Comprehensive Care Payment Innovation Act Case Study

The Arkansas Health Care Payment Improvement Initiative (“AHCPII”) is one part of the health care innovations the state has implemented with the aim of “increas[ing] health care quality and reducing the costs of care.” The AHCPII’s intent is to shift Arkansas’s payment system from “one that primarily rewards service volume to one that rewards desired outcomes, particularly with respect to quality and affordability.” Applying to Medicaid, Medicare, and private payers, payment innovation will move away from fee-for-service health care (where quantity all too often trumps quality) to pay for quality. In doing so, the hope is that Arkansas will gain a “new, sustainable model of financing” with the help of a multi-payer leadership and support.

A mixed payment system combined with physician monitoring, will provide physicians with incentives to consider costs and benefits of different treatment options, which will lead to an efficient level and quality of care. (1,2)

The care delivery enterprise must be re-tooled so that it functions in a fee-for-value reimbursement environment as is has in a fee-for-service reimbursement environment. The Centers for Medicare and Medicaid Services (CMS) is leading the

According to Sebelius, (2013) article, Affordable Care Act Incudes steps to improve the quality of health care and lower cost for you and the nation as a whole. This means avoiding costly mistakes and readmissions, keeping patients’ healthy, rewarding quality instead quantity, and creating the health information technology infrastructure that enables new payment of models to work. North Carolina foundation for Advance Health Programs is a model to create and maintain a centralized tracking system to monitor and disseminate new model of payments and delivery of reimbursements. This

The advantage of VBPS program is that it promotes and reimburses for all treatments that are planned to help to bring better health outcomes for Medicare patients. This program also plays a part in reducing the rate of unnecessary tests and referrals that are unrelated to treating of patients’ conditions. The program gives incentive rewards to healthcare facilities that are successful in reporting the high quality of cares and better patients’ health outcomes. It also serves as supports and guidelines for healthcare facilities to build needed infrastructures to improve their quality of services (Minemyer, 2016).

Another provision that the ACA provided was creating the Center for Medicare & Medicaid Innovations within the Centers for Medicare & Medicaid Services (CMS) in order to test new payment and service delivery models designed to reduce costs and increase quality of care to those that receive these benefits.² In this briefing, information about this organization, including financing and delivery, and the impact of the ACA on the Medicaid Program and the

Hospital reimbursement: Outline the significant components that make up the CMS IPPS (inpatient prospective payment system).

The aim of this paper is to provide a brief description of the bundle payment initiative will be addressed in relationship to the Affordable Care Act (ACA). Additional focuses will be placed on comparisons of the bundle strategy with traditional Medicare fee-for-service (FFS) payments. The purpose of the analysis is to implement and design a bundle payment program for community acquired pneumonia (CAP) patients utilizing the bundle program. The analysis will address health care providers and service vendors needed to successfully implement the program. Additionally, AONE nurse executive competencies will be discussed in relation to skills needed by nurse leaders in collaboration with the programs implementation.

With the law, hospitals have the opportunity to receive increased Medicare payments as long as they increase patient education about care after hospital discharge, provide patients with community healthcare resources, and increase discharge instructions for patients suffering from heart failure (Burton, 2012). The Centers for Medicare and Medicaid Services (CMS) has threatened to reduce hospital payments to one percent if the patient readmission rates of “heart failure, pneumonia, and myocardial infarction” increase past a certain limit (Burton, 2012). State Medicaid agencies will grant providers reimbursement if “comprehensive transitional care” is provided to patients (Burton, 2012). The law also offered $200 million towards projects aimed at increasing the number of advanced practicing nurses in areas including: chronic care, preventive care and primary care (Burton, 2012). Preventive care will allow nurses to reduce the rates of high acuity patients in their hospitals. If the PPACA fails to improve care transitions, the CMS plans to carry out other policies. These policies

The CIN infrastructure serves as FCHA’s collaboration vehicle for improving care and delivering value, as well as positions the organization to enter into accountable care organization (ACO) contractual arrangements. The FCHA ACO, which fosters greater collaboration by using a value-based compensation model to reward providers for improved outcomes and reduced costs, was selected to participate in the Centers for Medicare & Medicaid Services (CMS) Medicare Shared Savings Program (MSSP) to share in cost savings they achieve for Medicare

Background In 2012, the Center for Medicare and Medicaid Services (CMS) began to change the way hospitals were reimbursed for their services. This change would base reimbursement on the delivery of higher quality services. This new type of payment program meant hospitals would be rewarded for positive outcomes and be penalized for poor outcomes.

“Attention should be given to assessing the impact of new methods of organizing the delivery of health care services, adoption of electronic information systems, and health reform provisions that will test and reward health care organizations that are accountable for achieving better outcomes, higher quality, and lower costs” (Davis, 2012). Only collaboration between payers and physicians, with a focus on improving the health outcomes of patients will bend the projected cost curve set forth.

I enjoyed reading your post. The Center for Medicare and Medicaid Services (CMS) establishment of Hospital Value-Based Purchasing (VBP) Program related to acute care inpatient reimbursement and quality of care has definitely made a drastic change in many health care organizations for better. According to the U.S. Department of Health and Human Services, (2012), the major factors leading United States health care system is quality and performance improvement and it mirror the National Quality Strategic three aims, which are “Better Care, Healthy People/ Healthy Communities and Affordable Care”.

The health system in the United States is “broken” in a sense of providing all Americans with healthcare insurance. The system is very complex and fragmented which can be contributed to the lack of one governing body. Health care policy is largely driven by financing, insurance mechanisms, Medicare and Medicaid (Williams & Torrens, 2008). The understand complexity of the system can explain why there is not an “easy solution” of the current state of the healthcare system. Health care has evolved from a quantity to quality based system. Providers are being held accountable for the quality of services offered to patients to improve patient outcomes and decrease health care costs. The revised payment model requires providers and facilities to

OCS is facing external pressure to improve patient services. These forces come from a variety of sources, but payers such as Medicare and Medicaid are providing some of the greatest pressure. The U.S. spends more on health per capita than any other industrialized nation, yet continues to have worse outcomes than most comparable countries (Davis, Stremikis & Schoen, 2014). This realization has been the force behind public health policy change where the Centers for Medicare and Medicaid Services (CMS) is moving towards payment based on outcomes and quality rather than volume. The intention is that providers are rewarded for better outcomes and the result will be lower costs. This effort is demonstrated in the Accountable Care