Future Healthcare Reform Challenges
Question.1: Reforms
Health care organizations are facing several challenges that hinder the delivery of quality care to patients. The most fundamental challenges that need to be addressed by healthcare leaders include the aging population and leveraging the use of technology. According to this video, United States’ annual per capita spending on people aged above 55 years is the highest in comparison to Germany, Sweden, U.K, and Spain (Davis, Schoen, & Stremikis, 2016). The problem is compounded by the growing aged population above 65 years, estimated at 54 million. The shortage of healthcare professionals, majorly geriatric nurses, home care aides, and physical therapists further complicates the delivery of quality care to US seniors. Besides, large spending on these population groups does not translate to higher quality indicators than other developed countries. Therefore, considerable reform is needed to address the high cost of care and improve quality indicators.
Healthcare leaders are also expected to leverage the use of technology in the delivery of care to the rising patient population and medical complications amidst. Technology can be used remotely by caregivers to monitor patients’ vital signs and progress thus saving the cost of traveling to seek care (Zastocki, 2015). It is paramount for healthcare leaders to consider training healthcare professionals on advanced methods of care delivery based on technology.
Managed care organizations need to embrace policies that reduce wastage in health by eliminating unnecessary care expenses which do not improve care quality and patient outcomes. As asserted by Lustig et al (2016), MCOs should focus more on value-based care and bundled purchases for elderly patients. These practices will encourage physicians to make appropriate care decisions instead of just following guidelines to offer unnecessary procedures and tests of no significant benefits to the patients but only increase the cost of care. The reimbursement is tied to cost and quality of care thus forcing providers to offer quality care.
Question 2: PPACA
The ACA act has provisions for deterring fraud, waste, and abuses in federal programs such as CHIP, Medicare, and Medicaid to reduce the cost of healthcare. To enforce these provisions, the act has developed strict screening of healthcare providers before they are enlisted to participate in CHIP, Medicaid, and Medicare programs. Secondly, the act has enhanced penalties for violating these provisions. It has also improved the sharing of data amongst health programs to promote transparency, imposed several new requirements for claims, and expanded the power of RAC, and increased funding towards efforts for combating healthcare frauds.
In compliance with ACA requirements, my health care organizations have initiated measures aimed at providing value-based care. These include accounting for the value of drugs and care services including procedures and lab tests based on pharmaco-economic assessment (Mcrae et al, 2017). The accountability is developed to prevent possible fraud and wastage of care services and ensure fair pricing of drugs and medical services. In compliance with information sharing, the organizations also provide the pricing of its services to the secretary for PPACA referring pricing. The organization also provides a surety bond to the secretary as when required to the sum not less than $50,000 incommensurate with the billing volume of our organizations (Lustig et al 2016). Any overpayment on a prescription drug plan is reported and returned to the secretary within two months after the notice date of overpayments.
References
Davis K, Schoen C, Stremikis K. (2016). Mirror, mirror on the wall: how the performance of the US health care system compares internationally: 2016 update. The Commonwealth Fund. Retrieved from http://www.commonwealthfund.org/Publications/Fund-Reports/2010/Jun/Mirror-Mirror-Update.aspx.
Lustig, A., Ogden, M., Brenner, R. W., Penso, J., Westrich, K. D., & Dubois, R. W. (2016). The central role of physician leadership for driving change in value-based care environments. Journal of managed care & specialty pharmacy, 22(10), 1116-1122.
Mcrae, J., Vogenberg, F. R., Beaty, S. W., Mearns, E., Varga, S., & Pizzi, L. (2017). A review of US drug costs relevant to medicare, Medicaid, and commercial insurers post-affordable care act enactment, 2010-2016. PharmacoEconomics, 35(2), 215-223. doi:http://dx.doi.org.ezproxy.liberty.edu/10.1007/s40273-016-0458-0
Zastocki, D. K. (2015). Board governance: Transformational approaches under healthcare reform. Frontiers of Health Services Management, 31(4), 3-17.