service use and program retention and decrease in jail time served. Similar results were found in an evaluation of the impact of eleven different welfare-to-work approaches on adults and children in the course of five years .Two programs who had lower enforcement of the participation mandate compared to the other nine, had little to no impact on employment and earnings if its participants. It appears that a minimum level of involvement and enforcement by program staff is required to produce a moderate improvement in employment-- without it, participants who would not participate on their own volition would not engage in the program’s activities and reap the benefits from them. Within the same evaluation it was found that programs that appointed one caseworker per person rather than the traditional two, had better outcomes for participants than programs that had assigned two caseworkers per person.

When a social worker demonstrates to her clients by her actions that she respects them, a relationship is able to grow. Clients who feel respected by their social worker will be more likely to freely discuss difficult topics, explore their own contributions, and appoint themselves in efforts to achieve specific outcomes. A client’s perception of their provider’s level of regard for them was significantly related to their ability to achieve a certain outcome at the end of their program.Respect, although important throughout all phases of service, it is particularly crucial to interactions among newcomers or strangers. Such expressions would include vocal sounds (ex. greeting, calling), physical movements (ex. serving, guiding), bodily movements (acknowledging, polite posture), appearance (ex. proper dressing, grooming), and so forth.

When grievances do need be addressed by the welfare beneficiaries, they usually seek the assistance of a lawyer or advocate. Because advocacy is a practice of speaking for the advocate, no matter how “rebellious” they aspire to be, they inevitably perpetuate the same subordination of their client as the system they attempt to combat Lucie White presents this point in her “Goldberg v Kelly On the Paradox of Lawyering for the Poor” and proposes that when lawyers are representing poor welfare recipients, lawyers need to continuously cede to “clients” the power to speak for themselves. Such an act would transform the lawyer from a professional service that is imposed upon subordinated communities to partners that allow clients to take the lead of their own advocacy.