Health Care Proposal Paper

The Patients served in CCO’s are covered by Medicaid, and benefit greatly from CCO programs with an emphasis on preventive medicine, chronic illness management and person-centered care (Oregon Health Authority). The number of patients served by CCO’s are unlimited, and can rise based on the needs of the community. The time frame for the work of the CCO is also a part of the quality measures. Although there is no strict framework for implementation as with ACO’s, there is still an urgency to implement and grow these programs quickly, while also maintaining high quality standards and goals such as the Triple Aim - improve health, lower cost, better care (Providence CCO Case

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,

The administration of the United States is incompetent and is growing more useless, this is stated when a compare and contrast between the United States, who does not have universal healthcare, and Canada, who does have universal health care. Canada’s healthcare is not too far from the United States but it does vary with certain things. One of these key things is cost, and administration. (Woolhandler, Himmelstein. 1991) The cost of health care within the United States has enlarged, Canada’s spending has waned. Canada funds the hospitals and doctors with one payer (one lump sum) while The United States hospitals bills several different insurances (per-patient policy) who vary with policies, qualifications, and certification. Doing this causes a complex accounting scheme for acquiring payment and further charging insurance and patients. Another reason the administration of healthcare in the United States is incompetent is due to private insurance, because, the owner profits a percentage of premiums that is much larger that the federal government.

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).

The Medicare Shared Savings Program was established by section 3022 of the Affordable Care Act and aims to improve beneficiary outcomes and increase the value of care by providing better care for individuals, better health for populations, and lowering growth in expenditures (Lieberman, & Bertko, 2011). The Affordable Care Act created ACOs, which is part of Medicare since January 2012, together with a Shared Savings Program it has the potential to lower costs, improve the quality of care, facilitate delivery system reform, and promote innovation in health care ( Lieberman, & Bertko, 2011).

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 accountable care organization I researched is called the Physician Organization of Michigan ACO (POM ACO). The POM ACO is a joint venture of the U-M Health System and physician groups around the state, with the aim of improving care for 81,000 Michiganders enrolled in traditional Medicare and slowing the growth of health care costs, according to the announcement by the U-M Health System (Daly, 2013). The group was launched on January 1, 2013 under the Medicare Shared Savings Program. 12 physician organizations from around Michigan came together to take part in a Medicare-sponsored program that strives to improve on the quality of care for traditional Medicare recipients, while also containing cost growth. In 2014, POM ACO expanded to include all the University of Michigan faculty physicians and thousands of other providers from the University of Michigan Health System. The POM ACO is now one of the largest accountable care organizations nationwide. More than 5,700 physicians and other providers are now involved in the POM ACO. Therefore, the POM ACO is organized as a physician-hospital organization. Hence, the patient has more flexibility in where and how their care is delivered. The patient can still use any doctor or hospital that accepts Medicare at any time.

In recent years, health care has been a huge topic in public debates, legislations, and even in deciding who will become the next president. There have been many acts, legislations, and debates on what the country has to do in regards to health care. According to University of Phoenix Read Me First HCS/235 (n.d.), “How health care is financed influences access to health care, how health care is delivered, the quality of health care provided, and its cost”.

In today’s seemingly ever-changing world of healthcare regulation, medical professionals are burdened with many compliance requirements. On October 14, 2016, the Department of Health and Human Services released its final rule implementing the Quality Payment Program as part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Starting January 1, 2017, clinicians who are reimbursed by the Centers for Medicare and Medicaid Services(CMS) are required to participate in the Quality Payment Program (QPP). (Centers for Medicare & Medicaid Services, 2016) The QPP replaced the Sustainable Growth Rate formula with the new payment structure in which clinicians are rewarded for delivering high quality care. There are now two pathways for

One of the issues that is widely discussed and debated concerning the United States economy is the healthcare system. Unlike in the majority of developed and developing countries, the healthcare system in the United States is not public, meaning that the state does not provide free or cheap healthcare services. This paper addresses many of the factors contributing to the rising cost of healthcare.

When Obamacare or the Affordable Care Act (ACA) was enacted, there was no question about its intention. Health care coverage for all, while improving the delivery of care and maintaining the high quality in the delivery of this care. Certainly, the main focus was to have insurance coverage that is affordable, available and without discrimination to all (Hart, 2012). In addition, incentives, provisions, benefits were all brought to the table for health care organizations to develop new care delivery systems. Included in its meaning, ACA empowers communities to initiate, establish and evaluate an inter-disciplinary model of care delivery. “By creating incentives for integrated care delivery models and paying for coordination and quality of care,

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

There is an ongoing debate regarding the potency of the new health care reform—Patient Protection and Affordable Care Act—from the outset of its proposal. Many attempts had been presented in the past years but the root of the issue remains prevalent today, that there is a lack of quality in its delivery and the cost of care is continuously increasing beyond national economic edges. In this manuscript, we will discuss several factors that can positively sway the long-term significance, impact, and structure of the United States health care system. Many are wondering whether the Universal Coverage, to which will give more control and

Marvelous work Dana, I greatly appreciate your contribution to this discussion. I would like to add on the Medicare Shared Savings Program (MSSP) you mentioned in the discussion. Since the passage of the ACA, there has been over 400 Medicare ACOs established throughout the U.S.; therefore, MSSP was created to incentivize the organization that ensures an efficient, valuable, and economical health care is delivered to Medicare beneficiaries. However, to ascertain the success and transparency of this program, participants like the Accountable Care Organizations’ (ACOs) activities were followed, not only by CMS, but by various researchers. Scholars studied the 338 ACOs’ legitimate web pages extracted from the CMS’ list that was started in 2014

US health care expenditures have been rising quickly over the past few years; it has risen more than the national financial system. Nonetheless a number of citizens in the US still lack appropriate health care. If the truth be told, health care expenditures are going to continue to increase; in addition numerous individuals will possibly have to make difficult choices pertaining to their health care. Our health system has grave problems that require reform, through reforming, there is optimism that there will be an increase in affordable health care and high-quality of care for America. Medicaid, Medicare and private sector insurances are all going through trials and tribulations because of