Health Care Policy Analysis

Rising health care costs became an issue after the Medicare and Medicaid programs were formed in 1965 and have continued to be a factor in the United States economy since then. “By1970, U.S. government expenditures for health care services and supplies had grown by 140%, from $7.9 billion to $18.9 billion.”() By the 1990s the annual increase in the government health care expenditures was finally brought under control and has fluctuated between a 5% and 8% increase each year since then. This essay will discuss the different factors contributing to the rising costs of health care in the United States, as well as how the cost of health care affects the accessibility and quality of medical care throughout American history.

The Patient Protection and Affordable Care Act (ACA) has created new forms of care organizations in order to provide better healthcare to Medicare and Medicaid patients at a greater value. The two types of organizations that this paper will focus on are Accountable Care Organizations (ACO’s) and Coordinated Care Organizations (CCO’s). There has been much information gathered regarding the similarities and differences between these organizations. This research has been conducted to better understand the way that ACO’s and CCO’s effect the hospitals, physicians, insurance providers, and patients involved in their implementation.

Given the circumstances in which we find the American health care payment system, it is important to consider the potential impact of improved health care coverage on health care access. Costs could be improved by taking a deeper look into how hospital and providers are impacted. For instance, government medical coverage such as Medicaid or Medicare give American access to the health care system that they could not have otherwise. Coverage is decent in most cases and

Globally, the United States has one of the largest and most convoluted healthcare systems, whereas universal healthcare coverage seems extremely farfetched. Annually, the US spends over $3 trillion on healthcare. Nevertheless, we have the worst health outcomes when compared to other industrialized countries. As stated by Anja Rudiger (2008), “Recent data suggest that around 101,000 deaths a year can be attributed to the underperformance of the US healthcare system.” Thus, the United States’ healthcare system greatly relies on revenue. Both funding and the distribution of services are commercially structured and held accountable by investors to increase financial gains. According to Andrew Jameton and Jessica Pierce (1997), “the US healthcare system increasing appears to have

Healthcare is often driven by consumers and insurance companies; there is strong pushes for insurance companies to start paying better through Patient Care Medical Homes (PCMH) or Accountable Care Organizations (ACO) rather than paying at a per-visit basis (Hamlin, 2015). With PCMH or ACOs payment is made on a continuum of care, encouraging the provider to be involved in all aspects affecting health of the patient (Derksen, & Whelan,

America spends 2.5 times more on healthcare than most developed countries yet still ranking 51st in life expectancy in the world (Baum, 2015). The Affordable Care Act (ACA) was implemented January 1, 2014 by President Obama to expand coverage to millions of individuals in need. It consists of two separate pieces of legislation: the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (Centers for Medicaid and Medicaid Services, 2016). Although the ACA will give health benefits to millions of uninsured Americans, hospitals are receiving less compensation because of the high demand of health care from over qualified recipients. Through the Children’s Health Insurance Program and also the Social Security Act, states are able to pilot a test approach that could extend coverage up to 200 percent of the poverty line (Sommers, Kenney, & Epstein, 2015). Such a large increase in the size of the population that is now eligible to apply for the ACA comes with a sizable amount of fiscal responsibility from the states and puts an immense strain on the amount of money guaranteed to pay for the services provided (Sonier et al., 2013). Given the lack of funding from the Medicaid program, absence of reimbursement strategies, and budget of healthcare in America’s Gross Domestic Product (GDP),

The U.S government spends about 17% of GDP on healthcare industry which is enormously high as compared to any other industrialized nation. President Obama

The goal of the initiative is to increase efficiency of care, improve quality of care, and lower costs. This initiative consists of four different bundled payment models. The first three bundled payment models are retrospective payment arrangements based on patients’ historical data. However, the fourth model is proposed for the future. Centers for Medicare & Medicaid Services (CMS) make a single bundled payment to the hospital for all services during inpatient stays for hospitals, physicians, and other medical professional specialists.

The passage of the Affordable Care Act (ACA) has prompted policy makers and healthcare providers to review the current system of providing services to individuals and families. The previous system of providing healthcare services was impaired by inefficient systems that had elevated costs, waste of resources, and in some cases obstructions that prohibited individuals and families in seeking care in a timely manner. The goals of the ACA is to improve the health of the nation, increase quality of healthcare services, and reduce costs of the overall system while providing health insurance options to all people across the country. The health insurance exchanges provide options for all Americans to gain access to health insurance options, but

For anyone who has kept up with the news, the US healthcare system has undergone major changes in recent years. Insurance providers are no longer able to deny someone coverage based on pre-existing conditions. The advent of healthcare marketplaces has changed the way people purchase health insurance. Children can stay on their parents' health insurance plans until 26. Leading the healthcare revolution is InnovaCare Health. This organization is a leading provider of Medicaid and Medicare Advantage plans. InnovaCare Health recently announced it would partner with the Health Care Payment Learning and Action Network. This is a significant private-public partnership that seeks to change compensation models to reflect the quality of care instead of quantity. This new partnership reflects InnovaCare Health's to affect change in compensation sooner rather than later. The current healthcare model focuses on reimbursing physicians based on the number of patients seen or procedures performed. This encourages "treadmill medicine," or a model that focuses on rapid turnover. This can often lead to detrimental effects on patient health. The new quality model would reward physicians based on practice targets. Potential goals include HbA1c goals for patients with diabetes, the percentage of patients who smoke, and hospital stay after surgical procedures.

Healthcare spending growth rate trends show astounding estimates. Since 1960, spending has risen from $27 billion ($143 per capita, 5.1% pf GDP) to amazing $1,678.9 billion ($5,670 per capita, 15.3% of GDP, 2003 data) (HHS, 2005). Recent research estimated that by 2013, healthcare spending will be as high as 18.4% of the Growth Domestic Product. It is important to note that the gradual move from hospital to ambulatory setting has resulted in much higher spending on outpatient hospital services and prescription drugs. The spending growth for these two trends is much higher than the overall healthcare cost growth, which, in fact, increases faster than such important economic indicators as GDP growth, inflation growth, and population growth rates.

The state of California is active in the payment and delivery system reform. Of the 38 million residents in California, more than 15 million receive care through delegated arrangements with provider organizations in the commercial market, or through Medi-Cal (California’s Medicaid program), Healthy Families (California’s implementation of Children’s Health Insurance Program (CHIP)), and Medicare Advantage plans (California Health Care Almanac, 2015). For the past decade, California’s reimbursement has been through shared risk pool, pay-for-performance quality incentive programs, and full and partial capitation (Pegany & Connolly, 2014). Pegany & Connolly (2014) state that under the Accountable Care Collaborative (ACO) programs, providers and hospitals don’t want assume additional risk, and reward does not outweigh the risk and investments costs. To increase the potential and impact of ACA reform, California policymakers should take advantage of the ACA delivery and payment reforms, and do so will require careful attention.

The Medicare Access and CHI (Children's Health Insurance Program) Reauthorization Act (MACRA) was established in 2015. This act confirms policies for physicians and other clinicians to improve the payments through the modifications of quality measurement and Medicare incorporates. These policies within the health care system would unify and promote a greater value towards the Quality Payment Program, which would develop new guidelines to address the Alternative Payment Models (APMs). The MACRA has arisen for the advancements of coordinated framework towards healthcare providers and their organization as they strive to intend on succeeding in the CMS Quality Payment. I think the improvements towards the MACRA puts an increased focus on the quality

Everyone is entitled to get the universal health coverage insurance. According to World Health Organization constitution (1948), all individuals have the right to health care. However, when it comes to UHI, the government will consider the most vulnerable persons without imposing any restrictions. These are people living below the poverty levels and can barely afford treatment costs. Equity in the healthcare program will be paramount and the country will track the records of health care access based on different factors such as sex, income level, residence, immigration status, and age.

The center set ought to concentrate on patient experience and engagement, results identified with consideration coordination like readmissions, measures of vital well-being confusions, and actions of the populace and preventive wellbeing Situated to a limited extent on the change model confirmed by Massachusetts in 2006, this government arrangement. Endeavor extends access to scope utilizing four mechanisms: an individual. Medicaid qualification; reconfiguring of business. Wellbeing protection market controls; and setting up, state- based medical coverage trades (Exchange) that are scheduled to open for business by 2014. We condensed the Patient Protection and Affordable Care Act of 2010 (PPACA) and inspected four cost regulation and quality-change instruments mechanisms with Medicare installment strategy that will be actualized by this as of late passed law. The PPACA will grow human services scope and advance packaged payment frameworks, responsible consideration associations, and the patient-focused therapeutic home as the vehicles for containing cost and enhancing social insurance quality. The enactment will likewise build up a free commission to order cost-regulation approach, which may have critical ramifications as far as doctor repayment. In spite of the fact that the late