Incentives Of Medicaid : A New Method Of Delivering And Paying For Medicaid

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.

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,

One of the states that have not participated in the Medicaid expansion is Florida. States that are opting out in the Medicaid expansion can leave several citizens uninsured and their health will be at risk. Currently, since the America’s Supreme Court has given the states more flexibility relating to the Affordable Care Act, some states are opting out of the Medicaid expansion plan that is intended to give low-income citizens in the state dependable healthcare. To reasons the state of Florida opting out the Medicaid expansion, the governor of Florida stated, that Floridians are more interested in economic growth and employment, better quality of education for their children, and that they keep the cost of their living low. Florida State is

The Affordable Care Act was put in place by President Obama in 2010, providing Americans access to affordable health insurance. But South Carolina’s governor, the republican Nikki Haley is still rejecting the Medicaid expansion. My paper has detailed information on why Governor Haley and republicans made their decision to opt out of the expansion. Also, alternate approaches to expanding access to care and implementing or reconsidering the state’s decision of opting out of the expansion. Finally, recommendations to the state legislature to convey opting out of Medicaid expansion.

Why is Medicaid a huge topic in Texas and how does it relate to me? This is one important question to consider. Well this paper will help shed light to the matter and illustrate the urgency for action. Just recently Texas had an option to extend Medicaid, but hastily denied. Medicaid Expansion was part of the Obama care reform in which the federal government gave the 52 states an offer to expand the current Medicaid in was that it would include the coverage of low income adults not only children. The latest on the issue is Texas had agreed on a deal but only temporarily. The agreement on the reform has given Texas some light, but not enough to reach through the other side of the tunnel. Eventually, Texas

Pioneering an Accountable Care Organization Model which is a program which goes hand in hand with the Medicaid Shared Savings Program. They are focused on providing highly coordinated care for Medicare fee-for-service-beneficiaries.

Providing enhanced access to a better quality health care system is reliant upon the identification and modification of various barriers, which must be addressed. Complex health care systems and politics generate barriers to the delivery of high-quality access to care through knowledge deficits. Consumers are tasked with understanding what services are needed as well as their abilities comprehend their diagnoses are challenged. They must also over come barriers to communication to converse effectively with caregivers. Most importantly, they must understand their role in the process as patients and citizens when accessing health care services. (Ricketts, 2013) Comprehensive provisions built into the ACA help to energize endeavors aimed towards developing ways to ensured enhancements to the quality and access to health care provided in North Carolina. Accountable care organizations (ACO) were

The costs associated with Medicaid have continued to increase over the years, consuming a larger amount of both federal and state budgets throughout the country. There are now worries about Medicaid eating up state budgets throughout several states. In Kaiser Health News, Rau (2013) reported that "health spending will rise faster than economic growth." With such a significant increase in Medicaid costs, there is the danger of notable shortfalls within the Medicaid spending at the state level. Without adequate reforms, the costs associated with Medicaid threaten to consume a larger portion of state budgets, which could sequentially affect other budget items. An increase in the number of enrollees, growth in provider payments, and an increase in healthcare costs are some of the main reasons for an increase in Medicaid costs. The intricacy of the Medicaid costs problem within the United States is made worse by a decrease in state funds.

The Medicaid revisions and expansion under the ACA, exhibited the federal government overstepping their power as they tried to penalize any state governments in opposition of the expansion, consequently, taking away states’ power. The Medicaid Expansion Mandate would’ve compelled states to join due to the loss of federal funding towards Medicaid if they did not adhere to (Phi Le, par.40). The Supreme Court hearing allowed states to have a choice whether or not to participate in the expansion without a total loss of their Medicaid funding. In return, states who didn't participate wouldn’t receive additional funding that coupled with this mandate that required inclusion, extending coverage of those who were at “Income below or ar 133% federal

Ozark Medical Center (OMC) in West Plains, Missouri is one of them. It is considered a Disproportionate Share Hospital or ‘DSH’ and provides charity care. As Jennifer Davidson describes it in her Health and Wealth Update story on KSMU, “Charity care is healthcare that isn’t paid for, usually because the patient doesn’t have money or insurance” (p.1). Today the DSH designated hospitals do not receive the same amount of federal funds (DSH payments) they did before the ACA from 2010 was enacted. A supreme court decision in 2012 ruled the forced Medicaid expansion, which was included in the ACA, unconstitutional for all states and as a result the expansion is now an option for the states. However, Jennifer Davidson explains that when the remaining parts of the ACA were passed, “it included a 75 percent cut in those DSH payments. That’s because another part – the Medicaid expansion part – was supposed to make up for that reduction. So: more people covered by Medicaid, less charity care – and less need for DSH payments” (p.1). There are also cuts in the ACA to Medicare payments, which in addition to the reduced DSH payments could affect a hospitals finances by a large percentage. In Jennifer Davidson’s story, Ozarks Medical Center’s CEO David Zechman explained that “OMC could see a 60% reduction in its bottom line if Medicaid doesn’t get expanded”. OMC is not the only small rural hospital in Missouri which sees

The Affordable Care Act (ACA) highlighted the importance Medicaid played in insuring every American receive healthcare coverage. (42 U.S.C., 2010) Medicaid provides health benefits to over 71 million across the country. While involvement is optional, all 50 states participate in the program and requirements differ across the nation. The flexibility given to each state has allowed them to make their own decisions to work towards improvements that they believe would best benefit their region (Feldstein, 2015, p. 125-126).

A payor source, Medicare or Medicaid Medicaid is available to people with low incomes. These also include people who have reached a certain age, blind, disabled, and families who have dependent children. Poverty alone does not necessarily qualify someone for Medicaid; a patient has to fit into one of the seven categories which include assets, age, pregnancy, disability, blindness, income and resources, and one's status as a U.S. citizen or a lawfully admitted immigrant. Medicaid pays for some or all of the recipient's needs. The problem is that there is difficulty in describing 'low income' and many people who do deserve it are not on it.

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

The CIN infrastructure serves as FCHA’s collaboration vehicle for improving care and delivering value, as well as positions the organization to enter into accountable care organization (ACO) contractual arrangements. The FCHA ACO, which fosters greater collaboration by using a value-based compensation model to reward providers for improved outcomes and reduced costs, was selected to participate in the Centers for Medicare & Medicaid Services (CMS) Medicare Shared Savings Program (MSSP) to share in cost savings they achieve for Medicare

Today I got a glimpse of how difficult it is to get approval from Medicaid for services that were absolutely necessary. This patient was seen in the ER the previous night and was sent to our office for possible obstruction of a ureter and kidney stones. With Medicaid, the family physician has to refer the patient out to specialists in order for the services to be paid for, but in this particular case, the patient was sent directly from the ER to us for immediate care. We called the family doctor and explained what was going on with this patient that way he could go on with his referral so that Medicaid would approve the visit and whatever procedure or surgery that she might need. Needless to say that he would not do the approval and insisted that