NURS 8100 Health Care Reform
NURS 8100 Health Care Reform
This paper looks into an accountable care organization (ACO) in California and ways that it impacts population health. Accountable health care organizations play vital roles in promoting coordinated efforts between clinicians and medical practitioners while at the same time reducing costs and unnecessary treatments (McWilliams, 2016). Accountable care organizations are a representation of changing health dynamics in the American care system. Accountable care organizations are formed when medical providers, for instance, doctors, nurses, health organizations and non-physician providers collectively agree to be responsible for financial and quality of care in a defined population.
Accountable Care Organization
In California, one of the common ACOs is the Shared Savings Programs (SSP) which is a voluntary program that is formed to encourage hospitals, doctors and other health providers in the country to come together as accountable care organizations. The organization gives coordinated and high-quality care to members who are beneficiaries of Medicare. The SSP was formed wit the intention of moving the payment system of Medicare from a volume perspective to outcome and value-based (Lipa, 2020). SSP has significantly impacted population health in California. By coming together, SSP has improved the quality of care to patients who could not have afforded such care. The SSP ensures that patients from different areas in the state get the correct care at the right time. Quality care also means that patients do not go for unnecessary tests. Another way that SSP has impacted population health in California is by focusing on preventative care through coordination of services across the different levels of care (Milwee, 2020).
The concept of bundled care.
Bundled care is a concept that entails Medicare implementing voluntary episode of payment models. Medicare used to make individual payments to individual services offered to patients. In Bundled care, all payments are combined in a single payment for physicians and hospital facilities. Bundled care increases the incentives for providers to work together to deliver patient care. Bundled care exposes healthcare facilities to certain risks and challenges. Some of the risks of bundled care include the fact that patients may have comorbidities (Agrwal, 2020). This is where some patients might require expensive treatment procedures that are uncontrollable by the provider. Another risk of bundled care in handling cases of uncompliant patients. When patients fail to comply with their care plan such as the medication regimen, health care providers will have difficulties in managing the costs.
Benefits of showing pricing for care.
One benefit of showing pricing of care is that it promotes price transparency. When there is access to price transparency, it helps them to choose accountable payment models that are implemented by different organizations to improve healthcare quality. Another benefit of showing care pricing is that it empowers patients to make informed decisions and get more involved in their care. Care pricing also ensures equitable prices for both insured and uninsured patients since in most cases the uninsured patients are often charged more (Mummadi & Mishra, 2020). Finally, showing care prices helps the patient to make decisions on which provider will be most effective at a low cost. Showing care prices increase competition in healthcare facilities thereby improving the quality of care provided.
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In conclusion, the Shared Saving Program (SSP) is an accountable care organization (ACO) that is designed to improve population health as well as the quality of care to patients. Showing care pricing benefits healthcare in various ways. By showing care prices, patients can make an informed decision based on the pricing and quality of services offered.
Agarwal, R., Liao, J. M., Gupta, A., & Navathe, A. S. (2020). The Impact of Bundled Payment On Health Care Spending, Utilization, And Quality: A Systematic Review: A systematic review of the impact on spending, utilization, and quality outcomes from three Centers for Medicare and Medicaid Services bundled payment programs. Health Affairs, 39(1), 50-57.
Lipa, S. A., Sturgeon, D. J., Blucher, J. A., Harris, M. B., & Schoenfeld, A. J. (2020). Do Medicare Accountable Care Organizations Reduce Disparities After Spinal Fracture?. Journal of Surgical Research, 246, 123-130.
McWilliams, J., Hatfield, L., Chernew, M., Landon, B., & Schwartz, A. (2016). Early Performance of Accountable Care Organizations in Medicare.
Millwee, B. (2020). Accountable Care Organizations in Medicaid. The Journal of ambulatory care management, 43(1), 11-14.
Mummadi, S. R., Mishra, R., & Mummadi, R. R. (2020). Price Transparency in the Electronic Health Record. Jama, 323(3), 281-281.
One feature of the US health care system is that it is the most expensive healthcare in the world with results that would not agree with the cost. It is interesting to see that the US healthcare system has tried to evolve over the years and in that evolving has actually increased the cost of healthcare (Bodenheimer & Grumbach, 2020). Competition has fueled the improvement of healthcare, but at the cost of raising healthcare costs for the individual. There are other countries that have better health care systems in place, for a fraction of the cost. It would be interesting to investigate the actual cost of care and how much insurance companies gain compared to their actual payout. There is much that could be improved in the US health care system. It could be possible that the monetary issues prevent there from being major reform to the system because companies make such a large sum of money that they do not want things to change. As the US health care system has tried to change and become seemingly more affordable through the use of policy changes there has been an increase in the amount of money that they government pays, which is actually paid by US citizens through taxes (Bodenheimer & Grumbach, 2020). It seems that whenever the US health care system is taking one step forward it is also taking two steps back.
The Affordable Care Act (ACA) did provide more individuals with health care coverage. This has improved the health of many individuals. One condition of the ACA is that it protects individuals with preexisting conditions from insurance companies denying care based on their condition (Healthcare.gov, n.d.). This is a great benefit for many individuals, but it comes at a cost for the insurance companies. This mandatory coverage causes insurance companies to then have to try to balance out coverage for those individuals that are ill versus those individuals who are healthy which can end up costing those individuals that are healthy to pay for others in their groups (Bodenheimer & Grumbach, 2020). This causes insurances to have to base their premiums on an experience rating versus a community rating which potentially provides unfair coverage to individuals (Bodenhemier & Grumbach, 2020). This seemingly minor change from the ACA has a ripple effect in the way that insurance companies need to charge for care and how they will determine premiums for individuals. The ACA in general is an example of how the policy making process is in the United States. Making or changing policy in the United States is a very slow, very incremental process which makes it hard to change or add policies (Walden University, LLC, 2011). The ACA was a worked on for a long time and because of the changes that were made many companies had to adjust accordingly. Health reform in the United States is difficult because there are so many entities that want to make sure that they are not being left out or hurt in decisions or policies that are being made and so they will stall or stonewall different policies if they feel that it does not benefit them. When there are policy changes then there are adjustments that need to be made and sometimes that effects so many different things that the changes end up being a negative instead of a positive, such as individuals who have to pay too much for the ACA healthcare and therefore opt out and are fined for that decision (Bodenheim & Grumbach, 2020).
Bodenheimer, T., & Grumbach, K. (2020). Understanding health policy: A clinical approach (8th ed.). McGraw-Hill.
HealthCare.gov. (n.d.) Understanding the Affordable Care Act. Retrieved from https://www.hhs.gov/healthcare/about-the-aca/index.html
Walden University, LLC. (Executive Producer). (2011). Healthcare policy and advocacy: The policy process. Baltimore: Author.
The Affordable Care Act (ACA) was signed into law over 10 years ago and it has remained highly controversial by many law makers since its inception on March 23, 2010. Many law makers have tried to get rid of the ACA but have yet to find a health care system to replace the ACA that works with law makers and the public. Even though people may not like the ACA it has improved the health care system, provided health insurance to the uninsured, provided more prevention program to help improve the overall health of the American people. There was so much resistance to passing the ACA since the President at that time was African American and a Democratic (Silberman, 2020). The Patient Protection and Affordable Care Act (ACA) was passed by a Democratic Congress and signed into law by a Democratic president in 2010. Republican congresspeople, governors, and Republican candidates have consistently opposed the ACA and have vowed to repeal it during every election, but more than 50% of Americans support ACA. In the first year of ACA 10 million Americans gained accessed to health insurance. The ACA also eliminated the no coverage for prior conditions, it also decreased prescription drug cost and eliminated co-pay for preventive services. When people are asked why they oppose the ACA they mention they do not like the government involved in their healthcare, but they pay into Medicare which is a mandatory federal government insurance. Despite positive changes the ACA has brought to many Americans many politicians and people oppose ACA and want to get rid of ACA(Silberman,2020). While ACA has made great strides in improving health care, health disparity remains a major problem among people of color. The recent pandemic has shown the world once again that the health care system is even though Black Americans make up 13 percent of the US population over 23 percent of COVID deaths were Black Americans (USA, 2021).
In spite of significant advances in the diagnosis and treatment of most chronic diseases, there is evidence that racial and ethnic minorities tend to receive lower quality of care than non-minorities and that, patients of minority ethnicity experience greater morbidity and mortality from various chronic diseases than non-minorities. The Institute of Medicine (IOM) report from 2006 showed unequal treatment “racial and ethnic disparities in healthcare exist and, because that lead to worse outcomes in many cases. Minorities were provided less access to health care intervention, sources, and funding (Egede, 2006).
Egede, L. (2006). Race, Ethnicity, Culture, and Disparities in Health care
Silberman, P. (2020). The Affordable Care Act: Against the Odds, It’s Working. North Carolina Medical Journal, 81(6), 364–369. https://doi-org.ezp.waldenulibrary.org/10.18043/ncm.81.6.364
USA FACTS. (2021).US COVID-19 cases and deaths by state