Payment Mechanisms and Reform Initiatives under PPACA

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Darrius Cooley

in which Medicare payment is made based on a predetermined fixed amount. As a result of this, the payment amount for a particular service is derived based on this classification system. Whereas, retrospective payment plans pay healthcare providers based on their actual charges. With a retrospective payment plan, a provider will treat a patient and submit an itemized bill to an insurance company detailing services rendered.

Payment reform initiatives

     First, reforms regarding quality improvement provide incentives for programs that can show increases in managed care for patients with chronic medical conditions. Secondly, reforms regarding accessibility help create programs that address primary care shortages and support the building of the healthcare workforce. Lastly, reforms that address healthcare affordability and cost function by potentially cutting wasteful expenditures and controlling payment rates.

 Universal access to healthcare

     Equally important, is the potential for a universal healthcare system that will provide comprehensive incentives for all Americans. However, in my opinion our current financial status can not sustain any increases in our current healthcare system. Consider, that our current healthcare system was completely funded by the wealthy. How would this expansion affect our current healthcare quality? In this case, it is likely that cost savings measures would have to be enacted to sustain this type of program.

Patient education in healthcare

     There is no question that, patient education is key to understanding medical diagnosis the same way that insurance education should be emphasized to patients. In this case, it is important that we discuss the differences in private and government coverage. Consequently, the need for patient education also brings about a need for an efficient delivery method. For instance, since healthcare is currently technology driven the opportunities for patient education are endless. For example, when you check in for a medical appointment an insurance app could be automatically downloaded to your device. This app could then in turn outline the differences between private and government coverage. Furthermore, the app could generate a knowledge check prior to logging off to ensure you have a through understanding of those coverage differences.

REFERENCES

cms.gov

https://www.commonwealthfund.org/affordable-care-acts-payment-and-delivery-system-reforms