Jamie Ye Professor Treasurywala Mistry
MGMT 165
9 December 2015 Forecast for the Future of Healthcare
The fate of healthcare in America was sealed when President Obama’s administration passed the Patient Protection and Affordable Care Act of 2010 (ACA). Since its passage as a law, acquisitions and merger activities have surged in the United States with health care systems responding to provisions in the laws for health organizations of community (Vitalari 14). Here is about the forecast of healthcare industry in the United States with relevance to insurers, consumers, providers, health professionals, and the healthcare system itself.
The law specifies and recompense for preventative health care. All American will have access to healthcare,
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Moreover, the act, in relevance to various Health and Human Services initiatives, such as the Blue Button, will encourage third parties to provide various add-on services, including secure storage of data solutions for personalized health records, APIs and platforms of health that facilitate personalized, mobile devices. Such mandates will probably stimulate innovation in bio-informatics and biometric as regulators aspire to cut Medicare costs via bundled payments and motivate protocolization by providers of care. Protocolization refers to the adoption of evidence-based, standardized and accepted treatment protocols. It is an inherent concept in the ACA and connected incentives for Accountable and Care Organizations (ACOs) and incentivized reimbursement plans in the post-ACA Medicare setting. The consequences of protocolization are reduced discretion for payers, patients and physicians in selecting treatment alternatives, but with increased control over outcomes of treatment and experience of cost. Bundled payment approaches, which embed protocolization, increase transparency into costs, value and outcomes experience for the patient and other parties, thereby improving decision-making of healthcare consumers in decisions regarding health option choices (Vitalari 15). The preference for specific health protocols and treatment options to others will affect the survival of pharmaceutical companies, and motivate improved research and development by such companies to compete. In turn, the quality of care will
Impact of CMS Regulations and Reimbursement Models The Health Care Industry HCM307-1802B-03 Unit 1- Individual Project 1 Michael Green May 22, 2018 Introduction Healing Hands Hospital is preparing financially for the many different reimbursement changes associated with Medicare Advantage Plans. My financial team and I, have been asked to evaluate our current billing and operations workflow processes and incorporate the current trends. We will be discussing how Medicare Advantage affects Healing Hands Hospital, and how we can utilize these trends to maximize patient care. Organizational Budget Reimbursement and financial trends will change go hand and hand.
The authors of this journal discuss the healthcare systems cutbacks and its impact on the population. Every few years the Ontario government and the Ontario Medical Association (OMA) negotiate their contract called The Physician Services Agreement (PSA) The contract details how much physicians can bill for their services, as well as where health care funding should be invested in or where a cut back could be. In March of 2014, the contract had expired, which has led to negotiations for over the year. Over that year negotiations for the new PSA contract had many conflicts mostly due to the government’s goal try to end the province's deficit by 2017-2018.
Increasing costs all around the globe due to economic downfalls is making this issue even more challenging. It is vital that we have some focus on revenue, but we can’t lose focus on the costs of running a business. In health care this can be very challenging because of all the changes involved with the government, in laws regarding health care reform. “Understanding the total costs of services will allow the redeployment of resources which provide a higher payback, or will facilitate the elimination of those resources altogether.” (Hughes, 2011).
This rule adopts standards for eight electronic transactions and for code sets to be used in those transactions. It also contains requirements concerning the use of these standards by health plans, health care clearinghouses, and certain health care providers. The use of these standard transactions and code sets will improve the Medicare and Medicaid programs and other Federal health programs and private health programs, and the effectiveness and efficiency of the health care industry in general, by simplifying the administration of the system and enabling the efficient electronic transmission of certain health information. It implements some of the requirements of the Administrative Simplification subtitle of the Health Insurance.
In the Pioneer ACO pilot program, Medicare will give the ACO a population-based payment worth 50 percent of the estimated cost of care for the payees in the third year of the program if the costs are below the benchmark. Providers will only receive 50 percent of their typical payments in the form of fee-for-service reimbursement, and the ACO will determine what share of the population based payment each provider should receive (Shafrin,2011). The goal of both these project is basically to move towards more integrated care. Medicare put forward a proposal for health care agencies to participate in both the Medicare Shared Savings Program and the Pioneer Accountable Care Organization (ACO) pilot
Accountable care organization do not uses the transformational model. Instead, ACO’s are involved with the health outcomes of a certain population (Science Direct, 2014). ACOS treat many Medicare and Medicaid COMPARISON OF THE TRANSFORMATIONAL MODEL 4 recipients. They provide care and are given incentives and bonuses for the number patients they treat. ACO’ us the “fee for services” having the goal of providing care for patients yet avoiding unnecessary services (Science Direct, 2014).
“Healthcare Reform 101,” written by Rick Panning (2014), is a wonderful article that describes, in an easy-to-understand language, the Patient Protection and Affordable Care Act, signed into law March 23, 2010. The main goal of the Patient Protection and Affordable Care Act was to provide affordable, quality healthcare to Americans while simultaneously reducing some of the country’s economic problems. Two areas will be covered throughout this paper. The first section will include a summary of the major points and highlights of Panning’s (2014) article, including an introduction to the ACA, goals of the signed legislation, provided coverage, and downfalls of the current healthcare system. The second part will be comprised of a professional
The changes also make it a mandatory requirement for covers to have basic benefits. The basic benefits include maternity care, mental health care, and prescription drugs coverage. The house speaker retorted in support “It is another positive step toward keeping our promise to repeal and replace
However, when compared with other health care systems in the developed world, the U.S. is one of the few countries that doesn’t provide its citizens with universal coverage while also being the most costly (Dalen et al., 2015; Hirsch & Lyman, 2014). The individual mandate combined with provisions within the ACA guide the U.S. health care system towards universal coverage. Universal health care provides security to all people and it is in the best interest of public health. Despite the popular arguments made against the mandate, it is evident that it is not just economical but also, is in line with American values. The mandate ensures equitable health insurance for all which protects the rights of the American people to have access to quality health
The effects can be made through claiming through managed care by the organization. The managed care for the delivery and principles of finances, the patients and physicians must follow the policies and procedure of the health plans. The drug benefits in a pharmacy can be reduced in costs from 40 % to 10% comparing to people who are members and the non-members. The reimbursement if any the mechanism should be used by the MCOs that are effective. The MCOs should make sure that as much as the cost is low the services should be of a quality to make the patient keep coming.
Healthcare in the United States is in desperate need of reform. There are several rationales to further explain this proposition. As an illustration, the Declaration of Independence states our unalienable rights: life, liberty and the pursuit of happiness. In other words, every individual should be entitled to healthcare as it preserves life and promotes the general welfare. The federal government should, therefore, enact a program of universal health to better protect and serve all of its citizens.
Chicago, Illinois: American Health Information Management Association. Retrieved from http://www.amcp.org/WorkArea/DownloadAsset.aspx?id=12724 Health Care Reform. (2014, January 1). Retrieved October 18, 2014. http://www.hca.wa.gov/hcr/Pages/default.aspx Indian Health Service
The Accountable Care Organization (ACO) is the most aggressive organization in place to improve health care services and financially rewards their ACO members. The Accountable Care Organization has major emerging opportunities for cost reduction in health services. The ACO is continuously searching for methods to diminish the cost of medicinal services. Providing high quality care with a lower cost can increase their member’s quality of life and reduce the probability of their members utilizing health services. ACOs are working towards cutting health care expenses and increasing the quality of patient care in most organizations.
This is a major positive effect on health and nutrition services. Registered Dietitians will now be reimbursed by Medicare when working with primary care providers for primary prevention steps and treating risk factors of cardiovascular disease and obesity.3 A major provision that the act provides is that it requires that the majority of U.S citizens have health insurance. Additionally, the Medicaid program expands to the nation’s poor and private insurances cannot deny anyone coverage who has prior conditions or diseases.4 According to Dalen, et al., since the law became an act, “Americans without health insurance decreased from “18% in 2013 to 13% in 2014”.5 Young adults now have the option to have coverage available until the age of 26 which reduces the worry of graduating and not having insurance
Health care cost has seen to increase gradually as years go by. This has been influenced by major factors such as political influence, emerging chronic diseases, new procedures that are coming up including the technologies being invented for treating illnesses, pricing of medicines and treatment is not regulated and when treating ailment their may arise repetition of tests or a patient gets over treated for a particular ailment. The cost of healthcare has increased due to chronic diseases such as cancer and diabetes etc. The lifestyle people are living in this generation has led to the development of diseases that are expensive to treat or has led to there being over treatment in such for a cure of a particular ailment.