Identify And Explain The Importance Of Outcomes In Healthcare

Moreover, we see that some providers are focusing on what providers do and how they get reimbursed rather than what the patient needs, which is a focus that does not prioritize quality of care and therefore does not align with the Triple Aim framework. The problem presented regarding this matter is that the health care system lacks a patient-focused care of medical conditions that puts patients and their health needs first. For example, when we think of provider reimbursement, it is not in the patient’s best interest for the system to only have a simple fee-for-service structure. A structure like this one will only lead to an increase of health care expenses. Also, it fails to incentivize high-value service, which also does not align with the Triple Aim framework health care providers should go by. It is very crucial for the health care system in the United Stated to find a better balance between medical groups reimbursement and patients needs in order to reduce the risk of overutilization.

Over the course of our countries history, the delivery of our health care system has tried to meet the needs of our growing and changing population. However, we somehow seem to fall short in delivering our goals of providing quality, affordable and accessible healthcare to our citizens. The history of our delivery system will show we continuously changed the delivery of our system however never mange to control cost. If we can come up with efficient ways to cut cost, the delivery of quality care will follow.

The change to value based purchasing has bought many challenges to the healthcare industry. With the change to value-based purchasing for payments, it has changed how healthcare organization receive payment and delivery care. The advantage of have value based purchasing is that it improves the quality of care while reducing cost in an effort of aligning patient’s with the right provider and treatment plan (Minemyer, Jun 29, 2016). However, there are many disadvantages, such as it increases the patient volume as counteracting the reduction of procedure volume (Brown, B. & Crapo, 2016). Also it makes providers more responsible for care that is beyond the expected treatment of care needed (Minemyer, Jun 29, 2016). With quality measures tied

Through the history of health care, the standard of care changed from protecting our patient from injury and illness to a systemic entity to make money for insurance companies. Access to services and clinical outcomes are dependent on what health insurance providers will “pay” for in a clinical or community setting; as a result, patient safety, care and satisfaction has been negatively impacted.

There has been a challenge of rapidly rising costs in relation to qualify of outcomes. We have an insurance system that is costly and inadequate for those who really need it. We are faced with the high cost

There is a growing trend in the United States called pay-for-performance. Pay-for-performance is a system that is used where providers are compensated by payers for meeting certain pre-established measures for quality and efficiency (What is Pay-for-Performance, n.a.). We are going to be discussing what pay-for-performance is. There are different aspects of pay-for-performance which include; the effects of reimbursement by this approach, the impact cost reductions has on quality and efficiency of health care, the affects to the providers and patients, and the effects on the future of health care.

Health care economics involves making plenty of choices. Individuals, groups, businesses, and organizations choose how to use resources . Economics and health care are linked, because health care professionals apply economics in their everyday professional activities. They are able to do this through resource allocation. Any health care organization has to plan out how they will use their resources to their advantage. Health care economics are able to incorporate terms like cost, quality, and resources. In this paper, I will compare these terms as they relate to health care economics. In this paper, I will also explain how they

A major change is occurring in the healthcare system as the United States continues to move toward enhancing patient care quality and access while also decreasing cost. This significant transformation is driven by a variety of forces, including changes in managed care, a shift from pay for service to pay for quality, and ever-evolving client characteristics. This paper aims to discuss each of these factors and the ways in which they make this major transformation a difficult one for the nation to undergo.

The triad of cost, quality, and access has impacted the development of the Affordable Care Act on many levels. The Affordable Care Act aims to improve the quality of healthcare, while maintaining the cost of health care ("Quality of care," n.d.). Under the Affordable Care Act, there is more funding for each state to assist in treating people with chronic illness. The goal is for these patient populations to have high-quality services at an affordable cost (“Quality of care,” n.d.). To ensure that quality of care is provided, the Affordable Care Act requires quality measures to be met in order for organizations to receive reimbursement. Although the United States still needs improvement in providing high quality health care that is accessible

Congestive Heart Failure (CHF) patients and their consistent trending of hospital re-admissions continue to threaten quality care and patient quality of life. Considered a chronic condition, CHF is diagnosed in approximately 13% of patients 85 or older (Clarke, Shah & Sharma, 2011). Re-admissions have become so prevalent among the CHF populations, that Centers for Medicare has initiated a quality campaign and offers incentives when hospitals implement telemedicine programs and show reduction in CHF hospital admissions. In relation to CHF, Conway, Inglis, and Clark (2014) states that, “Telemedicine involves transmission of physiological data, such as weight, … from the measuring device to a central server via telephonic, satellite,

The Institute of Medicine released a report in 1999 titled To Err is Human: Building a Safer Health Care System concerning the number of medical error related deaths. The report states that between 44,000 and 98,000 medical error related deaths occur each year in hospitals across the country (Kohn, L. T., Corrigan, J., & Donaldson, M. S., 2000) In response to this report, the Institute of Medicine released Crossing the Quality Chasm: Health: A New Health Care System for the 21st Century that outlines six aims for the future of the healthcare system: safe, effective, patient-centered, timely, efficient, equitable (Institute of Medicine, 2001). These aims set to establish the quality of healthcare across the country. Quality is defined by the Institute of Medicine as ““the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge” (2001).

The fragmented and misaligned state of the U.S. health care system has become a catalyst for payment and delivery system reforms. Traditional fee-for service (FFS) payment structures incentivize high volume rather than high quality care, and lead to the suboptimal provision of medical services across the disjointed provider landscape. Despite various attempts to improve care delivery, health care costs continue to rise. The Accountable Care Organization (ACO) model seeks to reverse these trends by promoting a simultaneous restructure of the payment and delivery systems to incentivize higher quality, lower cost care.

In recent years, emphasis has been placed on improving the quality of health care services and the overall patient experience. Innovative measures are needed to meet these expectations, while also containing the rising costs of health care. The government has enacted new laws in attempts to provide incentives that base Medicare payments in part on quality. In fact, the Patient Protection and Affordable Care Act of 2010, requires the implementation of value-based purchasing (VBP), which bases Medicare reimbursement rates on the quality of care (Kennedy, Wetzel & Wright, 2013). Hospitals may experience a decrease in revenue initially, however, it is theorized that the increase of transparency and accountability will serve as an incentive for improvements in the overall quality of care provided in the United States.

The idea that the healthcare reimbursements should be linked to the quality outcomes and performance measures is central to the Patient Protection and Affordable Care Act. The legislation provides various reforms that either provide incentives to healthcare providers for better quality services and outcomes or reduce their payments if certain quality standards are unmet. This paper talks about the different reforms under PPACA, aimed at introducing payment variations based on quality of care such as, Hospital Value Based Purchasing (VBP) program, improvements to different quality reporting programs, payment adjustments for hospital acquired conditions (HAC), reduction of hospital readmission rates (HRRP), testing for

The goal of the HSCEC was to establish a reasonable, equitable, and transparent way to pay for uninsured care (Murray, 2009). This is achieved through fairness, as a politically independent agency, and equity, with all patients paying for their own care, not the care provided to other patients, along with a fair share of hospital cost, to include uncompensated care (Murray, 2009). Regulatory, this required all hospitals and payers to provide timely and accurate data to develop a payment methodology that is consistent with market-based principles and legislative intent (Murray, 2009). As a hybrid strategy, the state receives the benefits of both approaches, legislation that seeks to maximize equity for all, and market based approaches that maximize consumer sovereignty. By offering hospitals financial incentives, while allowing hospitals to be at financial risk for managing operating cost, the system can control cost, but not hospital profits. Payers and hospitals remain motivated to save money by lowering hospital costs, rather than shift those cost to other payers, ultimately leading to the successful achievement of long-term policy goals and the avoidance of major short term disruptions in the delivery system (Murray,