financialmanag 2

4

Venicia

Discuss how healthcare providers and patients can benefit when cost is correlated with quality of the healthcare services provided.

There are several ways that healthcare providers and patients can benefit when the cost is correlated with the quality of the healthcare services provided. For instance, healthcare providers can better plan and organize their efforts to address patient-specific conditions as a way to achieve optimal quality care. When multidisciplinary teams work together, healthcare organizations are able to advance the entire care cycle. This is extremely beneficial for patients who see multiple physicians due to a variety of different illnesses. Another benefit to this approach is it forces healthcare organizations to provide more accurate cost assessments for providing quality care. According to Porter & Lee (2016), “The Center for Medicare & Medicaid Services have committed that 90% of Medicare payments will be rewarded based on value by 2018” p. 1047.

I think the decision to stir away from the fee-for-service to value-based payment is a great way to promote accountability within the healthcare industry. With that being said, it will also help to address the large socioeconomic gap to provide all patients with affordable and high-quality health care. According to Bean (2022), “as the population becomes more diverse, addressing health care disparities in the United States will become even more important” para. 9. In recent years I have noticed that many healthcare organizations are taking the initiative to conduct surveys via phone, text, and email to gain feedback on how the patient experience was during their visit and to receive insight about recommendations/concerns.

Finally, when the cost is correlated with the quality of the healthcare services provided, better healthcare outcomes can be achieved. Not only will it help improve the patient’s experience of care but will also help to reduce the per capita cost of healthcare.  

 

References

Beam. (2022). US Healthcare Disparities By Socioeconomic Status. Beam Healthcare. Retrieved from https://www.beam.healthcare/en-us/blogs/us-healthcare-disparities-by-ses

Porter, M. E., & Lee, T. H. (2016). From Volume to Value in Health Care: The Work Begins. JAMA. 316(10), 1047-1048.

Rita

Health Insurance, Managed Care and Reimbursement Methodologies

According to (Michael E Porter, 2016) study, major changes are coming to the health care industry, and the delivery paradigm for medical services is being improved. The shift from a cost-based to a value-based payment structure is accelerating the transformation. The essay makes it evident that hospitals, medical service communities, and individual physicians should no longer waste time debating whether to participate in bundled payment systems, and instead focus instead on how to carry out the necessary tasks to achieve success inside them (Michael E Porter, 2016).

This article primarily discusses three approaches to achieving the volume to value ratio: First, the organization shifted its focus to enhancing value for its members rather than increasing fee-for-service revenue. As part of a long-term strategy, the healthcare organization invested heavily in new methods of calculating, categorizing, and reporting clinical outcomes and costs on an individual patient basis. The second major choice was to structure the project on certain patient circumstances. The medical services program understood the inadequacies of focusing on "conventional" major spending zones and include all clients, such as lowering readmission rates. Focusing on individual patients and how to best treat them is where the real potential for cost savings and quality gains lies. And last, the organization formed interdisciplinary committees to spearhead the enhancement effort. The management team concluded that value is created not in isolated spheres of competence but rather when diverse entities work together to coordinate and enhance medical attention across the whole care consideration cycle (Michael E Porter, 2016).

This necessitates a value-based approach, whereby the cost of care is determined by the outcome for the patient. In this context, value refers not to the expense incurred but to the benefit received by the patient. The added responsibility placed on health care providers to provide excellent service will pay off in improved patient outcomes. In the value-based paradigm, patients are expected to pay less on treatments for serious, ongoing conditions. Providers of healthcare services will place more emphasis on patient outcomes and less on patient numbers. Drug prices may be reduced, and supply chain inefficiencies reduced if manufacturers and suppliers tailor their products to the individual needs of patients. If people in a community take steps to improve their health, the government will save money and be able to provide more services at no extra cost (Michael E Porter, 2016).

References

Michael E Porter, T. H. (2016). From Volume to Value in Health Care: The Work Begins. National Library of Medicine 13;316(10):1047-8.