Jamie Ye Professor Treasurywala Mistry
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, …show more content…
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
In typical bundled payment models, providers and payers share in savings and/or losses. When actual health care costs fall below the lump-sum payment, both parties keep a portion of the difference as additional profit. Conversely, the provider must provide extra services at a loss when health care costs exceed the lump-sum payment, though payers mitigate some of this loss. The potential for savings for payers lies in upfront discounted payments for episodes of care, as well
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).
The focus of this paper will be geared toward the impact that the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and Health Information Technology have on the cost of health care. The regulations connected to HIPAA have an impact on cost through enforcement, noncompliance, and implementation. HIPAA is a vital tool in the protection of PHI of patients and the improvement of the Medicare and Medicaid programs (Cleverly). Trying to contribute to the improvement of Medicare alone can be a daunting and expensive task alone, but to add the addition of protecting the health records of millions of patients adds to the rising cost. Health Information Technology (HIT), aids in the enforcement of HIPAA and helps with billing patients accurately for services that they have received (Wizemann).
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.
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
Hospital and continuing to help increase patient flow and help increase their financial gain. Consequently, leading to higher medical cost for patients and insurance companies. The market of healthcare in the U.S is rapidly evolving and becoming more complex mostly due to the delivery of health care becoming corporatized by the help of IDSs and
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
Although the US is technologically advanced and has some of the highest caliber medical professionals in the world, compared to many other industrialized countries, it has one of the lowest outcomes in regards to quality of care. Moreover, it has some of the highest overall medical costs (Panning, 2014). In the US, low quality care and high costs have resulted in fragmentation of the healthcare delivery system. Fragmentation of services often results in patient experiences that are poor, with less than desired
Understanding the importance of provider reimbursement and the different methods of healthcare financing can be beneficial. This can aid in understanding which financing method provides the most benefits to providers. Healthcare providers along with healthcare organizations require funds to assist in the continuation and the revolving of healthcare services. References Casto, A. B., & Layman, E. (2006). Principles of healthcare reimbursement.
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
Perry Ashilevi, HADM 555, Fall 2016(Instructor: Scott Perryman) Reading Assignment #1: Modern Healthcare Article Topic: “Divided Over Bundled Payments” by Elizabeth Whitman, September 28, 2016. In the Modern Healthcare article “Divided Over Bundled Payments”, the author Elizabeth Whitman suggests that there is a separation between payers and providers as to the direction of bundled payment models. As a result of the passage of the Affordable Care Act in 2010, the author asserts that bundled payment is becoming more popular for value based payment in the healthcare industry.
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.
With this in mind, the process of getting treatment on such chronic diseases has led to increases on the cost of health care on individuals affected. Another factor that has led to the increase in cost of health care is the emerging of new procedures, drugs and technology that are coming up for treating diseases. When new procedures, drugs and technology are introduced to the health industry, there is usually monopoly of medical products in the market thus there being a demand for these products thus, an increase to the health care cost. One of the