Value Based Reimbursement Model In Health Care

The U.S. spends more resources on healthcare than any other nation. Yet, the The Commonwealth Fund (2014, para. 1) claim the U.S. health system consistently ranks last or near last relative to other industrialized nations regarding health outcomes. Consequently, insurance companies are adopting a value-based reimbursement system aimed at containing costs and improving clinical outcomes (U.S. Department of Health and Human Services, n.d., para. 35).

Quality patient centered care is vital to a hospital or clinic’s ability to treat whole patients. Dabney and Tzeng (2013) address the necessity to implement patient-centered care into clinic and hospital settings. The article clarifies what patient-centered care and service quality is by consolidating many works and sighting benefits medical professionals can observe in their practice.

Quality of care is the fundamental goal of health care, yet it is difficult to define. It is a concept that health care policy and programming strives for, and that many have attempted to elucidate. Given its many components and manifestations, defining and quantifying

Health care in the United States in known to be very pricey, with the quality of care not always meeting its expectations. In the year 2011 alone, the money spent towards healthcare was well over two trillion U.S. dollars. One answer to solve this dilemma would be to incorporate a value based care system. A value based care system is structured around the traditional evidence-based practice and medicine model, while emphasizing the quality of care, taking into consideration patient’s wishes and preferences at a reasonable cost in order to improve the quality of life (Harvard Business Review, 2013).

Reimbursement models are able to demand higher quality because of the widespread use of information technology (IT) in healthcare. Another example of this is the implementation of strategies required by the IMPACT Act of 2014. This act requires the reporting and collection of various standardized measures across multiple health care settings (CMS, 2015a).

There are various models designed to enhance the quality of health care provided in today’s society. Within the health care system the objective is to provide quality care to the patient is the primary goal, however, over time due to such a strong concentration on this objective expenses have been forgotten. Medical care has now grown to a ridiculous expense. Congress, medical professionals, administrators, and many others are now devising various plans and models to attempt to conquer and eliminate such expenses. The patient centered medical home, managed care plans, and accountable care organizations are just some of the ideas

Patient centered care is important to me because it shows empowerment to the patient by showing respect, giving them your undivided attention, being honest when providing them with information. Collaboration between the healthcare team and allowing patients to take part in the decision making process regarding their care.

A particular emphasis on the different areas of nursing, such as patient-centered care has captured the interest of many. The need for patient-centered care has grown, in part, from the evolving medical atmosphere in the United States (Reynolds, 2009). Nurses and other health care providers no longer are solely in charge of care. Patients demand to be active partners in the health care process (Reynolds, 2009). In patient-centered care, the needs of the patient and patient satisfaction are the priority (Reynolds, 2009). It does not focus exclusively on the sickness, but rather, on the patient and the patient’s psychological, spiritual and emotional needs. Patient-centered health care attempts to engage patients and their families in the active participation of the decision-making methodology. This is accomplished by supplying them with knowledge about the patient’s health condition. Patients critique the standard of healthcare they receive. They evaluate based on social graces and more importantly bedside manner. Most are incapable of evaluating a nurse’s level of skill or training, so the qualities they can assess become of the utmost importance in satisfying patients and providing patient-centered care (Reynolds, 2009).

With our healthcare system evolving now with the Affordable care Act focusing on less hospitalization and more outpatient settings, there will be more efforts for value-based healthcare, when targeting a specific population health group, to focus in providing better quality and patient-center care with more wellness programs and preventive regiments

“Attention should be given to assessing the impact of new methods of organizing the delivery of health care services, adoption of electronic information systems, and health reform provisions that will test and reward health care organizations that are accountable for achieving better outcomes, higher quality, and lower costs” (Davis, 2012). Only collaboration between payers and physicians, with a focus on improving the health outcomes of patients will bend the projected cost curve set forth.

This article is about today’s healthcare marketplace have broad demand for greater value in healthcare face two obligations according to HFMA survey. Those obligations consist of reducing costs for existing services, optimizing the efficiency with which those services are delivered and develop the infrastructure and capabilities required to thrive in the emerging value-based payment and care delivery environment (HFMA 2015). HFMA research seeks to understand the challenge organizations face today is not simply to contain costs, but rather to reconfigure cost structure so that spending reductions in one area can free up resources needed for new investments in another (HFMA 2015). Dan Piro, president of MedAssets Advisory Solutions, notes:

Health care costs in the United States continue to be on a raise as money is been wasted unnecessarily in all areas of health care. Wasteful spending in health care has many undesirable consequences that could be alleviated through waste reduction. Implementing waste-reduction strategies, and reducing the burden of unnecessary health care spending is one area that should be considered today (Bentley, T. G., Effros, R. M., Palar, K., & Keeler, E. B.,2008). Waste in health care is defined as healthcare services that do not add value or improve patient outcomes, where at the same time healthcare professionals are ethically obligated to provide the best care possible to individual patients and their families (Medicare Waste in Unnecessary Admissions,

In our healthcare society today, most of our professional have the same enthusiastic approach to view the challenges of pay for performance model. Therefore these demands for contractors to explore how so many sexual misconduct has plagued our daily livelihood throughout leadership from many of our local and government agencies as well as other corporation. While health care environment experience business to business challenges of diversity they must be innovative in how they deal with sexual predatory behavior.

With health care costs continuing to rise, it has become increasingly clear that we cannot afford all medically beneficial care. Advances in technology are pushing health care costs to an unmaintainable level. Statistics show that spending on health care has reached nearly fourteen percent of this country's Gross Domestic Product (GDP). To decrease costs, some savings can be achieved by eliminating waste in the health care system. However, elimination of waste would not free up enough resources to cover all necessary medical services. If facilities limit how much they spend on health care services, a significant amount of beneficial care can no longer be provided (Orentlicher, 1996).

Several key characteristics of which will help health insurance industries modernize the health care system is to increase quality of care, access to clinical services, and reduce health care cost by empowering technology. Empowering technology helps health insurance industries promote data collection and information sharing across the health care system as a method to increase provider communication and align patient care. The newly emerged payment and data-driven model called Value-based payment plan reflects this strategic objective. The Value-based payment comes in many forms such as pay for performance programs, patient-centered medical homes, and Accountable Care Organizations (Japson, 2015). In an ACO, health care providers are contracted to become in network providers. These in network providers are required to accept the responsibility of cost and quality of care for a defined population. The goal for in network providers in an ACO is to increase quality, patient satisfaction, reduce cost and maximize patient health (Mulestein,