Week 1 Discussion Response- Delivery of Healthcare

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Week 1 Discussion - Delivery of Healthcare

The Social Security Amendments of 1965, which established Medicare and Medicaid, dealt with the economic vulnerability of the aged and low-income groups who were not insured and hospitals that were not compensated, and lacked quality supervision. Prior to the enactment of the Patient Protection and Affordable Care Act of 2010, the uninsured working-age adults had issues with prematurely rising premiums, elimination of existing conditions, and inability to obtain routine primary care, which raised questions of inefficiency in cost and access (Ercia, 2021). The discontent with the fee-for-service payment system and the Sustainable Growth Rate formula at the time predetermined the introduction of the Medicare Access and CHIP Reauthorization Act in 2015, when policymakers aimed to reduce the pace of spending and base payments on performance.

All of these laws contributed to the promotion of value-based delivery, which was linked to requirements of efficient and high-quality care, which were tied to federal financing. This trend was increased by the Affordable Care Act by covering more and adding incentives, including accountable care organizations and hospital readmission fines, which tie payment to quality and cost performance (Ercia, 2021). MACRA expanded upon this base with the Quality Payment Program, which directs clinicians to either merit-based incentives or alternative payment models where better outcomes happen instead of volume in service received and relies upon performance metrics obtained via electronic health records (Anzalone et al., 2025). These changes transformed the policy of paying visits individually to paying for population health and coordinated care.

Medicare and Medicaid led to more coverage of older adults and low-income groups after their implementation and became national costs, which boosted interest in value-based strategies. The Affordable Care Act evidence shows that insurance coverage has increased, more people use primary and preventive services, and more people can now afford insurance despite some still having high deductibles or living in states that have not expanded Medicaid (Ercia, 2021). Initial reviews of MACRA have reported quality reporting improvements and involvement in alternative payment models, as well as administrative load-bearing and disparate preparedness in small practices (Anzalone et al., 2025). These acts transformed delivery into financial incentives and punishments that promote equity in access, results, and cost stewardship by organizations.

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