How The Behavioral Health Redesign?

First implemented in 1985 by Aetna (previously U.S. Healthcare), P4P programs were used to reward top performers and improve outcomes (Bruno, 2012). The incentives were meant to improve the quality of patient care by basing incentives on patient outcomes. Conversely, fee-for-service reimbursements are based on the treatments and set limits on the amount reimbursed for services. Because of these limits, incentives for use of pharmaceuticals and non-invasive procedures can impact how physicians practice.

Partners HealthCare is a non-profit, health system located in Boston that created a data based transformation (Davenport, 2013). It integrated a new system that aligned the participating organizations to cohesively run as one and to help shape the future of the organization. The system didn’t stop there as it was responsible for bettering the patient financing experience and the delivery of healthcare information to other organizations (Davenport, 2013). The initial goal of the organization was making patient care more affordable and accountable by providing integrated, evidence based, patient-oriented care.

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 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.

Patient access to affordable health care is an ongoing issue in the United States. The first portion of the policy process involves three different stages, the formulation stage, legislative stage, and the implementation stage. Three main stages exist in the process to transform a topic into a policy (Morone, J. A., Litman, T. J., & Robins, L.S., 2008). Coupled with the implementation stage is an evaluation of all the stages to determine effectiveness and gather information for use in future public health care policy making. In the formulation stage, the ideas, concepts, and information steam from this process of policy making. The

To guarantee that its members receive appropriate, high level quality care in a cost-effective manner, each managed care organization (MCO) tailors its networks according to the characteristics of the providers, consumers, and competitors in a specific market. Other considerations for creating the network are the managed care organization's own goals for quality, accessibility, cost savings, and member satisfaction. Strategic planning for networks is a continuing process. In addition to an initial evaluation of its markets and goals, the managed care organization must periodically reevaluate its target markets and objectives. After reviewing the markets, then the organization must

The purpose of this paper is to discuss the implications of healthcare reform in the United States and specifically, Ohio. The impact of healthcare reform in Ohio will be discussed with distinct focus placed on positive and negative outcomes as well as the financial implications of the initiatives.

Medicaid coverage and financing augmented access to a variety of behavioral health services, including psychiatric care, counseling, prescription medications, inpatient treatment, case management and supportive housing. Medicaid expansion states have seen higher rates of healthcare utilization in terms of medication and services for the treatment of behavioral and mental health conditions, highlighted by studies that have shown that Medicaid expansion is associated with increases in Medicaid-covered prescriptions for and Medicaid spending on medications to treat opioid use disorder and opioid overdose (1). States that have expanded Medicaid through Section 1115 Waivers experienced coverage gains similar to the states that implemented traditional Medicaid expansions (1). In fact, Indiana made large gains in Medicaid enrollment and the uninsured rate reductions between 2013 and 2015 were higher than the average decrease among the expansion states (1).

For instance, patients will receive urgent hospital care and then will not be able to pay back their bills. Another policy affecting provider reimbursements is the change from volume-based care to value-based care. For instance, the Centers of Medicare and Medicaid (CMS) have mandatory reporting guidelines that all healthcare providers have to participate in. These reports were based off volume of care (fee-for service) for the past 9 years, but due to the high costs in healthcare, the CMS is changing over to a valued based care (pay-for

In the Oregon Experiment, researchers found that expansion of Medicaid services in Oregon to low income individuals resulted in a significant increase of diagnosing and treating diabetes, increase of preventative healthcare services, lowered depression rates, and drastically lowered out-of-pocket costs for catastrophic events (Baicker, Taubman, Allen, Bernstein, Gruber, Newhouse, Schneider, Wright, Zaslavesky, & Finkelstein, 2013). Although expanding Medicaid programs significantly increases the budgets at the state level, the overall benefits of providing adequate care and financial protection to low income residents outweigh the alternative of the previous health delivery

On Friday September 14th, 2017, I attended the Behavioral Health Integration Advisory Committee Meeting. The main purpose of this committee is to discuss Nebraska’s care plan on how to properly deal with behavioral health institutions and what policies should be implemented to behavioral health institutions in Nebraska. The selection of the committee is by election every 2 years. There are 14 voting members on the committee that are represented from all areas of behavioral health in Nebraska.

Revenue determination is an important tool for health care organizations because it allows for efficient management of payment systems. This paper will look at the different components that form the payment-determination bases of revenue determination. Moreover, the difference between specific and bundled service payments will be discussed. Lastly, the three ways health care providers control their revenue function will be highlighted.

Effective May 30, 2018, the Virginia General Assembly approved Medicaid Expansion as a part of the 2019-2020 budgets. Virginia’s Governor Northam signed this approval into law on June 7, 2018, and as a result, approximately 400,000 low-income adults now qualify for health insurance (Norris, 2018). The General Assembly vote ended a “long-running partisan stalemate” with some Republicans joining the Democrats in support (The Associated Press, 2018). The Kaiser Family Foundation reports that Virginia is the 33rd state to approve the Medicaid Expansion (The Associated Press, 2018).

Our healthcare system needs major restructuring. Major improvements needs to begin with "all health care organizations, professional groups, and private and public purchasers should adopt as their explicit purpose to continually reduce the burden of illness, injury, and disability, and to improve the health and functioning of the people of the United States", (Crossing the ……, 2001).

The positive outcomes that have resulted due to value base programs have caused the model to gain traction and ignite one of the largest changes in history in the health care marketplace. By linking reimbursements to service quality, insurers such as the Centers for Medicare and Medicaid Services have facilitated a massive leap forward in the performance of United States health care providers. This achievement is a considerable accomplishment in the face of an institution that has received reimbursement from insurers via a fee-for-service model during the last 75 years. Soon, valued based payment models will represent the norm as more insurers support initiatives such as shared savings program, integrated clinical care, and accountable care payment models.