HSA4109- Assignment 4

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Feb 20, 2024

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1 Lesson 04 – Assignment Marie Heitzman Department of Business, Palm Beach State College Principles of Managed Care HSA4109 Dr. Anthony Johnson February 13 th , 2024
2 The healthcare industry is one of the most powerful in the world, and we spend the most money on hospitals and medical offices, making them examples of businesses that require operational expenses to be met. That is when reimbursement models become critical for compensating medical professionals for their services while also promoting better healthcare at lower costs. A few examples of physician reimbursements are: The fee-for-service (FFS), Value- based payment (VBP), Alternative payment models (APMs). The fee-for-service payment system rewards physicians based on the number of appointments, examinations, or treatments they provide, as opposed to the level of care or relevance of their services, leading to poor results. Value-based payment (VBP) and delivery system interventions were established with the purpose of changing payments based on quantity of services to payments that incentivize high- quality, cost-effective care. Nowadays, a quarter of all payments are connected to FFS, with some link to quality and value.
3 Alternative payment models (APMs) reward physicians and clinicians for providing high- quality, cost-effective care. They differ from traditional fee-for-service (FFS) structures by providing monetary rewards or penalties for satisfying quality and wasting targets for specific patient populations. Some APMs fix payment rates in advance, leaving physicians fully accountable for retaining savings or incurring additional expenditures. Because of the disparity in physician reimbursement methods the ACP have policy recommendations to improve the systems we utilize now a days. The three that stood out to me the most are: Redesign Health IT to Enhance the Patient–Physician relationship, Putting Patients First, and lastly, Creating Transparency to Inform Shared Decision Making. Health IT aims to enhance patient-focused treatment and support the execution of value- based healthcare reforms. To accomplish this objective, health IT ought to enhance the care of patients and the consumer-physician connection to enhance medical outcomes, in addition to facilitating seamless data collection, sharing, and accessibility that promote value-based care delivery and payment. I think this is a great area of focus as It sometimes can be overwhelming for a consumer when attempting to view financial or insurance information or simply to even make a payment. Patient- and family-centered treatment can lead to better results, improved security, and lower expenses. Cooperation with patients and their loved ones is crucial for accomplishing the "quadruple aim" of medical care, which involves enhancing the experience of patients, medical results, cost reduction, and physician satisfaction. Again, I think this is a great focus because sometimes the healthcare industry tends to turn into business where the patient is not the focus rather the number of profits that are available.
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4 The current healthcare system in the United States makes it difficult for consumers to obtain reliable early cost estimations related to the complexity of insurance companies, plan alternatives, medical and hospital networks. This lack of knowledge makes it difficult for patients to oversee their own medical treatment. Hence, Consumers from diverse cultural and socioeconomic backgrounds prefer clear information to make educated choices regarding suitable treatments, healthcare professionals, treatment teams, and therapies. My stance on Transparency, I can say I am a huge advocate for this. Consumers should be able to have upfront and honest information available at their fingertips. This would allow people to plan accordingly and plan health care. References : Erickson, S. M., Outland, B., Joy, S., Rockwern, B., Serchen, J., Mire, R. D., & Goldman, J. M. (2020). Envisioning a Better U.S. Health Care System for All: Health Care Delivery and Payment System Reforms. Annals of Internal Medicine, 172(2_Supplement), S33. https://doi.org/10.7326/m19-2407

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