@oriro/orirocli 0.1.11 → 0.1.12

package/skills/health/health-yoga-wellness/SKILL.md

@@ -1,58 +1,58 @@
----
-watermark: ORIRO
-disable-model-invocation: true
-name: health-yoga-wellness
-provider: ORIRO.ai
-copyright: Copyright (c) 2026 ORIRO.ai
-description: >
-  Yoga and wellness — yoga traditions, asana fundamentals, pranayama, philosophy
-  (Patanjali), and evidence-based wellness practices. Sources: Yoga Alliance (free),
-  WHO Traditional Medicine guidelines, Patanjali Yoga Sutras (public domain).
----
-
-# Yoga and Wellness
-
-## Yoga traditions
-
-**Hatha Yoga:** Physical postures (asana) + breathing (pranayama). Foundation of most Western yoga.
-**Vinyasa/Flow:** Postures linked with breath in continuous movement.
-**Ashtanga:** Fixed sequence, breath-movement synchronization. Physically demanding.
-**Iyengar:** Precision alignment, props (blocks, straps, bolsters). Therapeutic.
-**Yin Yoga:** Long holds (3-5 minutes), targeting connective tissue.
-**Restorative:** Fully supported postures. Deep relaxation.
-
-## Key asanas
-
-**Tadasana (Mountain Pose):** Foundation. Feet hip-width, weight even, lengthen spine.
-**Adho Mukha Svanasana (Downward Dog):** Inverted V. Press floor, lift hips, lengthen spine.
-**Virabhadrasana I (Warrior 1):** Front knee 90°, back leg straight, arms up.
-**Trikonasana (Triangle):** Wide stance, torso hinges sideways, bottom hand to shin.
-**Bhujangasana (Cobra):** Prone, lift chest with back muscles.
-**Ustrasana (Camel):** Kneeling, reach back for heels, open chest.
-
-## Pranayama (breath practices)
-
-**Ujjayi:** Slight throat constriction. Ocean sound. Used in Vinyasa.
-**Nadi Shodhana (Alternate Nostril):** Right thumb closes right nostril, inhale left, etc. Balancing.
-**Kapalabhati:** Rapid forceful exhales. Energizing. Contraindicated in pregnancy, high BP.
-**Box breathing:** Equal inhale:hold:exhale:hold (4:4:4:4). Stress regulation.
-
-## Patanjali's 8 limbs of yoga
-
-1. **Yama:** Ethical restraints (ahimsa-nonviolence, satya-truth, asteya-non-stealing).
-2. **Niyama:** Personal observances (saucha-purity, santosha-contentment, tapas-discipline).
-3. **Asana:** Physical postures.
-4. **Pranayama:** Breath control.
-5. **Pratyahara:** Withdrawal of senses.
-6. **Dharana:** Concentration.
-7. **Dhyana:** Meditation.
-8. **Samadhi:** Enlightenment/absorption.
-
-## Evidence base
-
-Mindfulness-Based Stress Reduction (MBSR) and yoga have robust evidence for:
-Reducing stress, anxiety, and depression. Chronic pain relief. Improving sleep quality.
-Yoga for chronic low back pain: Strong evidence. Comparable to physical therapy.
-
-Sources: Yoga Alliance (yogaalliance.org — free standards), WHO Traditional Medicine (free),
-Patanjali Yoga Sutras (public domain), NIH yoga research (free)
+---
+watermark: ORIRO
+disable-model-invocation: true
+name: health-yoga-wellness
+provider: ORIRO.ai
+copyright: Copyright (c) 2026 ORIRO.ai
+description: >
+  Yoga and wellness — yoga traditions, asana fundamentals, pranayama, philosophy
+  (Patanjali), and evidence-based wellness practices. Sources: Yoga Alliance (free),
+  WHO Traditional Medicine guidelines, Patanjali Yoga Sutras (public domain).
+---
+
+# Yoga and Wellness
+
+## Yoga traditions
+
+**Hatha Yoga:** Physical postures (asana) + breathing (pranayama). Foundation of most Western yoga.
+**Vinyasa/Flow:** Postures linked with breath in continuous movement.
+**Ashtanga:** Fixed sequence, breath-movement synchronization. Physically demanding.
+**Iyengar:** Precision alignment, props (blocks, straps, bolsters). Therapeutic.
+**Yin Yoga:** Long holds (3-5 minutes), targeting connective tissue.
+**Restorative:** Fully supported postures. Deep relaxation.
+
+## Key asanas
+
+**Tadasana (Mountain Pose):** Foundation. Feet hip-width, weight even, lengthen spine.
+**Adho Mukha Svanasana (Downward Dog):** Inverted V. Press floor, lift hips, lengthen spine.
+**Virabhadrasana I (Warrior 1):** Front knee 90°, back leg straight, arms up.
+**Trikonasana (Triangle):** Wide stance, torso hinges sideways, bottom hand to shin.
+**Bhujangasana (Cobra):** Prone, lift chest with back muscles.
+**Ustrasana (Camel):** Kneeling, reach back for heels, open chest.
+
+## Pranayama (breath practices)
+
+**Ujjayi:** Slight throat constriction. Ocean sound. Used in Vinyasa.
+**Nadi Shodhana (Alternate Nostril):** Right thumb closes right nostril, inhale left, etc. Balancing.
+**Kapalabhati:** Rapid forceful exhales. Energizing. Contraindicated in pregnancy, high BP.
+**Box breathing:** Equal inhale:hold:exhale:hold (4:4:4:4). Stress regulation.
+
+## Patanjali's 8 limbs of yoga
+
+1. **Yama:** Ethical restraints (ahimsa-nonviolence, satya-truth, asteya-non-stealing).
+2. **Niyama:** Personal observances (saucha-purity, santosha-contentment, tapas-discipline).
+3. **Asana:** Physical postures.
+4. **Pranayama:** Breath control.
+5. **Pratyahara:** Withdrawal of senses.
+6. **Dharana:** Concentration.
+7. **Dhyana:** Meditation.
+8. **Samadhi:** Enlightenment/absorption.
+
+## Evidence base
+
+Mindfulness-Based Stress Reduction (MBSR) and yoga have robust evidence for:
+Reducing stress, anxiety, and depression. Chronic pain relief. Improving sleep quality.
+Yoga for chronic low back pain: Strong evidence. Comparable to physical therapy.
+
+Sources: Yoga Alliance (yogaalliance.org — free standards), WHO Traditional Medicine (free),
+Patanjali Yoga Sutras (public domain), NIH yoga research (free)

package/skills/healthcare-systems/health-sys-global/LICENSE

@@ -1,21 +1,21 @@
-MIT License
-
-Copyright (c) 2026 ORIRO.ai
-
-Permission is hereby granted, free of charge, to any person obtaining a copy
-of this software and associated documentation files (the "Software"), to deal
-in the Software without restriction, including without limitation the rights
-to use, copy, modify, merge, publish, distribute, sublicense, and/or sell
-copies of the Software, and to permit persons to whom the Software is
-furnished to do so, subject to the following conditions:
-
-The above copyright notice and this permission notice shall be included in all
-copies or substantial portions of the Software.
-
-THE SOFTWARE IS PROVIDED "AS IS", WITHOUT WARRANTY OF ANY KIND, EXPRESS OR
-IMPLIED, INCLUDING BUT NOT LIMITED TO THE WARRANTIES OF MERCHANTABILITY,
-FITNESS FOR A PARTICULAR PURPOSE AND NONINFRINGEMENT. IN NO EVENT SHALL THE
-AUTHORS OR COPYRIGHT HOLDERS BE LIABLE FOR ANY CLAIM, DAMAGES OR OTHER
-LIABILITY, WHETHER IN AN ACTION OF CONTRACT, TORT OR OTHERWISE, ARISING FROM,
-OUT OF OR IN CONNECTION WITH THE SOFTWARE OR THE USE OR OTHER DEALINGS IN THE
-SOFTWARE.
+MIT License
+
+Copyright (c) 2026 ORIRO.ai
+
+Permission is hereby granted, free of charge, to any person obtaining a copy
+of this software and associated documentation files (the "Software"), to deal
+in the Software without restriction, including without limitation the rights
+to use, copy, modify, merge, publish, distribute, sublicense, and/or sell
+copies of the Software, and to permit persons to whom the Software is
+furnished to do so, subject to the following conditions:
+
+The above copyright notice and this permission notice shall be included in all
+copies or substantial portions of the Software.
+
+THE SOFTWARE IS PROVIDED "AS IS", WITHOUT WARRANTY OF ANY KIND, EXPRESS OR
+IMPLIED, INCLUDING BUT NOT LIMITED TO THE WARRANTIES OF MERCHANTABILITY,
+FITNESS FOR A PARTICULAR PURPOSE AND NONINFRINGEMENT. IN NO EVENT SHALL THE
+AUTHORS OR COPYRIGHT HOLDERS BE LIABLE FOR ANY CLAIM, DAMAGES OR OTHER
+LIABILITY, WHETHER IN AN ACTION OF CONTRACT, TORT OR OTHERWISE, ARISING FROM,
+OUT OF OR IN CONNECTION WITH THE SOFTWARE OR THE USE OR OTHER DEALINGS IN THE
+SOFTWARE.

package/skills/healthcare-systems/health-sys-global/SKILL.md

@@ -1,69 +1,69 @@
----
-watermark: ORIRO
-disable-model-invocation: true
-name: health-sys-global
-provider: ORIRO.ai
-copyright: Copyright (c) 2026 ORIRO.ai
-description: >
-
-
-  Global health — disease burden, health systems, global health financing, and equity.
-
-  Sources: CMS, CDC, WHO, AAMC, AHA health system resources.
----
-
-# Global Health
-
-## Global disease burden
-
-**Leading causes of death globally (WHO 2019):**
-
-1. Ischemic heart disease (16%)
-2. Stroke (11%)
-3. COPD (6%)
-4. Lower respiratory infections (6%)
-5. Neonatal conditions (5%)
-6. Trachea/bronchus/lung cancers (3%)
-7. Alzheimer's disease (3%)
-
-**DALY (Disability-Adjusted Life Year):** One year of healthy life lost. Combines years lost to premature death and years lived with disability. Better measure of burden than mortality alone.
-
-**Epidemiological transition:** As countries develop, burden shifts from communicable to non-communicable diseases. Low-income countries increasingly face double burden of both.
-
-## Major global health challenges
-
-### Infectious diseases still dominant
-
-**HIV/AIDS:** ~37 million people living with HIV. 1.5 million new infections/year (2021). Sub-Saharan Africa: ~70% of global burden. ART (antiretroviral therapy) transformed from death sentence to chronic disease management. 28 million on treatment.
-**Malaria:** ~247 million cases, ~619,000 deaths (2021, mostly under-5 children, Africa). RTS,S/AS01 vaccine (Mosquirix) and R21/Matrix-M vaccine: First malaria vaccines — 75-77% efficacy in Phase 3.
-**Tuberculosis:** #2 infectious disease killer. Drug-resistant TB growing concern. Latent TB: ~2 billion infected.
-**Neglected Tropical Diseases (NTDs):** Affect 1.7 billion people. Onchocerciasis, lymphatic filariasis, schistosomiasis, soil-transmitted helminths. Often preventable/treatable with low-cost interventions.
-
-## Health systems frameworks
-
-**WHO six building blocks:**
-
-1. Health service delivery
-2. Health workforce
-3. Health information systems
-4. Access to essential medicines
-5. Health financing
-6. Leadership and governance
-
-**Universal Health Coverage (UHC):** All people have access to quality health services without financial hardship. Core SDG target (3.8). 3.3-3.6 billion people lack access to essential health services.
-
-## Global health financing
-
-**Total global health spending:** ~$8.5 trillion/year.
-**Official Development Assistance (ODA) for health:** ~$40-50 billion/year.
-**Key institutions:** WHO, GAVI (vaccines, $15B+ committed), Global Fund (HIV/TB/malaria, $50B+ to date), UNITAID, PEPFAR ($110B+ committed by US, most by any government for a single disease).
-
-**Global health R&D:** Under-investment in diseases of the poor (neglected diseases). Less than 10% of global health R&D addresses 90% of global disease burden (10/90 gap). BARDA, CEPI for pandemic preparedness. Pooled procurement (PAHO revolving fund, Medicines Patent Pool).
-
-## Health equity
-
-**Social gradient in health:** Better health outcomes at every step up the socioeconomic ladder. Not just poor vs. rich binary.
-**Structural racism and health:** Race-based health disparities are documented in nearly every health indicator. Produced by historically rooted social structures.
-**One Health:** Human health, animal health, and environmental health are interconnected. Zoonotic diseases (COVID-19, Ebola, avian flu, HIV) emerge at human-animal interface. Antimicrobial resistance requires cross-sector response.
-
-Sources: WHO Global Health Estimates (who.int/data — free), IHME GBD (healthdata.org — free), Lancet global health (many open access), Global Fund (theglobalfund.org — free), PEPFAR (pepfar.gov — free)
+---
+watermark: ORIRO
+disable-model-invocation: true
+name: health-sys-global
+provider: ORIRO.ai
+copyright: Copyright (c) 2026 ORIRO.ai
+description: >
+
+
+  Global health — disease burden, health systems, global health financing, and equity.
+
+  Sources: CMS, CDC, WHO, AAMC, AHA health system resources.
+---
+
+# Global Health
+
+## Global disease burden
+
+**Leading causes of death globally (WHO 2019):**
+
+1. Ischemic heart disease (16%)
+2. Stroke (11%)
+3. COPD (6%)
+4. Lower respiratory infections (6%)
+5. Neonatal conditions (5%)
+6. Trachea/bronchus/lung cancers (3%)
+7. Alzheimer's disease (3%)
+
+**DALY (Disability-Adjusted Life Year):** One year of healthy life lost. Combines years lost to premature death and years lived with disability. Better measure of burden than mortality alone.
+
+**Epidemiological transition:** As countries develop, burden shifts from communicable to non-communicable diseases. Low-income countries increasingly face double burden of both.
+
+## Major global health challenges
+
+### Infectious diseases still dominant
+
+**HIV/AIDS:** ~37 million people living with HIV. 1.5 million new infections/year (2021). Sub-Saharan Africa: ~70% of global burden. ART (antiretroviral therapy) transformed from death sentence to chronic disease management. 28 million on treatment.
+**Malaria:** ~247 million cases, ~619,000 deaths (2021, mostly under-5 children, Africa). RTS,S/AS01 vaccine (Mosquirix) and R21/Matrix-M vaccine: First malaria vaccines — 75-77% efficacy in Phase 3.
+**Tuberculosis:** #2 infectious disease killer. Drug-resistant TB growing concern. Latent TB: ~2 billion infected.
+**Neglected Tropical Diseases (NTDs):** Affect 1.7 billion people. Onchocerciasis, lymphatic filariasis, schistosomiasis, soil-transmitted helminths. Often preventable/treatable with low-cost interventions.
+
+## Health systems frameworks
+
+**WHO six building blocks:**
+
+1. Health service delivery
+2. Health workforce
+3. Health information systems
+4. Access to essential medicines
+5. Health financing
+6. Leadership and governance
+
+**Universal Health Coverage (UHC):** All people have access to quality health services without financial hardship. Core SDG target (3.8). 3.3-3.6 billion people lack access to essential health services.
+
+## Global health financing
+
+**Total global health spending:** ~$8.5 trillion/year.
+**Official Development Assistance (ODA) for health:** ~$40-50 billion/year.
+**Key institutions:** WHO, GAVI (vaccines, $15B+ committed), Global Fund (HIV/TB/malaria, $50B+ to date), UNITAID, PEPFAR ($110B+ committed by US, most by any government for a single disease).
+
+**Global health R&D:** Under-investment in diseases of the poor (neglected diseases). Less than 10% of global health R&D addresses 90% of global disease burden (10/90 gap). BARDA, CEPI for pandemic preparedness. Pooled procurement (PAHO revolving fund, Medicines Patent Pool).
+
+## Health equity
+
+**Social gradient in health:** Better health outcomes at every step up the socioeconomic ladder. Not just poor vs. rich binary.
+**Structural racism and health:** Race-based health disparities are documented in nearly every health indicator. Produced by historically rooted social structures.
+**One Health:** Human health, animal health, and environmental health are interconnected. Zoonotic diseases (COVID-19, Ebola, avian flu, HIV) emerge at human-animal interface. Antimicrobial resistance requires cross-sector response.
+
+Sources: WHO Global Health Estimates (who.int/data — free), IHME GBD (healthdata.org — free), Lancet global health (many open access), Global Fund (theglobalfund.org — free), PEPFAR (pepfar.gov — free)

package/skills/healthcare-systems/health-sys-management/LICENSE

@@ -1,21 +1,21 @@
-MIT License
-
-Copyright (c) 2026 ORIRO.ai
-
-Permission is hereby granted, free of charge, to any person obtaining a copy
-of this software and associated documentation files (the "Software"), to deal
-in the Software without restriction, including without limitation the rights
-to use, copy, modify, merge, publish, distribute, sublicense, and/or sell
-copies of the Software, and to permit persons to whom the Software is
-furnished to do so, subject to the following conditions:
-
-The above copyright notice and this permission notice shall be included in all
-copies or substantial portions of the Software.
-
-THE SOFTWARE IS PROVIDED "AS IS", WITHOUT WARRANTY OF ANY KIND, EXPRESS OR
-IMPLIED, INCLUDING BUT NOT LIMITED TO THE WARRANTIES OF MERCHANTABILITY,
-FITNESS FOR A PARTICULAR PURPOSE AND NONINFRINGEMENT. IN NO EVENT SHALL THE
-AUTHORS OR COPYRIGHT HOLDERS BE LIABLE FOR ANY CLAIM, DAMAGES OR OTHER
-LIABILITY, WHETHER IN AN ACTION OF CONTRACT, TORT OR OTHERWISE, ARISING FROM,
-OUT OF OR IN CONNECTION WITH THE SOFTWARE OR THE USE OR OTHER DEALINGS IN THE
-SOFTWARE.
+MIT License
+
+Copyright (c) 2026 ORIRO.ai
+
+Permission is hereby granted, free of charge, to any person obtaining a copy
+of this software and associated documentation files (the "Software"), to deal
+in the Software without restriction, including without limitation the rights
+to use, copy, modify, merge, publish, distribute, sublicense, and/or sell
+copies of the Software, and to permit persons to whom the Software is
+furnished to do so, subject to the following conditions:
+
+The above copyright notice and this permission notice shall be included in all
+copies or substantial portions of the Software.
+
+THE SOFTWARE IS PROVIDED "AS IS", WITHOUT WARRANTY OF ANY KIND, EXPRESS OR
+IMPLIED, INCLUDING BUT NOT LIMITED TO THE WARRANTIES OF MERCHANTABILITY,
+FITNESS FOR A PARTICULAR PURPOSE AND NONINFRINGEMENT. IN NO EVENT SHALL THE
+AUTHORS OR COPYRIGHT HOLDERS BE LIABLE FOR ANY CLAIM, DAMAGES OR OTHER
+LIABILITY, WHETHER IN AN ACTION OF CONTRACT, TORT OR OTHERWISE, ARISING FROM,
+OUT OF OR IN CONNECTION WITH THE SOFTWARE OR THE USE OR OTHER DEALINGS IN THE
+SOFTWARE.

package/skills/healthcare-systems/health-sys-management/SKILL.md

@@ -1,71 +1,71 @@
----
-watermark: ORIRO
-disable-model-invocation: true
-name: health-sys-management
-provider: ORIRO.ai
-copyright: Copyright (c) 2026 ORIRO.ai
-description: >
-
-
-
-  Healthcare management — hospital operations, quality improvement, regulatory compliance, and health system leadership.
-  Sources: CMS, CDC, WHO, AAMC, AHA health system resources.
----
-
-# Healthcare Management
-
-## Hospital operations
-
-### Hospital structure
-
-**Governing body (board):** Fiduciary responsibility. Sets strategic direction. Quality oversight.
-**Medical staff:** Physicians credentialed to practice in hospital. Medical staff bylaws govern privileging.
-**Administration:** CEO, CFO, CMO (Chief Medical Officer), CNO (Chief Nursing Officer), COO.
-**Service lines:** Organized around clinical programs (cardiac, oncology, orthopaedics, women's health).
-
-### Key hospital metrics
-
-**Occupancy rate:** Occupied beds / Licensed beds. Target 80-85% (below = under-utilized; above = constrained).
-**Average length of stay (ALOS):** How long patients stay. Shorter is generally better (cost and outcomes).
-**Readmission rate:** % of patients readmitted within 30 days. CMS penalizes high readmission rates.
-**Patient experience (HCAHPS):** Survey scores affect CMS reimbursement.
-**Mortality and complication rates:** Risk-adjusted. Compared to benchmarks.
-**Operating margin:** Revenue - Expenses / Revenue. US hospital median: ~3-4% (thin margins).
-
-### Revenue cycle
-
-**Chargemaster:** Hospital's list price for every service (often 3-5× actual payment). Starting point for negotiations.
-**Payer mix:** Proportion of revenue from different payers (commercial, Medicare, Medicaid, self-pay).
-Medicare/Medicaid reimbursement often below cost. Commercial payer subsidizes.
-**DRG (Diagnosis-Related Group):** Medicare pays fixed amount per admission based on diagnosis, not actual costs. Incentivizes efficiency.
-**Value-based care:** Movement from fee-for-service (paid per procedure) to payments tied to outcomes (ACOs, bundled payments).
-
-## Quality improvement
-
-### Major quality frameworks
-
-**IHI Triple Aim / Quadruple Aim:**
-Improve population health + Enhance patient experience + Reduce per capita cost + (4th aim) Support care team wellbeing.
-
-**PDSA cycles:** Plan-Do-Study-Act. Rapid cycle improvement.
-**Lean:** Toyota Production System applied to healthcare. Eliminate waste. Value stream mapping.
-**Six Sigma:** Reduce variation and defects. DMAIC methodology.
-**High reliability organizations (HROs):** Preoccupation with failure. Resistance to oversimplification. Sensitivity to operations. Commitment to resilience. Deference to expertise.
-
-### Patient safety
-
-**Institute of Medicine "To Err is Human" (1999):** Landmark report. 44,000-98,000 deaths/year from medical errors.
-**Never events:** Serious, preventable events. Wrong-site surgery, retained foreign object, patient falls with injury, pressure ulcers, healthcare-acquired infections.
-**Root cause analysis (RCA):** After adverse events. Find system causes, not just individual blame.
-**Just culture:** Distinguish human error, at-risk behavior, reckless behavior. Learn from near-misses. Report without fear.
-**Patient safety bundles:** Evidence-based interventions packaged together. Central line bundle eliminates CLABSI.
-
-## Regulatory environment
-
-**Joint Commission (TJC):** Accreditation for hospitals. Standards for safety, quality, care management.
-**CMS Conditions of Participation:** Federal requirements for Medicare/Medicaid participation.
-**HIPAA:** Privacy and security of patient health information.
-**EMTALA:** Emergency Medical Treatment and Active Labor Act. Must evaluate/stabilize emergencies regardless of ability to pay.
-**Stark Law/Anti-Kickback:** Prohibit financial arrangements that could influence medical decisions.
-
-Sources: AHA (aha.org — free resources), ACHE (ache.org — free healthcare management content), IHI (ihi.org — free), TJC (jointcommission.org), CMS (cms.gov), Becker's Hospital Review (free)
+---
+watermark: ORIRO
+disable-model-invocation: true
+name: health-sys-management
+provider: ORIRO.ai
+copyright: Copyright (c) 2026 ORIRO.ai
+description: >
+
+
+
+  Healthcare management — hospital operations, quality improvement, regulatory compliance, and health system leadership.
+  Sources: CMS, CDC, WHO, AAMC, AHA health system resources.
+---
+
+# Healthcare Management
+
+## Hospital operations
+
+### Hospital structure
+
+**Governing body (board):** Fiduciary responsibility. Sets strategic direction. Quality oversight.
+**Medical staff:** Physicians credentialed to practice in hospital. Medical staff bylaws govern privileging.
+**Administration:** CEO, CFO, CMO (Chief Medical Officer), CNO (Chief Nursing Officer), COO.
+**Service lines:** Organized around clinical programs (cardiac, oncology, orthopaedics, women's health).
+
+### Key hospital metrics
+
+**Occupancy rate:** Occupied beds / Licensed beds. Target 80-85% (below = under-utilized; above = constrained).
+**Average length of stay (ALOS):** How long patients stay. Shorter is generally better (cost and outcomes).
+**Readmission rate:** % of patients readmitted within 30 days. CMS penalizes high readmission rates.
+**Patient experience (HCAHPS):** Survey scores affect CMS reimbursement.
+**Mortality and complication rates:** Risk-adjusted. Compared to benchmarks.
+**Operating margin:** Revenue - Expenses / Revenue. US hospital median: ~3-4% (thin margins).
+
+### Revenue cycle
+
+**Chargemaster:** Hospital's list price for every service (often 3-5× actual payment). Starting point for negotiations.
+**Payer mix:** Proportion of revenue from different payers (commercial, Medicare, Medicaid, self-pay).
+Medicare/Medicaid reimbursement often below cost. Commercial payer subsidizes.
+**DRG (Diagnosis-Related Group):** Medicare pays fixed amount per admission based on diagnosis, not actual costs. Incentivizes efficiency.
+**Value-based care:** Movement from fee-for-service (paid per procedure) to payments tied to outcomes (ACOs, bundled payments).
+
+## Quality improvement
+
+### Major quality frameworks
+
+**IHI Triple Aim / Quadruple Aim:**
+Improve population health + Enhance patient experience + Reduce per capita cost + (4th aim) Support care team wellbeing.
+
+**PDSA cycles:** Plan-Do-Study-Act. Rapid cycle improvement.
+**Lean:** Toyota Production System applied to healthcare. Eliminate waste. Value stream mapping.
+**Six Sigma:** Reduce variation and defects. DMAIC methodology.
+**High reliability organizations (HROs):** Preoccupation with failure. Resistance to oversimplification. Sensitivity to operations. Commitment to resilience. Deference to expertise.
+
+### Patient safety
+
+**Institute of Medicine "To Err is Human" (1999):** Landmark report. 44,000-98,000 deaths/year from medical errors.
+**Never events:** Serious, preventable events. Wrong-site surgery, retained foreign object, patient falls with injury, pressure ulcers, healthcare-acquired infections.
+**Root cause analysis (RCA):** After adverse events. Find system causes, not just individual blame.
+**Just culture:** Distinguish human error, at-risk behavior, reckless behavior. Learn from near-misses. Report without fear.
+**Patient safety bundles:** Evidence-based interventions packaged together. Central line bundle eliminates CLABSI.
+
+## Regulatory environment
+
+**Joint Commission (TJC):** Accreditation for hospitals. Standards for safety, quality, care management.
+**CMS Conditions of Participation:** Federal requirements for Medicare/Medicaid participation.
+**HIPAA:** Privacy and security of patient health information.
+**EMTALA:** Emergency Medical Treatment and Active Labor Act. Must evaluate/stabilize emergencies regardless of ability to pay.
+**Stark Law/Anti-Kickback:** Prohibit financial arrangements that could influence medical decisions.
+
+Sources: AHA (aha.org — free resources), ACHE (ache.org — free healthcare management content), IHI (ihi.org — free), TJC (jointcommission.org), CMS (cms.gov), Becker's Hospital Review (free)

package/skills/healthcare-systems/health-sys-navigation/LICENSE

@@ -1,21 +1,21 @@
-MIT License
-
-Copyright (c) 2026 ORIRO.ai
-
-Permission is hereby granted, free of charge, to any person obtaining a copy
-of this software and associated documentation files (the "Software"), to deal
-in the Software without restriction, including without limitation the rights
-to use, copy, modify, merge, publish, distribute, sublicense, and/or sell
-copies of the Software, and to permit persons to whom the Software is
-furnished to do so, subject to the following conditions:
-
-The above copyright notice and this permission notice shall be included in all
-copies or substantial portions of the Software.
-
-THE SOFTWARE IS PROVIDED "AS IS", WITHOUT WARRANTY OF ANY KIND, EXPRESS OR
-IMPLIED, INCLUDING BUT NOT LIMITED TO THE WARRANTIES OF MERCHANTABILITY,
-FITNESS FOR A PARTICULAR PURPOSE AND NONINFRINGEMENT. IN NO EVENT SHALL THE
-AUTHORS OR COPYRIGHT HOLDERS BE LIABLE FOR ANY CLAIM, DAMAGES OR OTHER
-LIABILITY, WHETHER IN AN ACTION OF CONTRACT, TORT OR OTHERWISE, ARISING FROM,
-OUT OF OR IN CONNECTION WITH THE SOFTWARE OR THE USE OR OTHER DEALINGS IN THE
-SOFTWARE.
+MIT License
+
+Copyright (c) 2026 ORIRO.ai
+
+Permission is hereby granted, free of charge, to any person obtaining a copy
+of this software and associated documentation files (the "Software"), to deal
+in the Software without restriction, including without limitation the rights
+to use, copy, modify, merge, publish, distribute, sublicense, and/or sell
+copies of the Software, and to permit persons to whom the Software is
+furnished to do so, subject to the following conditions:
+
+The above copyright notice and this permission notice shall be included in all
+copies or substantial portions of the Software.
+
+THE SOFTWARE IS PROVIDED "AS IS", WITHOUT WARRANTY OF ANY KIND, EXPRESS OR
+IMPLIED, INCLUDING BUT NOT LIMITED TO THE WARRANTIES OF MERCHANTABILITY,
+FITNESS FOR A PARTICULAR PURPOSE AND NONINFRINGEMENT. IN NO EVENT SHALL THE
+AUTHORS OR COPYRIGHT HOLDERS BE LIABLE FOR ANY CLAIM, DAMAGES OR OTHER
+LIABILITY, WHETHER IN AN ACTION OF CONTRACT, TORT OR OTHERWISE, ARISING FROM,
+OUT OF OR IN CONNECTION WITH THE SOFTWARE OR THE USE OR OTHER DEALINGS IN THE
+SOFTWARE.