Week 11 Discussion Response- Delivery of Healthcare
CJones65Colleague 1
Keona Wilson
One major concern shaping our health care system is the federal government's push to strengthen value-based care through new payment and delivery models implemented by the Centers for Medicare & Medicaid Services (CMS). This includes any alternative payment models that require quality and outcome rather than volume. Within these models, the central Medicare and Medicaid delivery system reform aims to reduce costs while still improving population health outcomes. (CMS,2023)
Applying a PESTLE analysis to this issue:
· Political: Federal policy and CMS Innovation initiatives continue to prioritize value-based care influenced by reimbursement structures and provider participation.
· Economic: Health care spending continues to rise, prompting payment reforms that centralize cost control and efficiency
· Social: value-based care encourages attention to population health and community needs that align with the initiatives, with social outcomes
· Technological: investments in health IT, like electronic health records, data analytics and interoperability, are necessary to measure quality and outcomes effectively under the value-based models
· Legal: regulatory frameworks around quality reporting, reimbursements, and compliance have been shown to impact how organizations adopt value-based care strategies
· Environmental: Public health trends and environmental stressors can reinforce the need for resilient care delivery that addresses all chronic diseases and community needs.
Among the six PESTLE factors, the economic factor is expected to have the greatest impact on my future as a healthcare administrator. Value-based payment arrangements often require administrators to manage financial risk, align organizational strategy with performance benchmarks, and ensure efficient use of all resources. (The Commonwealth Fund, 2023) Economic pressures can also shape staffing decisions, technology investments, and service delivery, making financial stewardship and strategic planning essential for leaders in a value-driven environment.
When considering environmental factors through external lenses, these forces suggest that future healthcare delivery in the United States will continue to move towards integrated, outcome-focused systems. Organizations that successfully align with policy arrangements, technological capacity, and population health strategies will be better positioned to improve quality while controlling costs. (CMS,2023) At the same time, administrators must be prepared to navigate the new regulatory complexity models in market competition.
One aspect of the PESTEL analysis directly relates to the social determinants of health is the social factor, primarily with socioeconomic conditions such as income, housing stability, education, and access to transportation. The evidence indicates that social and economic factors account for a substantial portion of health outcomes and of health care utilization. (Health Care Transformation Task Force, 2022) By incorporating social determinants of health screenings and interventions into our value-based care strategies, such as partnering with community organizations or addressing food insecurity and transportation barriers, healthcare organizations may be able to reduce preventable hospitalizations, improve chronic disease management, and advance health equity. These focuses can ultimately support both better patient outcomes and more sustainable healthcare systems.
Resources:
Centers for Medicare & Medicaid Services. (2023). Alternative payment models (APMs).
https://www.cms.gov/priorities/innovation/about/alternative-payment-modelLinks to an external site.
Centers for Medicare & Medicaid Services. (2023). Value-based programs.
https://www.cms.gov/medicare/quality/value-based-programsLinks to an external site.
Health Care Transformation Task Force. (2022). Value-based care and social determinants of health.
https://hcttf.org/value-and-sdoh/Links to an external site.
Office of Disease Prevention and Health Promotion. (2023). Social determinants of health.
The Commonwealth Fund. (2023). Value-based care: What it is, why it’s needed, and how it works.
Colleague 2
Jakheera Young Allums
ISSUE: HEALTH CARE ACCESS
Summary of Issue:
Access to health insurance is continually an issue that affects the delivery and value of care in the United States. For vulnerable and underserved populations lack of coverage inevitably leads to higher death rates. The Institute of Medicine reports that the odds of dying among uninsured relative to those who have coverage are .71 to .97 respectively (Woolhandler & Himmelstein, 2017). The lack of adequate coverage for many individuals due to high costs directly correlates with delayed care. Individuals in the uncovered population often only seek care as a last resort contributing to poorer health outcomes, increased emergency care (Cunningham & Kemper, 1998). Addressing insurance access requires understanding the complex interplay of policy, economic factors, and societal barriers that affect an individual’s ability to obtain and maintain coverage.
PESTLE Analysis:
Access to health insurance is heavily influenced by political policies and reforms that determine coverage options and eligibility criteria. Economic factors, such as individuals’ ability to afford premiums and out-of-pocket costs, significantly impact enrollment and retention. Social determinants like socioeconomic status, education, and cultural attitudes affect awareness and willingness to seek coverage. Technological advancements, including digital enrollment platforms and telehealth, have the potential to improve access but may also exacerbate disparities due to the digital divide. Legal regulations governing insurance markets and mandates shape the availability and scope of coverage for different populations. Environmental factors, such as economic recessions or public health emergencies, can alter enrollment patterns and prompt policy changes that either facilitate or hinder access to insurance.
Future Implications for Health Administrators:
Among the six factors addressed in the PESTLE analysis, I believe that the political factor will have the greatest impact on my future as a healthcare administrator. Government policies and reforms include healthcare regulations, funding allocations, insurance mandates, and public health initiatives, making them the largest contributor to what will create direct change. Political intervention is the only avenue of decisions that will spark real change in healthcare, especially concerning insurance coverage. As previously mentioned over the course of the semester, in comparison to other healthcare delivery in other countries the U.S. is lacking in value and the current policies in place or lack thereof, directly shape the current predicament. The lack of available resource management accompanied by the strategic profit-aimed priorities of healthcare organizations creates a healthcare system that is in dire need of interventional changes along with improved patient outcomes. Political decisions can influence everything from reimbursement rates to coverage expansion and directly affect access, quality, and care costs. As a healthcare administrator, staying actively engaging in policy advocacy and creation is a goal of mine, I aim to hold a position where I can facilitate change in these areas.
PESTLE & Social Determinant Access:
Focusing on socioeconomic status and education, key social determinants of health, can improve access to health insurance by reducing barriers and increasing awareness of issues by bringing it to the forefront of political agendas. Creating a social campaign, propaganda, and general societal motivation to get insured will lead to higher enrollment, better access to preventive care, and result in improved health outcomes. Addressing these factors promotes health equity, decreases disparities, and reduces long-term healthcare costs by preventing severe health issues caused by delayed care. It will also highlight the issue for policy makers, government officials and agencies, by increasing the importance and showing that health insurance and reform is valued by the people. Ultimately, this will become a campaign platform for future candidates on all levels/branches of government and that’s when real improvement begins.
References:
Cunningham, P. J., & Kemper, P. (1998). Ability to Obtain Medical Care for the Uninsured. JAMA, 280(10), 921. https://doi.org/10.1001/jama.280.10.921
Woolhandler, S., & Himmelstein, D. U. (2017). The Relationship of Health Insurance and Mortality: Is Lack of Insurance Deadly? Annals of Internal Medicine, 167(6), 424. https://doi.org/10.7326/m17-1403
7 months ago
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