By not taking advantage of these kinds of organizations, doctors and hospitals that do not wish to participate are missing out on cost savings, ease of patient treatment, efficiency, and much more. For patients, looking for doctors and hospitals that participate in accountable care organizations can be a good move, both financially and for ease of treatment. When records are shared and hospitals and doctors agree to be accountable to one another, there is less margin for error. That does not mean that problems cannot develop, but they are much less likely to happen and they will be smaller problems when they occur, overall. Health care workers should be accountable to patients and to other health care workers.
The team effort that was used to collect and provide this information is very important, because it is similar to the team effort that is used in accountable care organizations. In other…...
Even worse, because the negotiated rates for services is so much lower than the non-insured rates for those services, many providers may actually provide services more liberally than necessary to make up for the lower revenue of each service rendered.
Eventually, I believe the only way to really address the problem of healthcare costs is to adopt the results-based compensation structure already successfully in use in Britain. Unfortunately, such profound systemic changes will be tremendously difficult to implement in the U.S. In the meantime, therefore, the ACO concept may be the most viable means of incentivizing healthcare cost reduction on the part of providers as well as patients.
Relevance to Risk Management Concepts
Another aspect of increased flexibility associated with ACOs in comparison to HMOs is that ACOs encourage patients to utilize network providers but also permit them to exercise the autonomy to seek treatment from other providers. This, however, also represents…...
Medicaid and the ACA
Discuss the issues central to the expansion of Medicaid created by the Affordable Care Act. From state policy perspective is this a good way to increase access to healthcare at a reasonable cost? Be sure to discuss the success stories you uncover as you complete your research for this question. eview the following and consider the questions below as part of your initial post.
From the State's perspective, expanding Medicaid under the ACA is a sound financial investment. However, the Supreme Court ruled that each state could decide to enter the program individually and as a consequence many states have not. These states claim that they cannot afford the program. However, a report by the Congressional Budget Office clearly shows that the Federal Government will actually be responsible for the bulk of the costs in the first decade of the program -- about 93% of the total costs.
The…...
mlaReferences
Angeles, J. (2012, July 25). How Health Reform's Medicaid Expansion Will Impact State Budgets. Retrieved from Center on Budget and Policy Priorities: http://www.cbpp.org/research/how-health-reforms-medicaid-expansion-will-impact-state-budgets
Klein, S., McCarthy, D., & Cohen, A. (2014). Health Share of Oregon: A Community Oriented Approach to Accountable Care for Medicaid Beneficiaries. The Commonwealth Fund, 1-12.
Semro, B. (2014, April 29). Numbers Tell the Story of ACA's Success, But They Also Show Millions are Missing Out. Retrieved from The Huffington Post: http://www.huffingtonpost.com/bob-semro/numbers-tell-the-story-of-obamacare_b_5228695.html
ACA and EMS
The implementation of the Affordable Care Act (ACA) is sure to change the way EMS operate in the coming years. Accountable Care Organizations (ACO), for instance, are now responsible for overseeing how reimbursements are paid out to those agencies that provide health care -- and at the same time they are responsible for gauging whether or not quality care is delivered by providers (Koury et al., 2014). This is a tall order for a new functioning body and the ACOs tasked with these orders will have an indirect impact on how EMS operates. To see how that impact will be effected, an examination of the ACOs and hospitals interact requires examination -- because it is that interaction that will inevitably alter the way in which the EMS goes about their business. This paper will examine the relationship between the ACA, ACOs, hospitals and EMS and show how an…...
mlaReferences
ACA. (2010). Sec. 1204, 124 STAT. U.S. Government Publishing Office. Retrieved from https://www.gpo.gov/fdsys/pkg/PLAW-111publ148/pdf/PLAW-111publ148.pdf
Ahmed, A. et al. (2015). Not just an urban phenomenon: Uninsured rural trauma
patients at increased risk for mortality. Western Journal of Emergency Medicine, 16(5): 632-641.
Alpert, A. et al. (2013). Giving EMS flexibility in transporting low-acuity patients could
care in regards to EM when patients go from outpatient to inpatient to specialists
Effective Communication
The CMS (Centers for Medicare and Medicaid Services) uses the phrase 'care transition' to refer to patient transference between care settings (like hospitals, nursing facilities, home care, primary care, specialist care, or long-term patient care). Care coordination throughout the continuum of healthcare proves critical to patient treatment management, execution and assessment. Transferring health information of patients from one care location or level to another during patient transfers guarantees care continuity and fosters effective patient treatment. Direct communication between different healthcare providers is vital to smooth patient transition across healthcare settings. Partial knowledge of patient health details and absence of an EH (electronic health record) that may be accessed anywhere will restrict acute care professionals' capacity of accessing the patient's community pharmacy and ambulatory care records, especially if the professional is not the patient's primary care…...
mlaReferences
Rupal Patel Mansukhani, Mary Barna Bridgeman, Danielle Candelario, & Laurie J. Eckert. (2015). Exploring Transitional Care: Evidence-Based Strategies for Improving Provider Communication and Reducing Readmissions. Pharmacy and Therapeutics, 690-694.
Sharon Silow-Carrol. (2012). Using Electronic Health Records to Improve Quality and Efficiency: The Experiences of Leading Hospitals. Commonwealth Fund.
Unintended Consequences of Health Care Reform
Consequences of Health Care Reform
My discussion is related to the individual mandate of the Patient Protection and Affordable Care Act (PPACA) of 2010.
The policy problems addressed by the Patient Protection and Affordable Care Act (PPACA) of 2010 are the high cost of health insurance that is untenable for low and middle income earners and the discretionary criteria for enrollment and coverage exercised by medical and health insurance carriers. The PPACA is an excellent policy solution to these issues in the United States and, absent socialized medicine, is a robust response to what has been an intractable and escalating problem in the U.S. Many people who have unable to obtain medical insurance are now able to do so.
The Patient Protection and Affordable Care Act was designed to significantly reduce the number of people who are uninsured through the provision of a continuum of affordable coverage options,…...
Accountability and the Healthcare Industry
Accountability is absolutely crucial when it comes to the health care industry. The professional health care industry has an obligation to create an atmosphere of responsibility and obligation with strong ethical values and where these values are clearly enforced. One of the reasons why this is so absolutely crucial is because the stakes are so high in health care: clinicians deal with the high stakes of life and death each day. "Accountability encompasses the procedures and processes by which one party justifies and takes responsibility for its activities such as for achieving various organizational goals" (O'Hagan, 2009). Accountability creates a culture which can thus be focused on things like evidence-based practice and on a steady improvement of health and quality services because the atmosphere values and rewards things like these and is structured in such a way that it is demanded by the collective and individual…...
mlaReferences
Benjamin, B. (2003, December). Ethics and Self-Accountability. Retrieved from Massagetoday.com: http://www.massagetoday.com/archives/2003/12/07.html
Lion, M. (2012, July 30). Establishing Staff Accountability. Retrieved from Physiciansmoneydigest.com: http://www.physiciansmoneydigest.com/practice-management/Establishing-Staff-Accountability
McCullough, M. (2011). Responsible Leadership of Accountable Care Organizations. Retrieved from Acmq.org: http://www.acmq.org/natlconf/presentations/Ethics%20as%20an%20Essential%20Component%20of%20Responsible%20Leadership%20of%20ACOs.pdf
O'Hagan, J. (2009). Creating a Culture of Accountability in Health Care . The Health Care Manager, 124-133.
com). A certain amount of errors is to be expected, but there should not be so many that it demonstrates a certain level of skewedness about the model in its entirety. Thus, if the NHI model is the one which is selected, then it needs to be tested against a range of different scenarios. The following demonstrate some truly relevant what-ifs: what if the doctors only move half the projected volume; what if medicare slashes rates; what if competitors open a comparable program (dgapartners.com).
There are a range of factors which can change or adjust once a healthcare facility opens their doors for business. And as much as this facility is attempting to engage in a solid humanitarian effort, at the end of the day, it's still a business and people need to get paid. Thus, before engaging in further developmental activities, one needs to determine in what ways the model…...
mlaReferences
Brakatu Ofori-Adjei, a. (2007). Microfinance: An Alternative Means of Healthcare Financing for the Poor. Ghana Medical Journal, 193-194.
Burnstein, L., Harris, R., & Love, L. (2012, August 30). Top Four Legal Issues to Consider When Opening an Urgent Care Center. Retrieved from Mondaq.com: http://www.mondaq.com/unitedstates/x/194082/Healthcare/Estate+planning+is+important+step
Burnstein, M., Harris, R.L., & Love, L. (2012, August 20). Top Four Legal Issues to Consider When Opening an Urgent Care Center. Retrieved from Mondaq.com:
Health Care: The Next Twelve Months
Over the next twelve months, there will be many changes to health care in the United States. The largest and most ambitious goal is to provide the majority of Americans with health insurance (Blendon & Benson, 2010). However, there will be a presidential election and a Supreme Court ruling, which means that 2012 could be the year that determines whether the health care law moves forward or whether it is shut down. It could also go forward in part, after having large pieces of it removed, and it could go forward with some fundamental changes. How the elections go will greatly affect the law - unless, of course, the Supreme Court strikes the law down before the elections arrive. It seems like that the Supreme Court will rule on the individual mandate from a constitutional standpoint, and that could lead to some of the new…...
mlaReferences
Blendon R.J., Benson J.M. (2010). Public opinion at the time of the vote on health care reform. New England Journal of Medicine, 362 (16): e55.
Elmendorf, D.W. (2010). Additional information on the effect of the Patient Protection and Affordable Care Act on the Hospital Insurance Trust Fund. Congressional Budget Office.
Peterson, C.L. & Chaikind, H. (2010), Summary of small business health insurance tax credit under PPACA. Congressional Research Service.
Employer Healthcare Benefit Plans
More than half of the American population is covered by a comprehensive health plan of one type or another. That's approximately 160 million people. The programs that come under the above mentioned coverage include the likes of employer sponsored plans and other government initiatives for instance Medicaid and Medicare, a small proportion of health insurance which is purchased on individual basis may also be included in this. If we proceed to explain employer sponsored health programs, government initiatives and individual healthcare benefits individually, then briefly we can say that the employer benefit plans mostly comprise of group plans and are called "the employee welfare benefit plans"
Table of Contents
Introduction
Literature eview
Discussion
The Estimated Effects of PPACA on Coverage
The Number of Uninsured Decreases by 53%
Four Million Children Will Gain Coverage
The Individual Mandate Contributes Most to educing the Number of Uninsured
Premiums in the Non-group Market Also Decline
5. Conclusion 8
6. ecommendations 9
7. eferences…...
mlaReferences
Manning W. And Marquis S, "Health Insurance: The Tradeoff Between Risk Pooling and Moral Hazard," Journal of Health Economics, Vol. 15, No. 5, October 1996, pp. 609 -- 639.
Manning WG, Newhouse JP, Duan N, Keeler EB, Leibowitz A, and Marquis MS, "Health Insurance and the Demand for Medical Care: Evidence from a Randomized Experiment,"
American Economic Review, Vol. 77, No. 3, June 1987, pp. 251 -- 277.
Pauly MV and Herring BJ, "An Efficient Employer Strategy for Dealing with Adverse Selection in Multiple-Plan Offerings: An MSA Example," Journal of Health Economics, Vol. 19,
Coffee egional Medical Center, Inc. CMC") is a non-profit, 88-bed hospital located in Douglas, Georgia. Since 1953, CMC has served the healthcare needs of the community as the sole hospital-provider in Douglas, Georgia and surrounding Coffee County. CMC's mission is to provide the highest-quality healthcare, in a safe and caring environment, for both patients and families (Coffee egional Medical Center, N.d.).
CMC is an acute care hospital for adults and children in southern Georgia whose primary and secondary markets extend from Coffee to Jeff Davis and Bacon counties to Ben Hill and Atkinson counties.
Technological
Healthcare is miles behind the curve when it comes to technological innovation, an industry that historically has not been easy to innovate for. There are two key trends that have changed the game just in the last few months, explains Zoe Barry, CEO and Founder of Zappx, "opening up what could be a landgrab for ambitious startups who…...
mlaReferences
Coffee Regional Medical Center. (N.d.). 2013 Community Health Needs Assessment.
Pozin, I. (2013, October 17). Industry to Watch in 2014: Healthcare Tech. Retrieved from Forbes: http://www.forbes.com/sites/ilyapozin/2013/10/17/industry-to-watch-in-2014-healthcare-tech/
Healthcare Organizational Readiness & Strategy
Healthcare Organization Network
Company Profile
Vanguard operates 25 acute care and three specialty hospitals in urban and suburban areas of Arizona, Illinois, Massachusetts, Michigan, and exas. Across the Vanguard hospital system, there are roughly 7,100 licensed beds ("Hoover," 2014). he Vanguard regional health care system provides a continuum of care that spans outpatient centers, medical office buildings, clinics, and hospitals ("Hoover," 2014). Vanguard operates four managed health care plans serving members in Arizona, Illinois, Michigan, and exas ("Hoover," 2014).
Although Vanguard Health Systems declared it "wants to lead the way to better health care," in 2013, Vanguard was acquired by enet Healthcare ("Hoover," 2014). he enet Healthcare system extended the range of services to 80 hospitals, more than 190 outpatient centers, 36,000 affiliated physicians, more than 105,000 employee, and six health care plans ("Hoover," 2014). enet is a for-profit organization operating in 14 states in the U.S., including California,…...
mlaThe Tenet Health system exhibits a "culture of innovation that creates new solutions for the challenges and opportunities in the healthcare system" ("Tenet," 2014). The Tenet Health system claims include, "We're Improving Health. We're Transforming Care. We're Ready for What's Next" ("Tenet," 2014). Tenet is very much a business, an the company strives to enhance the level of service and care that is provided. One of the ways Tenet is working on this goal is through innovative partnerships with companies that share their passion for moving health forward ("Tenet," 2014). The company has invested in new technology to support their neurosurgery initiatives. Tenet provides the clinical and infrastructure for an extensive accountable care organizations (ACO) program that is designed to deliver better comprehensive care at lower cost by "accessing resources and best practices from across the company and rewarding physicians and hospitals for quality care improvements" ("Tenet," 2014).
For decades, Tenet has been plagued with lawsuits and federal investigations for unnecessary surgeries and hospitalizations, and for improperly billing Medicare. As recently as April 2012, Tenet paid $42.75 million to resolve allegations arising from the Medicare billing investigation between 2005 and 2007. Since roughly 2009, efforts by the Tenet Health system to improve their reputation and their share price have been successful. Tenet has implemented an ethics program and stresses that all employees, "See it. Say it. Fix it." ("Tenet," 2014).
Tenet's efforts to improve their reputation -- and their compliance with federal standards for providing and billing Medicare services -- has been kicked into full gear. One of the most innovative, forward-looking additions to Tenet Healthcare services is The Center for the Urban Child at St. Christopher's Hospital for Children. A comprehensive range of services is available for urban families with children, many of which are directed at the challenges of parenting and raising a family in cities. The Center for Urban Children, located in Philadelphia,
Evolution of Nursing oles in an Enlarged National Health Care System
The Affordable Care Act enables the provision of health insurance to 30 million people above the coverage figures prior to the enactment of the law. Because of this precipitous rise in the number of health insurance members, access to care as a function of the availability of primary care providers has been a leading issue in the transition to the nation-wide system of health care insurance. Public health models and nursing practice arrangements are changing in order to meet the immediate and anticipated care needs that have been brought to bear on the health care systems.
Public Health and Nurse Managed Health Centers (NMHCs)
From the earliest days of public health, the roles of nurses have been embedded in the social, educational, and political needs of communities. Health education has functioned as a springboard to community organizing, patient advocacy, and the…...
mlaReferences
Centers for Medicare & Medicaid Services. (2005, January). CMS.gov. Retrieved from http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO/index.html
Kulbok, P.A., Thatcher, E., Park, E., & Meszaros, P.S. (2012, May). Evolving public health nursing roles: Focus on community participatory health promotion and prevention. The Online Journal of Issues in Nursing (OJIN), 17(2). DOI: 10.3912/OJIN.Vol17No02Man01. Retrieved from http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-17-2012/No2-May-2012/Evolving-Public-Health-Nursing-Roles.html
National Conference of State Legislatures. (2012, September). The Medical Home Model of Care. Retrieved from http://www.ncsl.org/research/health/the-medical-home-model-of-care.aspx
Reid, R., Haggerty, J., & McKendry, R. (2002, March). Final Report. Defusing the confusion: Concepts and measures of continuity of healthcare. Canadian Health Services Research Foundation, the Canadian Institute for Health Information, and the Advisory Committee on Health Services of the Federal/Provincial/Territorial Deputy Ministers of Health. Retrieved from http://www.hpm.org/Downloads/Bellagio/Articles/Continuity/cr_contcare_e.pdf
Healthcare Reform Models
Health Care Reform Models
Preventive Psychiatry
Shim and colleagues (2012) argue for taking advantage of provisions within the Patient Protection and Affordable Care Act (ACA) of 2010 that emphasizes preventive and integrated care. They propose that the primary care setting is ideal for screening patients for signs of mental illness and associated risk factors. A mental health wellness program could also include coaches and other experts that interface with patients on an individual basis, including at the patient's home.
Long-Term Behavioral Health Care
Bao and colleagues (2012) examined four patient populations defined by disease severity and ability to pay, and then assessed how these four groups will fare under the behavioral health provisions in the ACA. Patients with private insurance and suffering from mild to moderate mental illness will probably receive the best care at a Patient-Centered Medical Home (PCMH). The authors suggest that the presence of comorbid conditions of sufficient severity…...
Health Information System
Promoting Action Design esearch to create value in healthcare through IT
ecently there has been varying proof showing that health IT reduces costs while improving the standard of care offered. The same factors that had caused delays in reaping benefits from IT investment made in other sectors (i.e. time consuming procedural change) are also very common within the healthcare sector. Due to the current transitive nature of the Healthcare sector, new IT investment is likely not going to provide maximum value unless this new investment is backed up with a total reform of healthcare delivery. The overall ability of healthcare IT value researchers to add value to practice will be severely limited as a result of the traditional ex-post approach to measuring IT and the fact that government spurs significant investment. It may be risky to generalize or compare results from traditional IT value research with those from healthcare…...
mlaReferences
Fichman, R., Kohli, R., & Krishnan, R. (2011). The role of information systems in healthcare: Current research and future trends. Information Systems Research, 22(3), 419-428.
Goh, J.M., Gao, G., & Agarwal, R. (n.d.). Evolving work routines: Adaptive routinization of information technology in healthcare. Information Systems Research, 22(3), 565-585.
Hoffnagel, E., Woods, D., & Leveson, N. (2006). Resilience engineering: Concepts and precepts. Abingdon: GBR: Ashgate Publishing.
Jones, S., Heaton, P., Riudin, R., & Schneider, E. (2012). Unraveling the IT productivity paradox lessons for health care. The New England Journal of Medicine, 366(24), 2243-2245.
Accountable Care Organizations (ACOs) like AdventHealth aim to improve healthcare quality by enhancing care coordination, reducing unnecessary spending, and focusing on preventative care. Metrics often used to evaluate their impact include patient satisfaction scores, hospital readmission rates, and the management of chronic conditions. ACOs are compared through benchmarks in these areas, cost savings, and quality of care improvements.
Determining the impact of AdventHealth ACO on healthcare quality and metrics requires a deep dive into several factors. Here's a breakdown of key aspects to consider:
Metrics used for evaluation:
1. Implement population health management strategies: Healthcare organizations can focus on preventive care, chronic disease management, and health education to improve the overall health of their patient population. This can include conducting regular screenings, providing access to healthy lifestyle programs, and offering targeted interventions for high-risk patients.
2. Utilize technology for patient engagement: Healthcare organizations can implement telemedicine, remote monitoring, and patient portals to enhance patient experiences and make healthcare more convenient and accessible. These tools can improve communication between patients and healthcare providers, reduce wait times, and increase satisfaction with the care received.
3. Collaborate with other providers and community organizations:....
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