Decision Support Systems Assignment 3 Essay

The American Recovery and Reinvestmant Act, along with the Affordable Care Act, have mandated a change in the business of health care. Federal reimbursement is now based on prevention and patient outcomes. Our class web links to Centers for Medicare & Medicaid Services(CMS.gov) and Institute for Healthcare Improvement (ihi.org) have a wealth of information on how we are going to change our current health care delivery system. The president of Institute for Healthcare Improvement Pat Rutherford, has a video on how our system is going to change-It’s Art & Science. She explains that we need evidence based on research to provide the best medical care, and then customize care to each person’s values, preferences and needs. She explains that

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).

In the past few years the American health care system has changed in many ways. First there was the passage of the Affordable Care Act, which is a law that is giving Americans the opportunity to obtain health care. Under this new law, in 2011, the Department of Health and Human Services decided to create Accountable Care Organizations (ACO) to help doctors, hospitals and other providers better coordinate care (AthenaHealth.com). The first idea of an Accountable Care Organization was brought up in 2006 by Elliot Fisher, MD, and now there are over 400 in the United States (Healthcatalyst.com). An ACO’s primary job is to improve health care delivery, performance, and payment. This is done through physicians and

The health restructuring dispute has centered on compensating providers particularly more when delivering quality care to their patients than for enhancing the volume of services they provide (Ries, 2014) Accountable care organizations (ACOs) is a single proposed way of altering compensation methods to accomplish this objective by generating encouragement to enhance care coordination and clinical integration (Thygeson, Frosch, and Carman, 2014).

2007). While highly skilled, the majority of primary care and family practitioners have minimal training in identifying or treating psychiatric conditions and/or substance use disorders (Collins, 2010). The Presidents New Freedom Commission on Mental Health (2003) indicated mental health conditions and substance use disorders often go unscreened and thus untreated in a primary care setting. Currently, working as an administrator of a behavioral healthcare agency I am a daily witness to the impact delays in appropriate care cause. This is not only worrisome, it often leads to a need for a higher level of care and higher cost of treatment due the prevalence of untreated illnesses. Marrying behavioral healthcare services within a primary care setting has shown promising outcomes, affording for greater access to care for those suffering from psychosocial conditions, all the while cutting costs and providing greater proficiency in service delivery. (Mauer, 2002). As an administrator, the potential to implement and manage programs that not only provide greater access to care, but also cut cost is an exciting avenue to

I am aware that there is many components to this process and transitioning to this style of patient care may be quite challenging. The primary six guidelines to creating a successful ACO is only the groundwork or blueprint to base organizations on, which most hospitals are expected to adhere by whether they are part of an ACO or not. These six guidelines tie in two major aspects of an organizations financial profile in terms of market characteristics and competitive pressures. Some of

“Evidence combined with the growing recognition that physical, mental, substance abuse and social challenges are interrelated-has led to calls to integrate behavioral health care into primary care services.” (Klein & Hostetter, 2014, p. 9) Behavioral health and substance abuse treatment in the primary care office is rare and in some cases non-existent. This is mostly due to no or little financial incentive or administrative advantages to integrating these services within the primary care office. Dr. Roger Kathol, M.D. president of the Cartesian Solutions Inc., believes the biggest obstacle in integrating mental health and substance abuse treatment into the primary care office is low payment from payers. Payers use separate provider networks,

The first ACO model started January 1, 2012 and consisted of 32 ACOs with 860,000 beneficiaries (CMS, 2016). ACOs are made up of groups of hospital, doctors, and other health care providers who provide coordinated high quality care to their patients. The goal of this coordinated care is to ensure patients receive the appropriate care in a timely manner while avoiding unnecessary services and duplication of services. The expected end result is the delivery of high quality care and reduction of health care cost and the incentive for the health care provider to meet the goal is the share of the savings they will receive. As stated by Dr. Berwick, (Its (ACOs) purpose is to foster change in patient care so as to accelerate progress toward a three-part aim: better care for individuals, better health for populations, and slower growth in costs through improvements in care” (Berwick, 2011). The ACO providers are held responsible for meeting quality improvement measures while reducing their rate of spending.

ACOs can be classified into six categories based on the number and leadership structure of parties involved in the ACO, the services provided directly by the ACO, and the services provided through contracted entities (see Table 1). ACOs can range from an “Independent Physician Group” that only directly provides outpatient care, to a larger, “Full-Spectrum Integrated” ACO that directly provides all core medical services, from ambulatory to inpatient and to post-acute settings. Using this taxonomy to identify different ACO types can help providers learn from like-entities by distinguishing structural commonalities between different organizations, and by highlighting common approaches to managing patient care. Further research using this taxonomy can also help ACOs and researchers’ alike better understand performance to date of these different accountable care arrangements and the factors most critical for success.

There are three core principles to any ACOs. First, provider-led organizations with primary maintenance and a strong base are liable communally and total per capita costs for quality with full continuum for the population of care for patients. Second, excellent improvements will have linked to also have complete costs reduced, and third, progressively and reliable sophisticated measurement performance to improve, support, and provide the savings of confidence are achieved with improvements of care, , McClellan M, McKethan AN, Lewis JL, Roski J, Fisher ES (2010).

It is needed to analyze customer behavior and preference data. To generate the necessary data and understand customers’ preferences, Harrah’s had to mine the data.

Kaufman believed that health care organizations, should stay cleat of ACO’s and Medicare Shared Saving programs to ensure preparation. Even with the warning from Kaufman; using the ACO provisions of the ACA could be the way to avoid the down fall in the health care system. Shared Saving Program really stood out to me during my research. Even thought this program is currently used for Medicare patients, adjustments could be made to accommodate other health care plans on the market. This use of incentives could create better care for individuals, better health for the population, and lower growth in expenditures (CMS,2015). Lastly, usage of these types of incentives could create equality in health care across the board. The would allow each part of the health care system to come to an agreement and provided customize health care option for the consumer and reduce the amount of out of patient health care

I suggested it would be best if we could list down some conditions based off the symptoms the patient presented with, and for each of us split up into smaller groups to research them to see if they were relevant.

Caring for cancer patients can be very complex at times. According some, the availability of a range of health care providers hones poor communication and

This assignment is a little difficult for me. I cannot pick one thing that really stood out as interesting to me. I use and have developed many different databases and information systems both professionally and in my personal life. I would not say I am an expert but I previously had a good grasp on the basics. This being said I could say that I found some value in the Decision support system lesson. This is because it gave me a better understanding on how to develop and use these types of systems more effectively.