U.s disc 11
BYSTANDER
peerdisc2.docx3
Diamond
The U.S. healthcare system is made up of so many fragmented layers and dimensions. This fragmentation has caused a variety of underlying challenges, issues, and barriers to become more prevalent. When looking at the big picture perspective, I would change the way population health is managed and addressed. By changing the way population health is managed and addressed in relation to the overall healthcare industry, the functionality behind the production, delivery and cost of care could potentially increase consumer access, improve quality and lower service costs overall.
According to (Population Health Management- Looking to the future,) the current health care system aims to treat consumers but ultimately the underlying determinants of health are left with no direct linkage to healthcare delivery systems. Unfortunately, vulnerable populations have a harder time accessing healthcare services because they face disparities beyond their means. These underlying determinants of health can greatly impact consumers health status. Also, the basis in which healthcare services are delivered has become more business centered rather than patient/ quality centered in my opinion. Every day it seems like prices for everyday items are rapidly increasing due to inflation and it’s 2022. According to (Lower Costs, Better Care: Reforming Our Health Care Delivery System. 2022,) there is no easy fix for the problems that embody the US healthcare system.
To improve healthcare, I would focus on trying to eliminate as many of these social determinates of health as possible for consumers. According to (Population Health Management- Looking to the future,) this can be done by networking, community education events, and even assisting with the creation of programs and resources to that could mitigate the need for medical services at all. I would also advocate for more community outreach programs held by healthcare professionals that aim to spread more information about health and the importance of it. According to (Otorkpa. 2022,) the World of Health aka WHO says that health is a state of complete physical, mental, and social well-being and not just the absence of disease or wellness. If healthcare professionals are sharing important information about health and ways to get/ stay healthy, the community served may have a better chance of mitigating some of those healthcare determinates while also avoiding higher costs and elevated levels or care.
I would make sure that the appropriate policies are being approved to assist with cost reduction and quality assurance. I would aim to address the healthcare crisis that many U.S citizens are being forced to face by advocating for a universal, equitable, non-discriminatory, and a publicly funded healthcare system. I would do this by researching and trying to gain a more in-depth international perspective. It is important to have an international perspective in health policy development because understanding what works for other countries can be important for policy makers. International policy development can influence the efficiency of the U.S healthcare system. Being able to utilize data from research done internationally can help give U.S. policy makers ideas on ways to improve our public health system and the policies put in place. I would also make sure that there is more coordination within the overall healthcare delivery system. According to (Population Health Management- Looking to the future,) it is important to manage the relationship between individuals and groups so that the appropriate health services and delivery can be implemented. This will help reduce the impact of the identified determinants while also reducing costs of care, creating more of a holistic approach and allowing the system to do more with less.
Lastly, simply by taking the initiative to improve the delivery, the quality of care and trying to ensure that all citizens have access to universal health insurance, would be taking a step in the right direction for the future of the healthcare industry. While the answer to this question seems simple, it is not in my opinion. If it was, the system would be far better off than it is and there would be so many people getting the proper care that they deserve. I think most importantly, making the government, health policy writers, and healthcare providers understand the basis in which healthcare was created may play a key role. Healthcare ultimately has become a business but access to affordable and quality health and healthcare services should be a human right for all not just a thought of dollar sign.
-Diamond
References:
Population Health Management- Looking to the future. PowerPoint Presentation
https://learn.umgc.edu/d2l/le/content/685478/viewContent/25911452/View
LOWER COSTS, BETTER CARE: REFORMING OUR HEALTH CARE DELIVERY SYSTEM | CMS. (2022).
Otorkpa, D. (2022). World Health Organization (WHO) Definition Of Health - Public Health. [online] Public Health.
https://www.publichealth.com.ng/world-health-organizationwho-definition-of-health/>
Kuressa
Reimbursement systems that provide financial incentives for value-based care aid quality care initiatives. The healthcare market is currently shifting away from quantity and more towards quality. Fee-for-service is a type of reimbursement that incentives quantity; the more patients a provider sees, the more they will be reimbursed. Per-day-per-member (PDPM) is a capitated system where the facility is paid based on the patient's medical condition. Ultimately this system has the potential to cut costs by incentives for only necessary services. However, providers may withhold some services due to the capitated limit to make more of a profit. Technological systems need to be strategically utilized to provide evidence to back physician and patient care plan decisions. The federal government should create a universal database platform of patient information to allow authorized users access to information to aid in patient health. Integrating HIT systems into this platform can allow for the most up-to-date information. The Office for Civil Rights (OCR) requires providers to allow patients to access their private health information (PHI) (OCR, 2022). A centralized system that allows patients to access their entire EHR aid providers to stay in compliance.
Additionally, coordination of care is streamlined with all providers that have a National provider identification (NPI), or a tax ID Number (TIN) can access the system to determine whether a referral is required and whether the referral was approved. Government programs, such as the Affordable Care Act, will aid in cost savings due to a large group of people being able to access care earlier and prevent worsening chronic conditions. Programs like Medicare for All Act (MAA) may save an estimated $450 billion annually while improving health, saving about 1.73 million life-years annually (Galvani et al., 2020). A barrier is determining how to afford initial expenses associated with these programs and making the healthcare system efficient and effective in caring for the entire American population. Ultimately technology will aid healthcare providers in planning for increased volumes by creating alternative service options and predictive resource reports. Further, technology provides evidence with a touch of a button supporting provider decisions.
Applying the Ethical Decision-Making Framework, justice, beneficence, non-maleficence, and autonomy are upheld. A platform for patient information, combined with government programs supporting universal health coverage, provides facts about patients and is not more beneficial for one patient or provider over another. However, governments would have to ensure policies are in place so insurance agencies do not take advantage of the data, for example, by setting premiums. The alternative option is the current system which causes fragmentation and stress on patients and providers. The second step in the decision-making model is to determine whether this solution addresses more than legal and efficiency factors. For example, electronic health records (EHRs) are required by law. However, some providers may not devote enough resources to their system, ultimately not reaping the benefits. However, a universal platform may be the key initiative for providers to fully adopt HIT.
Further, a universal database would be more efficient than the current system. Patients would not have to record their personal health information multiple times, ultimately increasing the risk of breaches or incorrect and missing information. Insurance companies could communicate benefits and eligibility to patients and providers. Finally, providers could coordinate care. To ensure accuracy, the platform would have to sync data from all healthcare market stakeholders in real-time.
Further, alerting providers who have provided care would aid in reimbursement based on health improvements. Again, policies must be created to ensure the system meets expectations and is used properly. In addition, autonomy may be questioned if individuals do not want all of their providers to be alerted of their health status. Finally, a universal platform allows insurance companies to compete through transparency. A single-payer system has been noted to create cost-efficiencies (Galvani et al., 2020). However, these systems disregard patient autonomy. Market competition has been shown to decrease costs. With patient information shared across all vendors, insurers must innovate ways to remain competitive. Ultimately, insurance companies decrease the burden on the federal government to manage patient coverage.
References:
Galvani, A. P., Parpia, A. S., Foster, E. M., Singer, B. H., & Fitzpatrick, M. C. (2020). Improving the prognosis of health care in the USA. The Lancet, 395(10223), 524-533. https://doi.org/10.1016/s0140-6736(19)33019-3
OCR. (2022, July 15). Healthcare data breach statistics. HIPAA Journal. https://www.hipaajournal.com/healthcare-data-breach-statistics/
Velasquez, M., Moberg, D., Meyer, M. J., Shanks, T., McLean, M. R., DeCosse, D., André, C., Hanson, K. O., Raicu, I., & Kwan, J. (2021, November 8). A framework for ethical decision making. Santa Clara University. https://www.scu.edu/ethics/ethics-resources/a-framework-for-ethical-decision-making/
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