Integration of behavioral and physical health care for a medicaid population through a public-public partnership.

This article documents a unique organizational, legal, and financial partnership between a state, a university, a Medicaid managed health care plan, and a county to provide integrated mental health, substance abuse, and primary and specialty health care services to Medicaid, low-income, and indigent consumers in Washtenaw county, Michigan. Major regulatory, financial, and clinical changes were required within and among the various partners in the Washtenaw County Integrated Health Care Project. A new entity--the Washtenaw Community Health Organization--was created to implement the project. By sharing resources as well as financial risks, the state, the county, and the university have been able to provide ongoing integrated care to a vulnerable population of patients. Although resource intensive in conceptualization and implementation, the project can be viewed as a model for other states that face growing needy populations and decreasing Medicaid budgets.

Asthma: the impact of policies on breathing easier.

Asthma's impact on health, quality of life, and the economy is substantial, and asthma rates are increasing. Currently, there is no way to prevent the initial onset of asthma, and there is no cure. However, people who have asthma can and do lead high quality, productive lives if they control their asthma by taking medication and, as appropriate, avoid contact with environmental "triggers." These environmental triggers include cockroaches, dust mites, furry pets, mold, tobacco smoke, and certain chemicals. This article provides an overview of the asthma epidemic in the United States and its impact on communities. It also discusses federal, state, and local obstacles and approaches to asthma control and provides examples of recent state legislation related to asthma and the key factors in their enactment.

QI as resolution to a major lawsuit.

BACKGROUND: In 1991, in response to a lawsuit filed in 1974, the Texas Department of Mental Health and Mental Retardation (TXMHMR) became the first major state agency in Texas to implement a systemwide effort to implement quality improvement (QI) in its Quality System Oversight (QSO) program. QSO: The QSO approach includes a uniform internal hospital management structure focusing on teams and data-based decision making; the development of uniform work processes for each of the issues cited in the lawsuit; and a uniform set of procedures for determining compliance, including the establishment of numeric targets for which each hospital is accountable. CASE STUDY: At one TXMHMR hospital, patient records in a monthly random sample were below the performance target. Data showed that approximately 40% of the patients leave the hospital (many for a community mental health center) before a treatment plan (at 14 days) is developed. Based on a team's recommendations, a uniform assessment package is being developed for use by all TXMHMR hospitals and community mental health centers. THE NEXT STEP: In 1994, again in response to external pressures to improve quality, TXMHMR used a simplified version of the Malcolm Baldrige National Quality Award criteria for organizational self-assessment. Two pilot sites have developed action plans for improving performance as indicated on the self-assessments. SUMMARY AND CONCLUSIONS: The QSO program, put into place as a result of a lawsuit, provides a structure and database for TXMHMR to efficiently and effectively manage the performance of all hospitals in the system. All but one of the eight hospitals have exited, or are close to exiting, the lawsuit.

State healthcare reform: an arena for the osteopathic medical profession's influence.

While healthcare reform proposals are debated at the national level, states continue to propose and implement reform measures to address Medicaid, health insurance, universal coverage and access, medical liability, and cost-containment. The authors examine the shared responsibility of the federal and state governments for healthcare regulation and the surprising number of powers that reside with the states. They review the major barriers to state reform represented by restrictions within Medicaid and the Employee Retirement Income Security Act of 1974 (ERISA) legislation. Established state programs in Maryland, Hawaii, and Arizona are revisited, and innovative reforms in Oregon, Tennessee, and Washington are examined. Finally, the authors concentrate on the reform measures under way in the five most heavily DO-populated states, pointing out the potential for one of the big three (Michigan, Pennsylvania, and Ohio) to emerge as a model for the larger states. They urge osteopathic physicians to exert influence, based on their record of serving the Medicaid and other underserved populations, in state settings where they can be most effective.

Is there a need for state health department sanitary codes for public hydrotherapy and swimming pools?

The Board of Health of the Commonwealth of Virginia has an outdated sanitary code for its public hydrotherapy and swimming pools. The code is restricted to pools in hotels and other lodging places. The absence of modern regulations for public hydrotherapy and swimming pools has permitted serious deficiencies in pool maintenance, which are highlighted in this report. The most notable of these deficiencies was the presence of high levels of bacterial contamination that could predispose to infect in the water of one public hot tub. The results of this study indicate that the Virginia Board of Health sanitary code for pool water must be revised immediately and should include all public hydrotherapy and swimming pools. Other states and communities may want to assess their codes for swimming pools and hydrotherapy tubs to avoid deficiencies that could be detrimental to public health.