1 Running Head: Policy Briefing 2 Policy Briefing Policy Briefing kwe Comment by Jason Richter: Nice job describing the major issues facing the population in the BR. You have a very thorough discussion of the structure of the delivery system (Q2) but don’t relate it back to the scenario from the test. Your recommendations are reasonable, although I think some of the key pieces were missing. I liked how you discussed an education campaign to increase awareness of the benefits of the ACA. You could have discussed mobile clinics which is a good way to overcome the transportation issue. Some discussion on how to overcome medical staff shortages would have been helpful. Options such as telehealth are appropriate here. HCAD 620 Fall 2016 Tables of Content Introduction3 Problem Statement3 Structure of the Delivery System4 Managed Care5 Military5 Subsystem for Vulnerable Populations6 Integrated Delivery System (IDS)7 The Effect of Healthcare Delivery Structure/System7 The Impact of ACA8 Alternatives9 Recommendations11 References13 Introduction Being a mid-career health policy administrator, the Director of the Louisiana State Health Department has assigned me hired as the Health Policy Coordinator for the Bayou Region of Louisiana.  The institutional healthcare services framework contains one regional medical center, five small community hospitals, a regional health center, and a contracted behavioral health provider group.  In 14 towns, there are physician medical clinics, but most of the Bayou Region is remote, consist of small villages, semi-swamp, or reservation land for several indigenous groups. According to Federal standards, the BR’s 100% of the population would be assumed rural, and only 23 % live in towns of 20,000 or more.  73% of residents belong to families with at least one member as a full-time worker. In the BR, the occupants who don't live in towns have a tendency to be seasonally employed, in as a part-time employee, or self-employed, with a low probability of employer's offered insurance policy.  Generally, of the uninsured who are poor, (50%) of those are from families with full-time employees. One-fourth of the uninsured are between the ages of 45 and 64, and 26% report being in reasonable or weak health condition. Latest studies of the behavioral healthcare framework, tribal health center, and clinics have identified that the residents of BR are more likely the victims of depression, schizophrenia, post-traumatic stress disorder, and substance abuse.  There is high concern that these problems are linked to increased rates of domestic violence and suicide. Problem Statement Despite many improvements in the healthcare system over the past decade, the healthcare disparities are still growing that is making a huge part of the BR underserved. The regions that are highly remained underserved are low income areas where the concentration of homeless people is high. Reports by social service agencies have identifi ...

1. 1
Running Head: Policy Briefing
2
Policy Briefing
Policy Briefing
kwe Comment by Jason Richter: Nice job describing the major
issues facing the population in the BR.
You have a very thorough discussion of the structure of the
delivery system (Q2) but don’t relate it back to the scenario
from the test.
Your recommendations are reasonable, although I think some of
the key pieces were missing. I liked how you discussed an
education campaign to increase awareness of the benefits of the
ACA. You could have discussed mobile clinics which is a good
way to overcome the transportation issue. Some discussion on
how to overcome medical staff shortages would have been
helpful. Options such as telehealth are appropriate here.
HCAD 620 Fall 2016
Tables of Content

2. Introduction3
Problem Statement3
Structure of the Delivery System4
The Effect of Healthcare Delivery Structure/System7
The Impact of ACA8
Alternatives9
Recommendations11
References13
Introduction
Being a mid-career health policy administrator, the Director of
the Louisiana State Health Department has assigned me hired as
the Health Policy Coordinator for the Bayou Region of
Louisiana. The institutional healthcare services framework
contains one regional medical center, five small community
hospitals, a regional health center, and a contracted behavioral
health provider group. In 14 towns, there are physician medical
clinics, but most of the Bayou Region is remote, consist of
small villages, semi-swamp, or reservation land for several
indigenous groups.
According to Federal standards, the BR’s 100% of the
population would be assumed rural, and only 23 % live in towns
of 20,000 or more. 73% of residents belong to families with at
least one member as a full-time worker. In the BR, the
occupants who don't live in towns have a tendency to be
seasonally employed, in as a part-time employee, or self-
employed, with a low probability of employer's offered
insurance policy. Generally, of the uninsured who are poor,
(50%) of those are from families with full-time employees. One-
fourth of the uninsured are between the ages of 45 and 64, and
26% report being in reasonable or weak health condition. Latest
studies of the behavioral healthcare framework, tribal health
center, and clinics have identified that the residents of BR are

3. more likely the victims of depression, schizophrenia, post-
traumatic stress disorder, and substance abuse. There is high
concern that these problems are linked to increased rates of
domestic violence and suicide. Problem Statement
Despite many improvements in the healthcare system over the
past decade, the healthcare disparities are still growing that is
making a huge part of the BR underserved. The regions that are
highly remained underserved are low income areas where the
concentration of homeless people is high. Reports by social
service agencies have identified that poverty is another
fundamental issue for the region. This issue is because the
numbers of homeless people in the BR are very high that are
mostly living seasonally (or in most cases year-round) in
campers, out of automobiles, tents, or moving between
campgrounds or camping areas in the state park grounds. In
some cases these homeless people also have families with
children.
The healthcare department of BR faces some serious issues in
the delivery of healthcare to the underserved groups because
due to lack of proper residents and jobs; it is hard to reach these
people on a regular basis. Minorities are making a significant
part of the underserved group that is more likely at a
disadvantage because of language and communication issues.
Moreover, poverty and low-income made this population highly
resistant to visit medical care centers due to the fear of out of
pocket expenses (Mullins, 2005).
The increasing trend of insured health care services has also
made it hard for the poor and low-income people to access
quality health care services which are another potential barrier.
In short, the region is highly exposed to a number of issues such
as language barriers, low income, and dependence of allied
medical staff (nurses and pharmacists), healthcare insurance
trend, and the unique culture and ethnicity, as well as the
mindset of the minorities of the region. All these issues are
posing serious challenges to the Louisiana State Health
Department to overcome the situation and to improve the

4. healthcare service system so that every single individual of the
region could become able to access health care services freely
and fairly (Mullins, 2005). Structure of the Delivery System
The structure of the delivery system in BR is in accordance with
that of the overall healthcare structure of the United States. The
US has not a universal health care delivery system like many
other developed countries. Some various subsystems have been
created through market forces and the requirement of some
specific population segments. The major subsystems of the US
delivery include Managed Care, Military, and Subsystems for
Vulnerable Populations, and Integrated delivery systems (Niles,
2014). · Managed Care
Managed care is one of the major systems of the health care
delivery; 1) to achieve efficiency by integrating four functions
of the healthcare delivery, i.e. Financing, Risk underwriting,
Capitation or discount, and Utilization control, 2) employs
techniques to monitor the use of health care systems, and 3)
helps in the determination of the of the services on which it
should be purchased or in other words, determines that how
much amount should be paid to the healthcare providers. This is
the most active medical care delivery system in the US in which
they major financier is the government. The purpose of this
system is to reduce the costs and to improve overall health care
system in the US (Niles, 2014).
Under this system, the enrollees (a member that would be
covered under a plan), or employees do not purchase an
insurance plan from companies directly using traditional means;
rather they are directed to purchase from the contractors of the
government/chief financier, i.e. from a managed care
organization (MCO). Examples of MCO include PPO or HMO.
In this situation, MCO deals with other service providers on
behalf of the employee or enrollee to get some discounted fees
from the service provider (Kamerow, 2008).
A study conducted by America’s Health Insurance Plan in 2009
discovered that people who are opting for out-of-network
providers have to pay high fees for getting same coverage. The

5. service providers got paid using different techniques with a
guaranteed patient population (Niles, 2014). · Military
This is a particular kind of health care delivery system that aims
to provide health
care services only to the active-duty military officers and
personnel of the US armed forces. It is also providing
healthcare services to certain non-military services such as
National Oceanographic and Atmospheric Association (NOAA),
and Public Health service. Under this system, routine
ambulatory care, preventive care, and treatment care, mostly
provided by salaried health care personnel. Many of them had
previously worked in a military force or uniformed services.
Veteran administration facilities are used to provide long-term
care to retired personnel, while TRICARE program is used to
provide healthcare services to the families and dependents of
the military personnel (Niles, 2014). · Subsystem for
Vulnerable Populations
To be able to deliver healthcare services to the vulnerable
population including poor, uninsured, minority, people living in
the geographically or economically disadvantaged regions, and
immigrants, the US healthcare delivery system has developed
subsystem called a “safety net” of the providers to ensure the
delivery of healthcare to those people. The safety net is
comprised of the essential health care services providers such as
physicians, health centers, hospital’s emergency departments,
and outpatient departments, and clinics. These health care
providers are specially designed to provide healthcare services
to the underserved population. As per the unique role of these
centres, some additional features are also added to them for the
ease and convenience of the patients such as language
translation, outreach, transportation, social support services,
nutrition, child care, health education, and case management to
fully help the vulnerable population of a state (Niles, 2014).
Government healthcare programs including State Children
Health Insurance Program (SCHIP), Medicaid, Bureau of
Primary Health Care (BPHC), and Medicare, etc., are few

6. examples of policies and special grants to reach vulnerable
populations. Recently, the Affordable Care Act (ACA) is
introduced in 2010 to bring a significant change and
improvement in the US healthcare system. The ACA refers to
two different types of legislations: the Patient Protection
and Affordable Care Act (P.L. 111-148) and the Health Care
and Education Reconciliation Act of 2010 (P.L. 111-152). The
two legislations together bring an expansion in the coverage of
Medicaid to provide intensive healthcare services to the
vulnerable population. Moreover, compared to Medicaid,
Medicare, and SCHIP programs, the eligibility criteria for ACA
is quite simple and effective that encourage the vulnerable
population to get access to essential health care services.
Although, this system has not reduced the numbers of uninsured
as expected by the government, however, it helped the
government in getting around 16 million people as newly
insured population of the US (Jonas, Goldsteen, Goldsteen, &
Jonas, 2013). · Integrated Delivery System (IDS)
The final major component of the US healthcare delivery system
is Integrated Delivery. This system was formed over the last
decade through organizational integration. The integrated
delivery system constitutes numerous shapes of ownership and
strategic connections between hospitals, insurers, and
physicians with an objective to provide a range of healthcare
services through a network of organizations to provide a
continuous healthcare service to a determined population
(Jonas, Goldsteen, Goldsteen, & Jonas, 2013). The Effect of
Healthcare Delivery Structure/System
The current healthcare delivery structure of the US seems less
valuable because it is providing high benefits to the wealthy and
middle class instead of poor and low-income families. In the
United States, regardless of the individual states of the country,
healthcare services can be accessed by people in the following
ways: health insurance through the employer, registered or
enrolled in any of the government healthcare program, ability or
financial power to purchase a healthcare policy using private

7. funds, ability to purchase services from private or commercial
insurance companies, and ability to access healthcare services
offered by government healthcare plans for vulnerable
population or charity based services (Jonas, Goldsteen,
Goldsteen, & Jonas, 2013).
Health insurance has a high impact on the health care delivery
system in the US that ensures a quick and quality access to the
healthcare service. Although, the government has offered
certain programs to provide health care services to the
uninsured, however, accessing those services are subjected to
high barriers. For example, federally provided or specified
centers or clinics usually have limited facilities and staff and
are available only in a particular location with an aim to cover a
huge part of a state. The eligibility criteria are very stringent
that makes fewer people eligible for the services (Niles, 2014).
Moreover, US laws have empowered the emergency departments
of the hospitals to evaluate the condition of patients and provide
free treatment only under certain conditions. Otherwise,
uninsured people have to pay for getting treatment. The existing
healthcare delivery system usually allows the uninsured
population to get treatment under government programs only for
acute care. In this regard, the structure of the healthcare
delivery system actually hinders health delivery to underserved
population (Niles, 2014). The Impact of ACA
Affordable Care Act (ACA) is introduced in 2010 with an aim
to bring massive changes in the US healthcare for the uninsured
and vulnerable population since the development of Medicaid
and Medicare programs introduced in 1965. The new Act has
expanded the coverage of healthcare delivery system by
improving the quality, efficiency, consumer protection, and by
reducing health care costs (Niles, 2014). Although, these
reforms have increased the benefits of health care to the
vulnerable population and has encouraged them to insure
themselves with government programs to get expanded health
care services (Monaghan, 2013).
The ACA has great potential to attract and provide healthcare

8. coverage to vulnerable population of the United States;
however, still there are some barriers that could create potential
difficulties in accessing expanded coverage. The biggest
problem is developing awareness among minorities, low-income
population, and homeless people about the expansion of the
medical care services under government programs because
people still are unaware about the expansion of the services
under Medicare and Medicaid. The reform has insured more
than 16 million people in a short period of 5 years making a
number of non-eligible people of Medicare and Medicaid
eligible under the new criteria. This reform has effectively
brought positive changes in the payment incentives of the
healthcare centres, hospitals, and physicians, has reduced the
hospital conditions for treating emergency patients, etc.
(Monaghan, 2013).
Moreover, the reform has increased the ability of the
government to control healthcare system and has encouraged it
to make the delivery system more efficient and fair to reach
vulnerable population. The current impact of the ACA on
healthcare delivery system seems positive and could become
more efficient by creating awareness among the underserved
population; however, the reform is too new to understand its
long-term effects on the health care delivery system (Jonas,
Goldsteen, Goldsteen, & Jonas, 2013).
Furthermore, the regulations of the ACA with respect to the
individual state laws and the individual small group markets of
the private insurance has made the reputation of ACA kind of
controversial. The biggest drawback of the ACA is that it has
completely excluded the immigrants from the benefits of ACA
(Stutz & Baig, 2013). In this regard, the new reform is still
making it hard for some of the vulnerable population of the BR
region to access healthcare which is hindering the success and
poverty controls of the government on the state. Alternatives
To meet the health delivery challenges in the Bayou Region,
Louisiana, the Director of the Louisiana State Health
Department needs to develop a proper plan to implement in

9. order to achieve desired improvements in the healthcare system.
It is hard to achieve those benefits overnight; therefore, a set of
alternatives is presented to the Louisiana State Health
Department to achieve desired results.
· The Louisiana State Health Department should launch
programs across the state with a focus on the vulnerable
population of the region in order to create awareness about the
ACA to enroll a high number of people under government-
funded healthcare system. It is because the majority of
individuals event do not understand what insurance is and when
they are called from the Bureau of Primary Healthcare and are
asked about their insurance status they usually say that they are
insured which is making a huge problem in the region ("Most
Americans unaware of impact of ACA on their lives", 2014).
· The Louisiana State Health Department needs to take is to
develop critical access hospitals and clinics in order to ensure
quick access to the timely and quality healthcare services for
the rural population. The development of new hospitals and
clinics with more facilities will allow the Louisiana State
Health Department to enjoy full benefits of the expansion of the
Medicaid. To improve the delivery of healthcare through these
hospitals, the Louisiana State Health Department should
recognize potential rural health providers and should
partnership with those providers to create a network of
organizations (Camann & Long, 2014).
· The Louisiana State Health Department should launch a
universal healthcare delivery plan throughout the state by
eliminating the health care differences of insured, uninsured,
and poor population (Soares, 2012).
· The Louisiana State Health Department should redesign the
healthcare service providing models to increase their incentives
to eliminate fee-for-service models to encourage them to
improve the coverage to underserved population to eliminate
health disparities (Addicott & Shortell, 2014). For this purpose,
the Louisiana State Health Department should consider bundled
payments and Accountable Care Organizations as potential

10. alternatives. Both the alternatives are based on certain
incentives to the health care providers that they will get in
response to the delivery of quality healthcare services to the
patients. The development of Accountable Care Organizations is
the most appropriate option for the Louisiana State Health
Department (Roehr, 2010). Recommendations
It is recommended to the Louisiana State Health Department to
implement the last two alternatives, i.e. the development of a
universal healthcare plan for the entire state and the
implementation of Accountable Care Organizations Network to
improve the quality and accessibility of BR population to health
care services. For this purpose, the state government should
charge a specific percentage of the income of the working group
of the region and needs to pair it with the federal and state
healthcare funds to form a single and universal health care
system to deliver equal access opportunities to the entire
population (Soares, 2012). Using those collective funds, the
Louisiana State Health Department should develop Accountable
Care Organizations network to help the healthcare service
providers in getting certain incentive against the provision of
quality health care services.
This would contribute to developing a strong coordination
between all the service providers in a region that will eventually
improve the overall system of the healthcare delivery. The
option will not only help in the improvement of overall health
care services but will also assist the government of the state as
well as the healthcare providers in making significant savings
(Roehr, 2010). Furthermore, this option would better assist the
Louisiana State Health Department in developing a universal
health care service plan by combining federal government
(Medicaid and ACA funds) and state government funds to form
a unified health care system to reach out the vulnerable
population of the Bayou Region (Addicott & Shortell, 2014).
References
Addicott, R. & Shortell, S. (2014). How “accountable” are
accountable care organizations?. Health Care Management

11. Review, 39(4), 270-278.
http://dx.doi.org/10.1097/hmr.0000000000000002
Camann, M. & Long, J. (2014). Health Promotion with
Vulnerable Population Groups. OJCCNH.Org,4(1), 29-37.
http://dx.doi.org/10.9730/ojccnh.org/v4n1a3
Jonas, S., Goldsteen, R., Goldsteen, K., & Jonas, S.
(2013). Jonas' introduction to the U.S. health care system. New
York: Springer Pub. Co.
Kamerow, D. (2008). Our perfectly designed US healthcare
system. BMJ, 337(nov24 2), a2702-a2702.
http://dx.doi.org/10.1136/bmj.a2702
Monaghan, M. (2013). The Affordable Care Act and
implications for young adult health. Translational Behavioral
Medicine, 4(2), 170-174. http://dx.doi.org/10.1007/s13142-013-
0245-9
Most Americans unaware of impact of ACA on their lives.
(2014). Pharmacoeconomics & Outcomes News, 714(1), 31-31.
http://dx.doi.org/10.1007/s40274-014-1652-y
Mullins, C. (2005). Health disparities: A barrier to high-quality
care. American Journal Of Health-System Pharmacy, 62(18),
1873-1882. http://dx.doi.org/10.2146/ajhp050064
Niles, N. (2014). Basics of the U.S. health care system.
Roehr, B. (2010). US health insurer begins shift from fee for
service payments. BMJ, 341(oct25 2), c6015-c6015.
http://dx.doi.org/10.1136/bmj.c6015
Soares, J. (2012). Social Security: Universal Versus Earnings-
dependent Benefits. Economica, n/a-n/a.
http://dx.doi.org/10.1111/j.1468-0335.2012.00930.x
Stutz, M. & Baig, A. (2013). International Examples of
Undocumented Immigration and the Affordable Care
Act. Journal Of Immigrant And Minority Health, 16(4), 765-
768. http://dx.doi.org/10.1007/s10903-013-9790-z
Mid-Term Examination

12. INSTRUCTIONS: Develop a policy paper based on the scenario
presented below. The product should be a minimum of 5 and a
maximum of 12 pages (excluding cover page, appendices,
charts, and references), double spaced, conforming to APA
standards.
NOTE: The facts in this scenario are hypothetical. While the
bayou region of Louisiana is a real place with geographic
characteristics as described, the population, health system, and
other particulars are hypothetical for purposes of this paper.
FACTS:
As a mid-career health policy administrator, you have recently
been hired as the Health Policy Coordinator for the Bayou
Region of Louisiana.
The Bayou Region of Louisiana (BR) contains some 12,600
square miles with a population of just 265,000 residents. The
institutional health care system contains one regional medical
center, 5 small community hospitals, a regional health center,
and a contracted behavioral health provider group. There are
physician medical clinics in 14 towns, but most of the BR is
remote, composed of small villages, semi-swamp, or reservation
land for several indigenous groups. (You do not manage this
health system, but these are the regional facilities in the area).
In the BR, 100% of the population would be considered rural by
Federal standards, and only 23 % live in towns of 20,000 or
more. 73% of residents come from families with at least one
full-time worker. In the BR, the residents who do not live in
towns tend to be more seasonally employed, in part-time work,
or self-employed, with a low likelihood of employer provided
insurance. Historically, of the uninsured who are poor, half
(50%) of those are from families with full-time workers. One-
fourth of the uninsured are between the ages of 45 and 64, and
26% report being in fair or poor health.
In addition, recent surveys of the behavioral health system,
clinics, and tribal health center report significant rates of
depression, post-traumatic stress disorder, schizophrenia and
substance abuse / dependence among BR residents. There is

13. concern that these problems are related to high rates of suicide
and domestic violence.
Finally, other reports from social service agencies report that
there is a significant population in the BR that is effectively
homeless, living seasonally (or sometimes year-round) in
campers, tents, or out of automobiles, moving between
campgrounds or camping areas in the state park grounds. This
population includes families with children in some cases.
The Director of the Louisiana State Health Department has
requested that you prepare a policy briefing discussing the
delivery of Health Care Services to the BR residents. The paper
should accomplish the following:
1. Discuss the problem of underserved populations and
subgroups, including characteristics of those groups and
barriers to delivery.
2. Examine the structure of the delivery system and how this
helps or hinders health delivery.
3. Discuss the impact of ACA.
4. Make clear recommendations as appropriate for meeting the
health delivery challenges of the BR.
Please prepare a well written, well organized, and
professionally structured policy paper as requested.