Affordable Care Reform
There have been numerous failed attempts to reform the United States healthcare system over the years. However, the most recent attempt that has been implemented is the Affordable Care Act, under the Obama Administration. As a result, since 2010 changes have been implemented to reform the United States healthcare industry, which affects the insurers, providers, and the subscribers in different ways. Consequently, the Affordable Care Act does not have full support from everyone and it faces numerous challenges (Bodenheimer & Grumbach, 2012). Overall, it is estimated that 2.6 trillion dollars is spent on healthcare in the United States each year (Van Gorder & Topol, 2012). Therefore, it is essential to acknowledge the inflation in healthcare
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costs, but inadequate quality of care in some locations and/or from some healthcare providers. After all, there is an undeniable fact that the healthcare system in the United States is broken (Van Gorder & Topol, 2012). The purpose of this paper is to evaluate the future of healthcare delivery.
Increased Role of Preventive Care
Preventive care is the healthcare services that are performed routinely for patients to help prevent illnesses and/or to diagnose diseases in the early stages. It is estimated that 20% of Americans schedule an annual health exam while 8% of ambulatory care visits are for check-ups (Liu, Perkins, & Duffy, 2015). However, the periodic health exams do not necessarily result in optimal preventive care (Liu et al., 2015). As a result, primary care providers are being held accountable for the physician's performance on preventive care measures (Liu et al., 2015). Therefore, there has been an increased role of preventive care. In addition, under the new healthcare reform physicians must meet a variety of quality measures to ensure their reimbursement for services provided from different payers, such as Medicare. Furthermore, physicians are required to provide data on preventive outcomes and measures if they are a Medicare subscribed provider (Liu et al., 2015). Consequently, the preventive care services under the Affordable Care Act are often covered without any costs to the patient, such as copayments, deductibles, or coinsurance (Liu et al., 2015). Overall, the changes in the healthcare industry are focused on improved outcomes and quality care (Liu et al., 2015). Therefore, an increased focus on preventive care is occurring nationwide. After all, taking the steps to prevent illnesses or diagnosing the illness in early stages may help reduce healthcare costs in the end.
Importance of Actively Treating Chronic Diseases
Over the years, there have been significant percentage of healthcare expenditures associated with chronic diseases and/or individuals that are considered to have complex healthcare needs (Chien, 2012). Therefore, as of 2012, in the United States healthcare expenses for individuals with chronic diseases were seventeen times higher versus individuals with zero chronic diseases (Chien, 2012). In addition, by the year 2023 chronic diseases are estimated to cost the healthcare industry 277 billion dollars (Bender, 2014). Therefore, it is essential that healthcare providers actively treat chronic diseases. However, healthcare providers can treat chronic diseases, but it does not guarantee patient adherence to the treatment plan although, the variety of healthcare systems control procedures and policies that influence how one manages chronic health illnesses (Bender, 2014). Overall, it is easy to acknowledge that if chronic diseases are not actively treated then healthcare costs will significantly increase. Therefore, healthcare organizations need to treat chronic diseases by ensuring adequate patient support and access to the healthcare organization, support from the healthcare provider, and patient incentives to the patient for participation, and information technology so the patient has access to their records and/or physicians can collaborate with other providers (Bender, 2014). Overall, the focus on healthcare management may have the ability to reduce healthcare costs while enhancing the quality of care for people with chronic diseases (Chien, 2012). Therefore, it is essential that the entire healthcare system interact to help treat chronic diseases and reduce the costs associated with these chronic illnesses.
Role of HMOs and other Healthcare Organizations
Health maintenance organizations are organizations whose patients must receive care from participating providers in the HMO unless it is an emergency (Bodenheimer & Grumbach, 2012).
Therefore, there are a variety of HMOs available, which reimburse physicians in different ways, such as salary, per diem, or capitation payments (Bodenheimer & Grumbach, 2012). In addition, HMOs are considered a form of managed care, which was thought to reduce the costs of care (Bodenheimer &Grumbach, 2012). However, HMOs are not as important in the healthcare market today versus two decades ago (Bodenheimer & Grumbach, 2012). Overall, it seems that the healthcare industry is fading out HMOs and second-guessing whether or not HMOs can control healthcare …show more content…
costs. On the other hand, Preferred Provider Organizations (PPOs) is similar to HMOs, however patients can seek medical services outside the network for a higher share of out-of-pocket costs (Bodenheimer & Grumbach, 2012). In addition, PPOs provide little change in the delivery of care in the healthcare organizations (Bodenheimer & Grumbach, 2012). Overall, PPOs are organizations that insurance companies contract with a limited number of healthcare providers on a discounted fee-for-service agreement (Bodenheimer & Grumbach, 2012).
Accountable Care Organizations have been implemented since 2012, which are provider-led organizations that manage the full continuum of care and are accountable for the quality of care and costs of a specific population (Bodenheimer & Grumbach, 2012). Therefore, Accountable Care Organizations are authorized under Medicare, the Medicare program offers cost savings to the physicians, and hospitals that are in the Accountable Care Organization network if quality metrics are met and costs are controlled (Bodenheimer & Grumbach, 2012). In addition, patients have the ability to seek that hospitals and/or physicians that they want to within the Accountable Care Organizations and not a specific list such as the HMO network (Bodenheimer & Grumbach, 2012). Overall, the Accountable Care Organizations tend to focus on preventive or proactive care whether than on individual patients that are already suffering from a disease or illness and it tends to hold physicians and/or other healthcare providers accountable for the costs of care and the quality of care delivered to patients (Bodenheimer & Grumbach, 2012). Consequently, the Accountable Care Organizations have only been around for the past three years so it is hard to decide if these organizations will reform the healthcare in the United States while improving the quality of care and the inflation in healthcare costs.
All of these healthcare systems establish healthcare policies or insurance policies that influence patient behaviors to seek treatment and/or adhere to the treatment plan (Bender, 2014). Therefore, some policies may reflect short-term profits for the healthcare systems while some policies may increase healthcare costs long-term (Bender, 2014). Therefore, some policies from these healthcare organizations may result in patients neglecting healthcare services or discourage effective management of chronic diseases (Bender, 2014). Overall, if a HMO decides to increase the amount of copayments for individuals than individuals may decide to stop seeking treatment from their primary care provider until necessary. In addition, a variety of healthcare organizations are seeking the higher return on investment and may not see the promise of investing in preventive measures, encourage exercise, or to encourage a healthy diet for patients (Bender, 2014).
Impact of these Current Trends on Necessary Changes for the Future of Healthcare
The new healthcare reform has been implemented in hopes to improve the quality of care delivered while reducing the costs of care.
However, there are numerous debates for and against the new changes to the healthcare industry. To be honest, I am unsure about where I tend to stand regarding the new healthcare industry changes. As a result, it seems that the healthcare costs are still going to be expensive for majority of Americans and it could be years before we determine if the changes implemented are effective. Consequently, the focus of the changes on preventive care, chronic disease management, quality of care, and reducing costs there has been a reduction in specialty care for individuals with chronic diseases and elderly patients with several comorbidities (Kuramoto, 2014). Therefore, future challenges can occur if there is no focus on specialty care due to the growing population of the elderly and/or high-risk patient profiles (Kuramoto, 2014). Overall, if some focus is set on specialty care for the high costs expenditures then clinical and costs outcomes can improve (Kuramoto, 2014). Furthermore, with focus on specialty care as well as preventive measures then the amount of hospital admissions will decrease, the readmission rate will lower, and it will lower unnecessary treatment protocols from primary care providers (Kuramoto, 2014). In addition, if Medicare, Medicaid, and other health insurance companies decide to lower the reimbursement rates too low then a
variety of healthcare providers may opt out of provide healthcare services to those recipients, which again will make individuals rely on emergency department services and limit access to quality healthcare.
Conclusion
Over the past two decades, there have been numerous attempts to change the delivery of healthcare services and to control the soaring costs of healthcare in the United States. However, until the past five years there have been minimal successful attempts to implement any changes to the healthcare industry. Consequently, with the Affordable Care Act changes are being made to the healthcare industry, which tends to affect patients, payers, and providers of healthcare in a variety of ways. Therefore, there is now an increase role of preventive care, providers are seeing the importance of actively treating chronic health diseases, and the Affordable Care Organizations are being implemented with less reliance on HMOs. Overall, these current changes have not provided much of an impact on the costs of healthcare yet since it is too soon to determine if the changes will positively influence the healthcare industry or leave a negative mark on the healthcare industry. In addition, there are still challenges that healthcare policymakers, providers, and patients must deal with to continue to battle the increasing costs of healthcare while ensuring patients receive the quality care deserved.
costs, but inadequate quality of care in some locations and/or from some healthcare providers. After all, there is an undeniable fact that the healthcare system in the United States is broken (Van Gorder & Topol, 2012). The purpose of this paper is to evaluate the future of healthcare delivery.
Increased Role of Preventive Care
Preventive care is the healthcare services that are performed routinely for patients to help prevent illnesses and/or to diagnose diseases in the early stages. It is estimated that 20% of Americans schedule an annual health exam while 8% of ambulatory care visits are for check-ups (Liu, Perkins, & Duffy, 2015). However, the periodic health exams do not necessarily result in optimal preventive care (Liu et al., 2015). As a result, primary care providers are being held accountable for the physician's performance on preventive care measures (Liu et al., 2015). Therefore, there has been an increased role of preventive care. In addition, under the new healthcare reform physicians must meet a variety of quality measures to ensure their reimbursement for services provided from different payers, such as Medicare. Furthermore, physicians are required to provide data on preventive outcomes and measures if they are a Medicare subscribed provider (Liu et al., 2015). Consequently, the preventive care services under the Affordable Care Act are often covered without any costs to the patient, such as copayments, deductibles, or coinsurance (Liu et al., 2015). Overall, the changes in the healthcare industry are focused on improved outcomes and quality care (Liu et al., 2015). Therefore, an increased focus on preventive care is occurring nationwide. After all, taking the steps to prevent illnesses or diagnosing the illness in early stages may help reduce healthcare costs in the end.
Importance of Actively Treating Chronic Diseases
Over the years, there have been significant percentage of healthcare expenditures associated with chronic diseases and/or individuals that are considered to have complex healthcare needs (Chien, 2012). Therefore, as of 2012, in the United States healthcare expenses for individuals with chronic diseases were seventeen times higher versus individuals with zero chronic diseases (Chien, 2012). In addition, by the year 2023 chronic diseases are estimated to cost the healthcare industry 277 billion dollars (Bender, 2014). Therefore, it is essential that healthcare providers actively treat chronic diseases. However, healthcare providers can treat chronic diseases, but it does not guarantee patient adherence to the treatment plan although, the variety of healthcare systems control procedures and policies that influence how one manages chronic health illnesses (Bender, 2014). Overall, it is easy to acknowledge that if chronic diseases are not actively treated then healthcare costs will significantly increase. Therefore, healthcare organizations need to treat chronic diseases by ensuring adequate patient support and access to the healthcare organization, support from the healthcare provider, and patient incentives to the patient for participation, and information technology so the patient has access to their records and/or physicians can collaborate with other providers (Bender, 2014). Overall, the focus on healthcare management may have the ability to reduce healthcare costs while enhancing the quality of care for people with chronic diseases (Chien, 2012). Therefore, it is essential that the entire healthcare system interact to help treat chronic diseases and reduce the costs associated with these chronic illnesses.
Role of HMOs and other Healthcare Organizations
Health maintenance organizations are organizations whose patients must receive care from participating providers in the HMO unless it is an emergency (Bodenheimer & Grumbach, 2012).
Therefore, there are a variety of HMOs available, which reimburse physicians in different ways, such as salary, per diem, or capitation payments (Bodenheimer & Grumbach, 2012). In addition, HMOs are considered a form of managed care, which was thought to reduce the costs of care (Bodenheimer &Grumbach, 2012). However, HMOs are not as important in the healthcare market today versus two decades ago (Bodenheimer & Grumbach, 2012). Overall, it seems that the healthcare industry is fading out HMOs and second-guessing whether or not HMOs can control healthcare …show more content…
costs. On the other hand, Preferred Provider Organizations (PPOs) is similar to HMOs, however patients can seek medical services outside the network for a higher share of out-of-pocket costs (Bodenheimer & Grumbach, 2012). In addition, PPOs provide little change in the delivery of care in the healthcare organizations (Bodenheimer & Grumbach, 2012). Overall, PPOs are organizations that insurance companies contract with a limited number of healthcare providers on a discounted fee-for-service agreement (Bodenheimer & Grumbach, 2012).
Accountable Care Organizations have been implemented since 2012, which are provider-led organizations that manage the full continuum of care and are accountable for the quality of care and costs of a specific population (Bodenheimer & Grumbach, 2012). Therefore, Accountable Care Organizations are authorized under Medicare, the Medicare program offers cost savings to the physicians, and hospitals that are in the Accountable Care Organization network if quality metrics are met and costs are controlled (Bodenheimer & Grumbach, 2012). In addition, patients have the ability to seek that hospitals and/or physicians that they want to within the Accountable Care Organizations and not a specific list such as the HMO network (Bodenheimer & Grumbach, 2012). Overall, the Accountable Care Organizations tend to focus on preventive or proactive care whether than on individual patients that are already suffering from a disease or illness and it tends to hold physicians and/or other healthcare providers accountable for the costs of care and the quality of care delivered to patients (Bodenheimer & Grumbach, 2012). Consequently, the Accountable Care Organizations have only been around for the past three years so it is hard to decide if these organizations will reform the healthcare in the United States while improving the quality of care and the inflation in healthcare costs.
All of these healthcare systems establish healthcare policies or insurance policies that influence patient behaviors to seek treatment and/or adhere to the treatment plan (Bender, 2014). Therefore, some policies may reflect short-term profits for the healthcare systems while some policies may increase healthcare costs long-term (Bender, 2014). Therefore, some policies from these healthcare organizations may result in patients neglecting healthcare services or discourage effective management of chronic diseases (Bender, 2014). Overall, if a HMO decides to increase the amount of copayments for individuals than individuals may decide to stop seeking treatment from their primary care provider until necessary. In addition, a variety of healthcare organizations are seeking the higher return on investment and may not see the promise of investing in preventive measures, encourage exercise, or to encourage a healthy diet for patients (Bender, 2014).
Impact of these Current Trends on Necessary Changes for the Future of Healthcare
The new healthcare reform has been implemented in hopes to improve the quality of care delivered while reducing the costs of care.
However, there are numerous debates for and against the new changes to the healthcare industry. To be honest, I am unsure about where I tend to stand regarding the new healthcare industry changes. As a result, it seems that the healthcare costs are still going to be expensive for majority of Americans and it could be years before we determine if the changes implemented are effective. Consequently, the focus of the changes on preventive care, chronic disease management, quality of care, and reducing costs there has been a reduction in specialty care for individuals with chronic diseases and elderly patients with several comorbidities (Kuramoto, 2014). Therefore, future challenges can occur if there is no focus on specialty care due to the growing population of the elderly and/or high-risk patient profiles (Kuramoto, 2014). Overall, if some focus is set on specialty care for the high costs expenditures then clinical and costs outcomes can improve (Kuramoto, 2014). Furthermore, with focus on specialty care as well as preventive measures then the amount of hospital admissions will decrease, the readmission rate will lower, and it will lower unnecessary treatment protocols from primary care providers (Kuramoto, 2014). In addition, if Medicare, Medicaid, and other health insurance companies decide to lower the reimbursement rates too low then a
variety of healthcare providers may opt out of provide healthcare services to those recipients, which again will make individuals rely on emergency department services and limit access to quality healthcare.
Conclusion
Over the past two decades, there have been numerous attempts to change the delivery of healthcare services and to control the soaring costs of healthcare in the United States. However, until the past five years there have been minimal successful attempts to implement any changes to the healthcare industry. Consequently, with the Affordable Care Act changes are being made to the healthcare industry, which tends to affect patients, payers, and providers of healthcare in a variety of ways. Therefore, there is now an increase role of preventive care, providers are seeing the importance of actively treating chronic health diseases, and the Affordable Care Organizations are being implemented with less reliance on HMOs. Overall, these current changes have not provided much of an impact on the costs of healthcare yet since it is too soon to determine if the changes will positively influence the healthcare industry or leave a negative mark on the healthcare industry. In addition, there are still challenges that healthcare policymakers, providers, and patients must deal with to continue to battle the increasing costs of healthcare while ensuring patients receive the quality care deserved.