The Value-Based Care: The New Model

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.

They will now receive payments from the quality of care they provide to their patients. Those with higher based value will receive higher payments than their counterparts (Berenson 2010). I think this is very important because the healthcare system has been volume driven for so long that quality healthcare has been an issue for quite some time. In addition to value, this would definitely improve quality and efficiency needed for better patient outcomes.

Reading and understanding the information that was given in our text book about transforming the healthcare system for improved quality, rely on enhancing the value on healthcare. Their ideas is to improve healthcare in both financial and clinical aspect that could adjust the quality of healthcare. Meanwhile, if hospitals, doctors, and medical team. improve the value base care, it can or may provide better care, better health and lower cost. According to the Aetna the solution is to provide and deliver better health and more

The first ACO model started January 1, 2012 and consisted of 32 ACOs with 860,000 beneficiaries (CMS, 2016). ACOs are made up of groups of hospital, doctors, and other health care providers who provide coordinated high quality care to their patients. The goal of this coordinated care is to ensure patients receive the appropriate care in a timely manner while avoiding unnecessary services and duplication of services. The expected end result is the delivery of high quality care and reduction of health care cost and the incentive for the health care provider to meet the goal is the share of the savings they will receive. As stated by Dr. Berwick, (Its (ACOs) purpose is to foster change in patient care so as to accelerate progress toward a three-part aim: better care for individuals, better health for populations, and slower growth in costs through improvements in care” (Berwick, 2011). The ACO providers are held responsible for meeting quality improvement measures while reducing their rate of spending.

Besides, the financial incentives for hospitals and physicians that belong to ACOs, Jaffery & Golden 2013, asked and then answered the question “why would providers join this program? One reason is to prepare for the future”. Fee-for-service reimbursement, which has been how hospitals get paid for their services rely solely on the volume of patient seen without taking into consideration the quality of care provided. Payers today, such as government, commercial insurers, employers, and individual consumers are now requesting on value -based-payment, which consist of delivering the highest level of care at a lower cost. The volume based system even though the traditional way of how payments are made is not a viable long-term option (Jaffery and Golden, 2013, p.98).

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

Value-based reimbursement is a natural progression toward improved patient care. When hospitals and other providers are financially incentivized to provide excellent patient care (i.e. customer service) the difference in patient satisfaction and the quality of services provided is measurable. In the article you referenced the authors Brown and Carpo state that “these new value-based models require providers to prove that they’re meeting quality standards and benefitting patients while cutting costs” (n.d.).

To present a health care reform, one must first find out what can be improved within a health care organization. For financial reforms, there is normally a focus on rebuilding an existing budget or making cuts so that funs can be put toward a new project. As for America’s current health care system, there is a desperate need to insure more citizens. The Affordable Care Act of 2010 has created a starting point for our health care system from which can progress. More patients with preexisting conditions are now able to obtain insurance thanks to the policy within the ACA of 2010. The focus now is reimbursement for physicians. One financial operating change that should be made to America’s current health care system is the reimbursement rate to physicians. According to the lecture

Value-Based Payments (VBP) is a tactic utilized by purchasers to encourage quality and the value of health care services (Health Care Incentives, 2017). Value-Based Payments offer financial incentives to doctors, hospitals, medical groups, and health care providers (Webb, 2015). The incentive is to provide better care for their patients and to focus on the quality of the care they are providing rather than the number of people they treat. This payment model is being used as a way to keep DSRIP sustainable (NYSDOH, 2015). The VBP Model offers a roadmap, which outlines a five year plan to attaining inclusive payment reform; which includes a shift to 80% VBP through Medicaid managed care plans (The Commonwealth Fund, 2017). This payment reform should be accomplished by the end of DSRIP enactment period of five years (The Commonwealth Fund, 2017).

In this essay I will be focusing on social care values, the ethical issues which challenge social care workers and approaches adopted to challenge discrimination in today’s society. Three social care values that link to person centred care are, human dignity, being trustworthy and having respect for the individual. Human dignity means that the care worker should be understanding that every human life has value, regardless of an individual’s gender or beliefs. This is central to person centered care as the service user has their own individuality and ethical and moral beliefs. The care worker should take time to understand and respect the differences between their own beliefs and the service users, so that you are not biased towards the service user. They should have a positive and encouraging attitude, following and catering to the individuals wants and needs without making any assumptions for them. Being trustworthy means that the carer is trying to build up a strong healthy relationship with the individual, this then helps the individual to open up to their carer about how they are feeling and any situations that may be worrying them. The individual is able to open up to their carer as they will feel like they aren’t going to neglect them or lie to by their carer. Being trustworthy is central to person centred care as the service user will be able to feel like they can rely on their carer to do what they promised and be responsible. Being able to have trust in a carer

Since the passing of the Affordable Care Act (ACA) in 2010, the healthcare revenue cycle has significantly change. Physicians and managed care organization saw a spike in the number of patients. iThe health care also law created initiatives to transition from the traditional fee-for-service (FFS) system to a payment-for-value delivery system, with key attention to cost containment and quality improvement. Managed care organizations are restructuring how they deliver care and receive reimbursement in a value-based system to maximize their profit.

The introduction of value-based purchasing by the Centers for Medicare & Medicaid Services’ (CMS), implemented a program in which participating hospitals are paid based on the quality of care of the services the patient received (Hospital Value-Based Purchasing, 2015). Therefore, if hospitals want to recoup benefits from Medicare and Medicaid, excellent care and services must be provided.

Paradise Hospital, Inc. is a for-profit hospital. As the facility’s new hospital administrator, you have been tasked with improving the service value of the hospital. The administration has not done this process since the hospital began operating in the year 1995. The investors are not familiar with the value proposition strategies of hospitals in the current day America.

Under payment, an ideal healthcare system will have the challenge of delivering higher quality for lower costs. The system’s payment reform will involve a transition from fee-for-service to global from systems that are value-based important for the achievement of the overall healthcare goals. An ideal healthcare payment system will give a great deal of support to value-driven system of healthcare delivery (Kent, 2013). The fee-for-service payment system will be of great importance to the healthcare system as it will help control the costs of health care.