The Healthcare Delivery Landscape Is Dramatically Changing

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.

Impact to Healthcare organizations - These increases in cost raise questions of health care expenses at the hospital level. As higher profits are sought, the cost will become unstable for all, thus causing many to postpone going to the doctor. However, there are many complicated problems associated with our healthcare system. We will focus on main issues that can correct many related problems within the current structure. More importantly, we need to find ways to ensure all Americans have access to health care; and we need to hone in on how we can get the best value for the $2 trillion dollars we spend annually on healthcare.

The main economic challenge for the healthcare system in the United State will be the rising expenses associated with Medicare and Medicaid. The Governments share of healthcare spending is predicted to rise to 31 percent by the year 2020 (Keehan, Sisko, Truffer, Poisal, Cuckler, Madison, Lizonitz, and Smith, 2011). This may jeopardize the economic stability and financial security of the nation.

In the past several years, there have been several changes in economic policy at federal and state levels. The two economic policies that present to be the most precedent for healthcare leaders with concern to facility reimbursement are the Affordable Care Act (ACA) and the switch from volume to value reimbursement. First, there is the ACA policy, which have affected healthcare facilities and their reimbursement methods. In fact, ever since this policy was implemented, provider reimbursement has started to decrease in terms of fee-for-service payments (The Common-Wealth Fund, 2015). In other words, the intention of this policy was to provide budget relief to the government payers as well as giving providers an incentive to provider patients with great quality of care.

In a world of budget cut and layoffs, medical corporations face new and different challenges in addition to helping and healing patients. I used to work as a medical biller in a physician’s office for five years and I experienced how difficult for the health care providers to get reimbursed. The government and the insurance companies have been limiting the budget towards the health care services. This action also affects the hospitals greatly because Centers for Medicare & Medicaid Services (CMS) and some policymakers have requested the hospitals to reduce the

The increase of expenses - As politicians continue their dissension amongst each other, the situation is worsening in our healthcare system. According to the World Health Organization, to achieve universal health coverage, countries need a financial system that enables people access to all types of health services without incurring financial hardship (Carrin, Mathauer, Xu, & Evans, 2011). This idea would be the foundation of innovative ideas that the U.S. could reform its healthcare system, but too many ideas are sabotaging any valid efforts. In the mean time, the U.S. healthcare system continues to deal with issues such as the increasing uninsured Americans (over 49 million), expensive administrative procedures and the inability to measure the accuracy of quality of care, access of care, and the increasing healthcare spending and financing that limit our ability to efficient utilize resources.

The cost of healthcare has and will continue to rise in the United States. Some factors that contribute to those hikes are due to the consumer demanding more complex services from health care providers. Things such as new technology, equipment, research and testing procedures, along with pharmacy, and the number of uninsured are all dynamics of the increased cost in health care. The U.S. health care system relies heavily on third-party payers; these payers include commercial insurers and the Federal and state governments. According to the Centers for Medicare and Medicaid Services, or CMS, the National Health Expenditure grew 3.6% to $2.9 trillion in 2013, or $9,255 per person, and accounted for 17.4% of Gross Domestic Product (GDP). Id.

Another factor that has contributed to the over-utilization and increased treatment charges is the fact that providers set the prices for services. Patients were free to seek any type of healthcare services that they thought they required for their well-being, while providers set the costs for each service that was billed to indemnity insurance companies (Shi & Singh, 2015). Insurance companies had little control on the types of services that the patient received and prices billed for each service. The fee-for-service model encourages excessive and unwarranted procedures and offers no incentives to utilize economical services

One element of an external environmental assessment is the complicated, dynamic process of a competitor analysis. The new paradigm of healthcare delivery makes it necessary for organizations to think about their competitive edge, something that healthcare administrators did not have to think about in the past. Ginter, Duncan, and Swayne (2013) identify the essential elements of a service area competitor analysis: establishing the categories of service; determine the service area, the geographical boundaries; and identification and analysis of weaknesses and strengths of those vying for the same market share (p. 78). Today’s healthcare leaders need to think beyond the facilities that are most close, owing to the fact that consumers of care are willing to move past their neighborhoods to centers of excellence that deliver the highest quality care. Leaders also need to consider service providers that are dissimilar in structure. These ventures are new to the healthcare market, offering one profitable, specialized service. Market niches should not be overlooked or underestimated because they are likely contenders (Ginter et al. p. 80). This paper offers a competitive analysis for detoxification, the first level of treatment for substance use disorders (SUDs). There is a discussion of the service category and service area of one treatment offered in a freestanding psychiatric facility in metro Boston, Massachusetts, and ends with a discussion on how the

Background: The Federal Agency for Healthcare Research and Quality (AHRQ) identified five goals for adopting health information technology (HIT) into the current health care systems that would significantly improve healthcare in America. (Abdelhak, Grostick, & Hanken, 2012, p. 82) These goals will help improve the quality of care within the federal health system by reducing medical errors, cost, and duplication of workload.

People living with HIV and AIDS have always had a difficult time obtaining access to health coverage (Sorian, 2010). Medicaid, Medicare, and the Ryan White HIV/AIDS Program have provided a critical safety net (Sorian, 2010). But today, nearly 30% of people living with HIV do not have any health insurance coverage, and many others have limited coverage (Sorian, 2010). In addition, people living with HIV and AIDS have faced hurdles to getting quality care from qualified providers (Sorian, 2010).

Today, health care issues within the United States are still a major concern in regards to where people of our communities do not always agree with what is being done and what is not being done. The three major issues with health care spending is how much is it going to cost and where is the money going to come from? The amount of per-patient costs have doubled more in the United States than other nations around us. The last issue is the amount of Americans that has no health care at all. This paper will discuss the healthcare expenditures that is necessary for our entire population.

Americans to the coverage rolls” (HHS, 2013). This shows that on the potential positive side of

Healthcare spending growth rate trends show astounding estimates. Since 1960, spending has risen from $27 billion ($143 per capita, 5.1% pf GDP) to amazing $1,678.9 billion ($5,670 per capita, 15.3% of GDP, 2003 data) (HHS, 2005). Recent research estimated that by 2013, healthcare spending will be as high as 18.4% of the Growth Domestic Product. It is important to note that the gradual move from hospital to ambulatory setting has resulted in much higher spending on outpatient hospital services and prescription drugs. The spending growth for these two trends is much higher than the overall healthcare cost growth, which, in fact, increases faster than such important economic indicators as GDP growth, inflation growth, and population growth rates.

Jude Odu, the founder of Health Data Intelligence, wants to to have a profound and positive impact on America’s healthcare system, serving self insured employers, large organizations with many employees, hospitals and health systems. His company has created a software that helps better effectively manage the health of their client’s employees, assisting them in identifying which patients or employees are likely to become expensive in the near future.