Importance Of Value Based Health Care Purchasing

External and internal influences are relevant in health care. These influences continue to affect the total operations of a health care facility. I will summarize the insights I have gained into the external influences of the new health care reform policy and quality initiatives. The recent health care reform legislation was passed in the house and senate this year. The senior vice president, that I have interviewed, states that health care reform is an “unknown” for organizations. In addition, I will research the quality improvement initiatives and how these external influences include implications for organizations and health care administrators.

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

Health insurance is important as it allows people to receive health care. However, health insurance providers are not equal, which result in an unequal quality of care. Private health insurance leads to an increase quality of health care. This is show in the article “A National and State Profile of Leading Health Problems and Health Care Quality for US

What’s next? Some experts say that if the consumer-directed approach doesn’t succeed, em wash their hands of health care altogether. A recent study by the Employee Benefit Researc showed that the proportion of U.S. residents covered by employment-based health benefits d percent in 2000 to 60 percent in 2004. Decades from now, observers may conclude that a counter- revolution in employer coverage began in these early years of the 21st century. —Terence F. Shea

Employers are continuing to face rising health benefit costs and are constantly looking for alternatives to control these escalating costs. Health benefit premiums continue to increase at a double digit pace for employers and employees (Poor, Ross & Tollen, 2004). This escalation is putting environmental pressures on all impacted stakeholders. Companies and insurance providers are squeezing this industry to get a handle on cost while still providing an appropriate level of care. This cycle puts the patient front and center as the ultimate stakeholder who incurs changes in health benefits. This mandate of cost control, efficient operations and market share has facilitated a constant analysis of the dynamic health

Employers should offer affordable( employee premium less than 9.5% of employee’s wages) and of minimum value( employers must pay at least 60% of insurance cost) healthcare benefits to their employees depending on factors like number of FTE, number of employees receiving premium tax credits and other complex measurements to calculate the amounts. Employers should also notify employees by written about State exchanges, and advise them that if an employee decides to purchase a health Plan through an exchange, they may lose the employers’

I have chosen the topic “Examine the financial characteristics of health care delivery along with managing costs, revenues, and human

“a) Contracts that explicitly detail the responsibilities of employers as purchasers with insurance, managed care, and hospitals and physician groups as suppliers, b) Information to support the management of purchasing activities, c) Quality management to drive continuous improvement in the process of healthcare purchasing and in the delivery of healthcare services, d) Incentives to encourage and reward consumers, and e) Education to assist employees become better healthcare consumers” (p. 352).

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.

The Centers for Medicare and Medicaid’s (CMS) Value-Based Purchasing program (VBP) was implemented in 2012. This program adjusts what CMS will pay hospitals based on the quality of care hospitals give patients. The value-based purchasing is a financial incentive for hospitals to get and maintain higher patient satisfaction scores.

The idea of consumer-directed care was mentioned by Krugman & Wells (2006) however, the authors stated that although there was a reduction in the amount of medical care used, there was no rational thought driving the patient’s decisions concerning good or bad care. While this may be true Giancola (2013), argued for the system to work properly employers involved in this type of health coverage must ensure employees selecting it are fully informed on the program and the responsibilities of using the program. While this may help with health care costs the employer would have to invest a substantial amount of time to ensure their employees

Patient satisfaction has been identified as a key determinant of quality care under the Centers for Medicare and Medicaid (CMS) value-based purchasing program. Hospital Consumer Assessment of Healthcare Providers and Systems (HCHAPS) is a publicly reported survey providing a national standard for collecting and reporting data. HCHAPS has become an important determinant for satisfaction of care received in hospitals. Frankfort Regional Medical Center (FRMC), a 170-bed tertiary care hospital located in central Kentucky, is acutely aware of the importance of maintaining high quality care reflected in patient satisfaction scores. In an effort to improve patient satisfaction scores related to nursing specific indicators, bedside reporting was introduced in 2012. Despite its introduction, HCHAPS scores showed no improvement. Harrington et al. (2013) established that nurses more often react to patient problems rather than focusing on preventing problems. Brosey and March (2014) proposed that “hourly nurse rounding is an effective method to improve patient satisfaction and clinical outcomes” (p.1). This paper would propose the implementation of a structured process of intentional rounding (IR) in an effort to improve patient satisfaction, patient safety, and quality of care.

Healthcare today is a very important issue. Lack of health insurance can affect the health and productivity of workers. Many people today do not have health insurance. Employment-based health insurance is in high demand to retain employees. The high healthcare costs make it hard for employers to offer employees quality health plans. The premiums for employers are increasing so they are forced to opt for cost-saving health insurance plans. Consumer-driven health plans are on the rise and have become an option for many employers.

One of the must have necessities of a human being is the provision of sound health care and every government, both national or local is obligated to offer this essential service to all the citizens without favor or any discrimination of any kind. Where else it is paramount that every employer to make sure the health and the safety of the employees are given the first priory. This will make sure the employees who are injured during the work are taken care of, and they are relieved the burden of the cost of health care. Thus, it is common to find most companies get the services of insurance companies and other organizations which provide health care programs for workers such as IndUShealth to make sure the welfare of the employees is in safe

The hospital reports data to several entities, there is Hospital Compare, Value-based Purchasing, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), and National Database of Nursing Quality Indicators (NDNQI), in addition to Press Ganey patient satisfaction surveys.