HCMG 3113 - Unit 6 - Interactive Assessment

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LeTourneau University *

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3113

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Health Science

Date

Oct 30, 2023

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docx

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Unit 6 Interactive Assessment discuss the progression that has occurred in this relationship between cost and quality and where things should be post pandemic. Though there is much room to improve there has not been a lot of movement forward. In the future, we could utilize a combination of approaches to bring costs down and quality up. The reduction of excessively costly health care is a national priority. The quality of treatment and the outcomes for patients must be protected while exploring ways to reduce costs. When it comes to increases in expenses paid by the government and businesses, the public is considerably less worried about increases in expenditure than they are about increases in costs overall. There are around three in ten people who indicate that they are "very" worried about the increasing costs of public health insurance programs such as Medicare and Medicaid (34%) or the amount that businesses pay for the health care of their workers (31%). ( KFF Health Tracking Poll December 2022).  First, we should aim to provide payments to decision-making bodies (clinicians or healthcare organizations) based in part on quality measurements, both of which link reimbursements to indicators of service quality.  Second, the Centers for Medicare & Medicaid Services (CMS) should collaborate with commercial insurance to explore alternative healthcare financing models.  Third, it is crucial to invest in comparative efficiency research and utilize the findings to make value-based decisions on national standards and insurance benefits.  Fourth, we must facilitate access to pricing information and reference pricing for private payers. These two factors have the potential to reduce the range of prices and costs.  Fifth, there has to be research and development of standards by the medical community to monitor and measure service overuse. Showing differences between regions and waste healthcare resources. Although the opaque nature of healthcare prices has long been problematic, price transparency as a strategy to address rising healthcare costs is a relatively new development. The rising profile of price transparency reflects changes in the structure of private health insurance plans. We think that the data are hard to use right now for several reasons: It's not always clear what services the prices relate to, especially for episodes of care (for example, agreed rates for a treatment episode for a hip or knee replacement might match a per diem charge instead of the full episode). ( Ongoing Challenges with Hospital Price Transparency - Peterson-KFF Health System Tracker , 2023)  Data quality can be very different, with low and high agreed rates that are hard to believe.  There are important pieces of information missing that make it hard to figure out if price applies. In a free market, many buyers (consumers) and sellers (providers) act on their own, and patients can choose providers based on things like cost and quality of care. Contrary to what most people

think, the patient does not pay the bill. Instead, an MCO, Medicare, or Medicaid does. Prices are not just set by supply and demand because people outside of the market can mess with them. Shi, L., Singh, et. al., p.12. (2019). The potential value of price transparency was confirmed by an analysis of data on healthcare prices published in 2013. As part of the Affordable Care Act, a committee of the Institute of Medicine analyzed geographic variation in healthcare spending. The committee identified significant variations in the negotiated prices paid to physicians and healthcare organizations by commercial insurers nationwide. Glied and Kim (2022). This study spurred a series of such analyses, which showed that negotiated prices varied substantially, even within narrow geographic regions and often even for the same service provided in the same hospital. Moreover, prices were systematically higher in concentrated markets where a few health professionals had more negotiating power. This evidence of price variation suggested that reinforcing price- shopping behavior could potentially reduce overall health expenditures. It also meant that markets are not competitive unless the price is correlated with real differences in quality and alternative price-setting mechanisms should be established. References Glied, S., & Kim, G. (2022). Which price should be transparent and why? AMA Journal of Ethics , 24 (11), E1075-1082. https://doi.org/10.1001/amajethics.2022.1075 KFF Health Tracking Poll December 2022: The Public’s Health Care Priorities For The New Congress | KFF . (2022, December 20). KFF. https://www.kff.org/mental-health/poll- finding/kff-health-tracking-poll-december-2022/ Ongoing challenges with hospital price transparency - Peterson-KFF Health System Tracker . (2023, February 10). Peterson-KFF Health System Tracker. https://www.healthsystemtracker.org/brief/ongoing-challenges-with-hospital-price- transparency/ Shi, L., Singh, D. A., & Shi, L. (2019., p.12). In Essentials of the U.S. health care system . Burlington, MA: Jones & Bartlett Learning.

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