The Status of Healthcare Payment Systems in United States (Essay Sample)

Accountability in Healthcare
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Accountability in Healthcare
The healthcare payment system is one of the issues of concern being addressed in the United States to date. Over the years, the healthcare systems were more concerned with quantity over quality; how many patients they could be supported for a certain period. The government and private insurance entities are looking out for the most efficient payment system or model whose structures are rooted in quality patient care and better patient experience to promote a developed health care system while achieving health policy objectives. And the most common and recent payment models include accountable care organizations, bundling payments models, pay-for-performance, and value-based purchasing models. These models are more concerned with value to patient care. This is because they are built under the components of good information technology and accountability mechanisms that deliver more than typical payments to cover care costs and encourage accountable care, quality patient care, and equity in healthcare services. This paper examines the different healthcare payment models, including accountable care organizations, bundling payments, pay-for-performance and, value-based purchasing model, and their impact on patient care quality.
The Concepts of Healthcare Payment Models
Accountable Care Organisation and its Impacts on Healthcare Providers
Accountable Care Organization (ACO) is a group of healthcare entities, specialists, and physicians who collaborate to contract and provide quality care for the assigned care population by sharing medical and financial responsibility (Salmond and Echevarria, 2017, p.18). Its primary purpose was to create a healthcare system that enhances quality patient care delivered across all care systems, including social and community support services. To ensure quality care is provided, ACOs tie payment of healthcare services to quality of services to patients, such as patient satisfaction, thus creating accountability among healthcare providers. Consequently, ACOs impact healthcare providers in several ways. It facilitates improved coordination among healthcare providers through Health Information Technology (HIT), which reduces medical errors such as duplication of tests or procedures. ACOs bring several components, such as hospitals specialists and ensure they work jointly to guarantee patients better treatment care. Healthcare providers provide improved services and outcomes as a result of accountable care rooted by ACOs.
Difference Between Accountable Care Organization and Health Maintenance Organization
Accountable Care Organization model establishment was to help meet accountable care, which is quality over volume. This model differs from other earlier models, such as the health maintenance organization model (HMOs), established in the 90s. According to Salmond and Echevarria (2017), the ACOs focus is on delivering patient-centered healthcare. In essence, the strategies, care design management, and decision-making indicate how patients get involved through practice and quality improvements. Another difference is that ACOs do not restrict the physician that a patient wants to see. For instance, if a patient feels uncomfortable with one specialist, they have the freedom to change the specialist as opposed to HMOs. It rewards all providers that have participated in providing patient care. Lastly, unlike HMOs, ACOs do not require a pre-authorization provision, and therefore a patient can seek consultation with other providers.
The Role of Health Information Technology on Newer Models of Care
One of the strategies that help to foster accountable care is health information technology (HIT). HIT is a tool that tracks patient’s medical information and makes it accessible to all healthcare providers and the patient for better care management between the ACOs. HIT’s main role is to help reduce instances of duplicative tests or procedures. HIT ensures care providers prepare before a patient’s appointment to establish quality and best treatment plans through the patient’s electronic health record. According to Salmond and Echevarria (2017), another role of HIT is to allow patients to access and update their medical information with ease and consult with doctors through the patient portal. As a result, there is better communication between patients and their caregivers, empowering them to manage their healthcare plans better.
Significance of Hospitals Partnering with Primary Care Providers
For better patient care, models like ACO integrates healthcare components, including primary care and hospital care, to enhance population health. Primary care is the basic prevention of diseases such as chronic diseases (diabetes) through early diagnosis and treatment, which might otherwise cause death. Therefore, hospitals typically rely on primary care to obtain patient information to efficiently manage a patient’s condition and have a better experience. A study by the Center for Care Innovations CCI (2018) indicates that primary care partnering with hospitals enhances better communication, reducing unnecessary re-admission of patients in the hospitals through primary care follow-ups after hospitalization. Reports show that at least one in three patients experience medical error; therefore, primary care services become crucial to ensure patients are not re-admitted. With minimal re-admission, hospitals save on finances that otherwise could have been used to re-admit patients.