American Health Alliance Failure

Coordinating Primary Care/Team Effort: “patient Centered Medical Home” Geisinger calls it “Personal Health Navigator” aims to help patients manage all the complexities of their care in one setting. Focus on putting patients/families at the center of care. Doctors, nurses, technicians and case managers (who coordinates it all). Constantly

Patient-Centered Medical Homes (PCMH) are growing in popularity as the right thing to do improve patient care. PCMH are growing in popularity, as there is early evidence of their effectiveness (Egge, M. 2012). The PCMH concept has been widely promoted as a way to enhance primary care and deliver better care to patients with chronic conditions. This model of care has stimulated the attention of payers, Medicaid policy makers, physicians, and patient advocates, as it has the potential to address several of the limitations of the current healthcare system (Wang, J. et al 2014). Currently, primary care in the United States is focused on acute and episodic illness, it inadvertently limits comprehensive, coordinated, preventive and chronic care (Bleser, W. et al 2014). The PCMH address these limitations through organizing patient care, emphasizing team work, and coordinating data tracking (Bleser, W. et al 2014). A PCMH and HMO have some similarities but are markedly different.

The fact that there are broad spectrums of services available within the Kaiser Permanente network makes it easier to coordinate patient care. For example the Northern California site has implemented programs that focus on five “imperatives of personal care”, which are: patients have to have a primary care doctor, they need to be able to see that physician, patients that call have a short telephone wait, patients should receive timely appointments and have a great care experience (Commonwealth fund June 2009). Care management definitely plays a crucial role in health care. When the patients needs are met and quality care is received the result is patient satisfaction and potentially cost saving for the organization. Patients not only have to deal with health issues, many experience challenges within their environment and certain limitations depending on socioeconomic status. Therefore , coordination of patient care is key to the success of any health care delivery system.

Berry, L., Rock, B., Houskamp, B., Brueggeman, J., & Tucker, L., (2013). Care coordination for patients with complex health profiles in inpatient and outpatient settings. Mayo Clinic Proceedings, 88(2), 184-94. Retrieved from http://search.proquest.com/docview/1312503895?accountid=34574

The Accountable Care Organization (ACO) are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high-quality care to their Medicare patients (McCarty, B., 2016). For example, Medicare Shared Savings Program was created by The Center for Medicare & Medicaid Services to monitor and establish that all ACO’s are meeting the quality performance benchmarks and reduce Medicare spending by certain percentages (H., 2017). The growth of ACO’s from 2011 to 2016 is astonishing, in 2011 there was 64 ACO’s and by 2016 they have risen to 838 in the U.S. (H., 2017).

How do ACOs work for patients? In the current health system, patients handle coordinating their care. For instance, a patient with breast cancer

While the Affordable Care Act has rapidly reduced the number of uninsured Americans, there are still millions of people living without health insurance. According to the Kaiser Family Foundation’s 2015 poll, 46% of Americans tried to get Marketplace coverage- such as independent insurance companies- but the cost was too expensive. Many uninsured citizens are a part of a “coverage gap” that doesn’t give an affordable option for healthcare. The population that is a part of the coverage gap would earn too much to qualify for Medicaid, yet not enough to qualify for a Marketplace monthly premium. By eliminating or reducing the coverage gap through the creation of policy changes, the number of uninsured Americans would decline. Additionally, only

The Affordable Care Act (ACA) was the first step that the United States takes in order to provide greater access to health care coverage, reduce health care spending rate, and improve the quality of service. Ever since the implantation of the ACA, millions of Americans were able to have access to health care coverage. However, the ACA fails to include the undocumented immigrants. Compared with other immigrant group in the United States, undocumented immigrants have lower rates of health insurance coverage. The studies shows that undocumented Latinos were less likely to check their health and they report that “blood pressure being check in the past 2 years and cholesterol checked in the past 5 years. There was 40% reported that reported receiving

The Accountable Care Collaborative is Health First Colorado’s program that is the primary resource to provide enhanced coordinated care. The three primary goals of the ACC program are to better health, improve the experience of both the providers and the ACC members, and to contain costs. The ACC connects primary care medical providers (PCMPs), the statewide data and analytics contractor (SDAC) and the Regional Care Collaborative Organizations

The American health care system has been victim to an escalation in the prices of health care services juxtaposed with inefficiency in delivery of care services. There has even been cases where State spending on the actual health care increased dramatically in the United States and one of the key components of curbing this problem which has been prevalent over the mass media and has been a major discussion among physicians is the advent of Accountable Care Organizations. Accountable Care Organizations (ACOs) is structured with the goal of trying to improve health care delivery and aid in the reduction of the overall cost of services (Weissert & Weissert, 2012). If there is insufficient coordination of high quality care delivery in the health care industry, this will have a negative impact on patient safety and diminish affordable care for patients. Hence, the development of ACOs is envisioned to be the savior of medical practices and can improve the overall fabric of the American society (Bresnick, 2013). ACOs serves as one of the answers for curbing the problem of high costs, low quality care and possible segmented delivery and as much as it serve as the major determinant for improvement in patient satisfaction, there are minor

The current health care sector is too costly and too fragmented with a lot of variation in care even with established evidence based guidelines. Providers lack the tools, support and information they need to offer the coordinated health management that can reduce cost and improve outcomes. Primary Care Physicians are constrained in their abilities to perform any proactive care that involves avoiding Hospital or ER visits, and influencing healthy lifestyles.

In the United States, our health care system is often characterized by communication failures. According to the American Nurses Association (2012), “Care coordination has been proposed as a solution to many of the seemingly intractable problems of American health care: high costs, uneven quality, and too frequent disappointing patient outcomes” (para. 14). Care coordination is a very important aspect in nursing roles and is extremely valuable because it can improve outcomes for everyone: patients, payers, and providers. Although it is obvious that the changes will improve patient care and general efficiency, applying changes in the general approach and everyday routines may be overwhelming. Luckily, there are resources available for those interested in taking a more coordinated approach to primary care practice (“Social Media’s leading Physician Voice,” 2012).

Dr. Robert Master, the founder of Commonwealth Care Alliance (CAA), had created the company with the vision to ‘bring high-quality and personalized care to people with complex medical and behavioral needs, resulting in improved health and better self-management of chronic illness, thereby reducing hospitalizations and institutionalizations.' Therefore, the main objective was to provide care outside the walls of hospitals and institutions to make it easier for the chronically ill and disabled to receive the attention they

The mission of the AHA is to “build healthier lives, free of cardiovascular diseases and stroke”. Their “2020” vision is to “improve the cardiovascular health of all Americans by 20 percent, and reduce deaths from cardiovascular diseases and

Managing the growth of allied health care sector in the United State. Healthcare delivery system changings are most effectual when they are cohesive and ensure real answerability from providers to patient to improve outcomes. With the expected increase in allied health staff in the healthcare organizations, the first need will be to ensure that the care provided to patients is not impacted in anyway. Hiring new allied health staff allows organization to provide to provide adequate care for patients, but it also increases the cost to provide care. This means that recovering the financial costs of care and minimizing the cost of care takes a higher priority. Evidence proposes that multiple methods to delivery system changes may be necessary bend the cost curve and improve care quality. For example, the efficiency of a single disease administration program may be limited for patients who have multiple chronic conditions and who require coordinated care from many