Reducing Healthcare Cost

Even though within the Managed care trends there have been many rapid transformations throughout the years with the HIPAA laws enforcements throughout health care facilities within the United States and Obamacare. Currently, there are challenges ahead with the healthcare reform due to the new presidency stirring up changes with health insurance and getting rid of Obamacare. Throughout the managed care trends chronic condition management have affected two-thirds of the baby boomer’s generation causing them to have chronic health conditions that them to receive medical treatment constantly with elevated health care cost. Next, a trend of having the options available for mobile health has grown tremendously by allowing many a chance to gain access

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.

Many chronic conditions can greatly affect an individual physically with some sort of chronic pain, mentally with depression, and socially by rendering them unable to work (Harris & Wallace, 2012). These effects can thus put strain on families and society as more individuals suffer from various chronic conditions. In recent years, many of those working as health care professionals, such as primary care providers (PCPs) are affected greatly by the widespread prevalence of chronic disease in the US. For PCPs, approximately 75% of their patients schedule visits for multiple chronic illnesses (Zamosky, 2013). This has caused a shift in health care to focus on tertiary prevention in limiting comorbidities and issues associated with chronic diseases. PCPs face challenges by having less time to treat chronic disease because they only having have approximately eighteen minutes to deal with on average seven issues for each patient (Zamosky, 2013). Since the Affordable Care Act (ACA) was implemented, insurance companies can no longer deny coverage or charge more for people with preexisting conditions which includes those with chronic diseases (ObamaCare Facts, n.d.). The ACA helps people with chronic illnesses to obtain insurance; however, since these people are insured

The United States healthcare system has undergone a wide variety of changes over the past few years. As the overall health of its citizens continues to deteriorate and people live longer, certain aspects of healthcare are costing an increasingly large portion of the healthcare budget. Problems such as obesity, diabetes, cancer, and substance abuse have become the most pressing issues facing healthcare providers today.

An aspect of Medicare and Medicaid that is important to look at is disease management because this affects budget and financial costs for both patient and government. Before we can look at the issue itself we need to be able to define what Disease Management is. According to Wikipedia.org (Wikipedia, 2008) disease management is “a system of coordinated health care interventions and communications for populations with conditions in which patient self-care efforts are significant. It is the process of reducing healthcare costs and/or improving quality of life for individuals by preventing or minimizing the effects of a disease, usually a chronic condition, through integrative care.” The Centers for Medicare and Medicaid (CMS) organized a study to determine if disease management programs helped reduce costs for long term care for chronic conditions. Approximately 300,000 Medicare participants took part in about 35 programs. The idea was to assist these Medicare patients with chronic illnesses such as COPD, severe heart conditions, cancer and other conditions between office visits to prevent hospitalizations. The goal was to reduce the costs that accumulate with hospital visits, help the patient to have a better quality of life and the program save money (American Journal Health Pharmacy, 2009). The program worked as follows: health care providers were supposed to work with patients in return for receiving a small fee from CMS. The

Decreasing healthcare “cost” has been repeatedly debated for decades now. Despite tremendous efforts to reduce cost, the US Healthcare System is still struggling to deliver an effective and affordable level of care. Not only the cost of healthcare is higher in the U.S., there is also much waste due to unnecessary laboratory, radiology & other investigations, unwanted hospitalizations, procedures, longer hospital stay, preventable emergency room visits, and a lot of medications waste, that costs the U.S. $750 billion annually according to IOM in 2012 (Glicksman E. , 2015).

For patients with chronic conditions, costs, even with insurance, can add up very quickly with numerous doctor’s visits, emergency room visits, and hospital admissions. The CDC (2016), states, “Treating people with chronic diseases accounts for 86% of the nation’s health care costs” (Center of Disease Control and Prevention, 2016). Despite the amount of time and money spent preventing and treating

Medicaid is a vital lifeline for some 72 million Americans. Two-thirds of all Medicaid spending supports senior citizens and persons with disabilities. Cutting Medicaid would jeopardize the quality of healthcare, long-term services, and nursing home care for tens of millions of Americans. There are significant cost issues in America’s healthcare system that must be effectively addressed, but these challenges will not be remedied by benefit cuts to vulnerable

It is no secret that the US healthcare has many issues in its system. Especially, when you compare it to other countries like: Great Britain, Japan, France, Canada etc. According to Sultz and Young states that “The United States ranks eighth behind all of these nations in life expectancy at birth, highest in infant mortality rate, and highest in the probability of people dying between the age of 15 and 60 years.” The US healthcare system has many issues like a large number of uninsured According to Sara R. Collins, Munira Gunja and Sophie Beutel in the 2014 census 33 million people were uninsured. Other issues are medical professional shortage, medical error or infection, people using apps to diagnose themselves, and rising cost of care. The main focus in these paper will be the rising of cost. The cost of current health care explains for most of the issues that is happening in this country.

Due to the passing of Obamacare, also known as The Affordable Care Act, American’s today are provided more access to healthcare than ever before. The Patient Protection and Affordable Care Act (ACA) was signed into law by President Barack Obama in March 2010 and signifies universal healthcare reform. This legislation includes provision in healthcare to extend coverage to millions of uninsured Americans. The ACA reform bill contains many other important changes as well, including, implemented measures to lower healthcare costs, improve system efficiency, eliminate coverage denial for pre-existing conditions, and increase coverage for children or dependents to age 26. What effect will this new law for healthcare reform have on hospitals, individuals, nurses, other healthcare providers, and on America? Throughout this paper the author will explore the changes and how our economy, political, and healthcare delivery system is affected.

Health care costs have become a major issue in the United States, both socially and politically. According to the U.S. Census Bureau, 50.7 million people, or nearly one in six U.S. residents, were uninsured in 2009 (Kaiser Health News, 2010).This is because the high cost of health care has driven the cost of insurance out of the reach of many Americans.

Unnecessary services are provided far too often because there is little coordination across sites or among providers, yet care management, cross disciplinary care, and preventive care are often uncovered or poorly reimbursed. Notably, 45% of the U.S. population have chronic conditions requiring care management. Of this population, 60 million, or roughly half of those with chronic conditions, have multiple conditions. Current care delivery systems are not designed to support the care of these complex patients, which requires multiple providers and services.

“The United States spends a larger share of its gross domestic product (GPD) on health care than any other major industrialized country” (Robert Wood Johnson Foundation, 2002). However, American’s health is not better than that of citizens of comparable countries. Health care in the U.S. is expensive for many reasons; newer technology, lack of standardized health plans, overuse of services, and highly paid medical professionals are a few. The identified concepts that would help reduce the cost of health care while improving population health. Changing the face of medicine in America from curative to preventative would reduce the cost of care in the long term. According to the CDC, the most expensive care is hospital care at 31% of the total health care expenditure. Therefore, creating better home health programs help to shorten hospital stays and reduce the risk of readmission for chronic illnesses or rehabilitation, which will lower overall cost of care. Continuing to promote coordinated care through evidence based medicine when treating and discharging patients from the hospital will reduce expensive hospital readmissions and lessen wasteful spending for double treatment or testing (The Commonwealth Fund). The U.S. Government has seen the need for change in order to reduce overall expenditure and provide health care to all citizens. Enaction of the ACA is an attempt to lift the burden of issues facing American healthcare. However, the ACA is not enough to fix the

With the increasing costs of managing chronic disease states, health care facilities are being driven to create disease management –specific programs for diabetes to improve the health of these individuals, prevent disease complications such as heart disease, macular degeneration, chronic kidney disease that can lead to kidney failure and reduce the cost related to hospitalizations and emergency room visits. A review of the available literature has shown that significant reductions in the use of health care service and expenditures have resulted for many patients enrolled in disease management

There are many issues that are causing changings in the healthcare system. Population aging, rapidly increasing costs of healthcare and the growing burden of chronic disease are challenges to health systems worldwide. To meet these challenges will require new approaches to healthcare delivery and comprehensive population health management. Many states are not prepared to tackle this issue yet. The US has the most expensive healthcare system in the world with health status indicators that are only average in comparison