ACO Reach Program An Advanced Value-Based Payment Model.pptx
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The healthcare landscape in the United States is ever-evolving, and the introduction of the Accountable Care Organization (ACO) Realizing Equity, Access, and Community Health model stands out as a milestone. As cited in CMS's "A Year in Review June 2021-May 2022," the ACO REACH program is a key accomplishment in advancing strategic initiatives.
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In today’s ever-evolving healthcare landscape, the Centers for Medicare & Medicaid Services (CMS) is constantly striving to enhance the efficiency and effectiveness of Medicare payment models. One such groundbreaking initiative is the CMS ACO Reach, which is poised to usher in a new era of advanced Medicare payment models.
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Read the scenario that you will use for the Individual Projects in ea.pdf
Read the scenario that you will use for the Individual Projects in each week of the course. The
Centers for Medicare and Medicaid Services (CMS) has taken on a more visible role in health
care delivery. Many changes have transpired to improve patient safety along with the
implementation of additional quality metrics, and these changes impact reimbursement rates
Likewise, the Patient Protection and Affordable Care Act has changed the reimbursement fee
structure of Medicare and Medicaid reimbursement for health care services. Other legislation
including the HITECH Act and the Medicare Authorization and CHIP Reactivation Act of 2015
(MACRA) all impact how healthcare organizations receive reimbursement and demonstrate use
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summary of the current regulations regarding Medicare reimbursement including how MACR
impact reimbursement if/when Healing Hands coordinates delivery of services by affiliating with
physician practices For this assignment, write a 2-3 page report that you will deliver to Mr.
Magone on how the new CMS initiatives and regulations impact the organization\'s revenue
structure. In your presentation, address the following questions: Why did CMS become more
involved in the reimbursement component of health care? How does CMS\'s involvement impact
the reimbursement model for Healing Hands Hospital and other health care organizations If
CMS reimbursement regulations for Medicare and Medicaid change, does it follow that other
insurance providers change heir policies on reimbursement? What tools can be implemented to
ensure organizations such as Healing Hands Hospital and physician practices are meeting the
policies and procedures set forth by CMS? Identify 3 tools from the CMS Web site that are
helpful in meeting the requirements for Medicare reimbursement set forth by CMS
Solution
Part-a & part-b:
The physician’s work, practice expense, and malpractice, RVU values, CMS (centers for
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organization. Therefore, CMS become highly involved in the reimbursement component of
health care to patients as per their \"insurance packages\". The CMS\' involvement in “budget
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organizations is mainly for physician RVU based payments from Medicare & Medicare that can
control its physician costs by adjusting physician payment rates based on “previous periods in a
calendar year” as per federal acts and regulations. The Medicare is going to control physicians
costs according to “medical procedures and medical visits of their record” in a Jan- 1 ending Dec
31. Conversion Factor is main basis to control the physician costs ac.
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In today’s ever-evolving healthcare landscape, the Centers for Medicare & Medicaid Services (CMS) is constantly striving to enhance the efficiency and effectiveness of Medicare payment models. One such groundbreaking initiative is the CMS ACO Reach, which is poised to usher in a new era of advanced Medicare payment models.
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Read the scenario that you will use for the Individual Projects in ea.pdf
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Centers for Medicare and Medicaid Services (CMS) has taken on a more visible role in health
care delivery. Many changes have transpired to improve patient safety along with the
implementation of additional quality metrics, and these changes impact reimbursement rates
Likewise, the Patient Protection and Affordable Care Act has changed the reimbursement fee
structure of Medicare and Medicaid reimbursement for health care services. Other legislation
including the HITECH Act and the Medicare Authorization and CHIP Reactivation Act of 2015
(MACRA) all impact how healthcare organizations receive reimbursement and demonstrate use
of data to improve quality and delivery of patient care Mr. Magone, CEO of Healing Hands
Hospital, has asked you to join the \"Future of Healing Hands Task Force, and your first
assignment is to work with the Hospital Chief Financial Officer, Mr. Johnson, and provide a
summary of the current regulations regarding Medicare reimbursement including how MACR
impact reimbursement if/when Healing Hands coordinates delivery of services by affiliating with
physician practices For this assignment, write a 2-3 page report that you will deliver to Mr.
Magone on how the new CMS initiatives and regulations impact the organization\'s revenue
structure. In your presentation, address the following questions: Why did CMS become more
involved in the reimbursement component of health care? How does CMS\'s involvement impact
the reimbursement model for Healing Hands Hospital and other health care organizations If
CMS reimbursement regulations for Medicare and Medicaid change, does it follow that other
insurance providers change heir policies on reimbursement? What tools can be implemented to
ensure organizations such as Healing Hands Hospital and physician practices are meeting the
policies and procedures set forth by CMS? Identify 3 tools from the CMS Web site that are
helpful in meeting the requirements for Medicare reimbursement set forth by CMS
Solution
Part-a & part-b:
The physician’s work, practice expense, and malpractice, RVU values, CMS (centers for
Medicare and Medicaid services) is required to control overall expenditures in health care
organization. Therefore, CMS become highly involved in the reimbursement component of
health care to patients as per their \"insurance packages\". The CMS\' involvement in “budget
Neutrality” & the reimbursement model at Healing Hand hospital & other health care
organizations is mainly for physician RVU based payments from Medicare & Medicare that can
control its physician costs by adjusting physician payment rates based on “previous periods in a
calendar year” as per federal acts and regulations. The Medicare is going to control physicians
costs according to “medical procedures and medical visits of their record” in a Jan- 1 ending Dec
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Integrated health care delivery systems (IDS) was developed to initiate excellence health care access and quality of care to entire populations and community by collaborating and coordinating diverse healthcare professionals. Main driving force of IDS is patient centered care by using resources such as collaborating care from physicians and allied health care professionals to construct continuum of care, to deliver care in the most cost-effective way, utilize trained and competent providers by utilizing evidenced -based practice and combine innovation such as EHR (Electronic Health Records) system and team work to produce improved healthcare system.
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Dq 3-1
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Washington (DC): National Academies Press (US); 2010.
5 Approaches to Improving Value—Provider and Manufacturer
Payments
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Payment design, coverage policies, reimbursement rules, and other financial incentives and
disincentives are powerful motivators when attempting to steer the healthcare system toward
more desirable care patterns (Guterman et al., 2009). Experiments with payment design and
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testing rates (Rosenthal et al., 2005). After underscoring that the current incentive system and
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photo 1.JPGphoto 2.JPGLESSON 16 Transition to Elec.docx
photo 1.JPG
photo 2.JPG
LESSON 16
Transition to Electronic Health Record
LEARNING OUTCOMES
______________________________________________________________________________
In this lesson, you will do the following:
Evaluate the factors that drive an organization to adopt a strategy to create an electronic health
care record.
READINGS
The following reading assignments are for Lessons 13 through 16:
Gartee Text:
Chapter 2, pp. 27 - 41
Chapter 7, pp. 152 - 181
Chapter 8, pp. 182 - 206
ACTIVITIES / ASSESSMENTS
The following activities/assessments are for Lessons 13 through 16:
1. Read the assigned pages from the Gartee text, Unit 4 PowerPoint, and Lecture Notes.
2. Participate in the weekly discussion question.
3. Complete the written assignment.
WRITTEN ASSIGNMENTS
Research and discuss three challenges facing an organization, and review how the conversion to
a full electronic health record could address the challenges identified.
PLEASE NOTE: All graded assignments for the lessons in this unit should be grouped together
and submitted as ONE document using the Assignment Submission form accessed from your
course homepage or http://www.sjcme.edu/gps/assignments.
All activities/assignments for this unit should be as follows:
1. Should include a cover sheet for each assignment stating the following:
Course (HA 214)
Your Name
Unit and Lesson Number
Date Submitted
2. Each individual assignment number and copy of the assignment directions should be
included in the submission as the starting header of each lesson.
3. Carefully check grammar and spelling.
4. Use APA format for any research or sources that are being used or quoted.
5. Email the instructor if you have questions regarding the assignments.
http://www.sjcme.edu/gps/assignments
LESSON 16
Transition to Electronic Health Record
LECTURE NOTES
______________________________________________________________________________________
The push for the conversion from paper-based to electronic health records is clear and definite.
The mandate comes from the federal government in terms of regulatory requirements, financial
incentives, and a desire to reduce costs and improve quality. Research and experience has
indicated that a fully deployed electronic health record system will achieve these desired
outcomes. The ability to enhance the productivity of personnel is another business outcome that
health care providers will need to consider. However, there are major challenges and barriers to
achieving full implementation of interoperable electronic health records.
Costs of Care
The costs of health care in the United States are reported to be almost 17% of the gross national
product (GNP), or about $7000 per capita for every person in the country. The costs for health
care continue to rise faster than consumer inflation.
This makes the cost of h.
California health care markets vary significantly by metropolitan ar
California health care markets vary significantly by metropolitan area. Some are highly consolidated, while others are markedly less so. Kaiser Permanente has a large presence in some areas, but a smaller one in others. The degree of commitment to population health and ACO contracting varies, and populations are different, varying by age, income, health, and access to care.
Recent developments—including ACA insurance expansions, changes in Medicare and Medicaid provider payments, ACOs, and increases in patient cost-sharing—affect the delivery of care in California markets. These developments challenge the viability of hospitals, physician groups, and other health care organizations, and they threaten to hinder access to local health services as premiums and insurance prevalence grow. In 2013, a group of health care leaders from across the state convened to address the health care delivery issues facing California. They came up with a report that sketched out a vision for health care in California in the early 2020s:
A New Vision for California's Healthcare System: Integrated Care with Aligned Financial Incentives
(Review the Executive Summary on pages 6-9 and the Vision found on pages 12-13.)
The objective of this exercise is to develop a set of recommendations for provider organizations in each of the following California markets to change in ways consistent with the vision expressed in the Berkeley report:
Orange County
Recent CHCF reports provide details regarding the diversity of organizational models and affected populations within several California markets:
California Health Care Almanac: Regional Markets
. Another resource to consider for ideas on how change is happening is a California Health Care Foundation Report:
“Many Routes to the Top: Efforts to Improve Care Quality, Coordination, and Costs through Provider Collaborations.”
Create 3-4 slides answering the following:
1. Analyze and describe the structure of the health care delivery in OC
2. What services are delivered by various providers in OC?
3. How do the services relate to each other in OC?
Please cite and reference:
1. The links in the instruction (above)
2. Feldstein, P. J. (2015).
Health policy issues: An economic perspective
.
Using speaker notes too.
...
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The tools needed to capture, organize, and share healthcare data are truly evolving at the speed of light. Patient Centered Medical Homes play a vital role in the path toward accountable care and technology, staff, and workflow transformation are necessary to achieve PCMH recognition. This transformation allows healthcare providers to deliver higher quality coordinated care by streamlining and rationalizing the patient experience.
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Market Power, Transactions Costs, and the Entry
of Accountable Care Organizations in Health Care
H. E. Frech III.1 • Christopher Whaley2 •
Benjamin R. Handel3 • Liora Bowers4 •
Carol J. Simon5 • Richard M. Scheffler6
Published online: 15 July 2015
� Springer Science+Business Media New York 2015
Abstract ACOs were promoted in the 2010 Patient Protection and Affordable
Care Act (ACA) to incentivize integrated care and cost control. Because they
involve vertical and horizontal collaboration, ACOs also have the potential to harm
competition. In this paper, we analyze ACO entry and formation patterns with the
use of a unique, proprietary database that includes public (Medicare) and private
ACOs. We estimate an empirical model that explains county-level ACO entry as a
function of: physician, hospital, and insurance market structure; demographics; and
other economic and regulatory factors. We find that physician concentration by
organization has little effect. In contrast, physician concentration by geographic
Earlier versions of this paper were presented at the International Industrial Organization Conference in
Boston, the International Health Economics Association meeting in Sydney, the Allied Social Science
meetings in Philadelphia, the ACO Workshop in Berkeley, and the Bates White Health Care and Life
Science Seminar in Washington, D.C. Thanks are due to the participants of those meetings, especially
Martha Starr, Dean Rice, and Martin Gaynor for helpful comments. Thanks are also due to Sandra
Decker, Abe Dunn, Robert Obstfeldt, Jim Rebitzer, Michael Morrisey, Jessica Foster, and Lee Mobley
for helpful comments on earlier versions and to the referees and editor of this journal for more recent
useful comments.
& H. E. Frech III.
[email protected]
Christopher Whaley
[email protected]
Benjamin R. Handel
[email protected]
Liora Bowers
[email protected]
Carol J. Simon
[email protected]
1
Department of Economics, University of California, Santa Barbara, Santa Barbara, CA 93106,
USA
123
Rev Ind Organ (2015) 47:167–193
DOI 10.1007/s11151-015-9467-y
http://crossmark.crossref.org/dialog/?doi=10.1007/s11151-015-9467-y&domain=pdf
http://crossmark.crossref.org/dialog/?doi=10.1007/s11151-015-9467-y&domain=pdf
site—which is a new measure of locational concentration of physicians—discour-
ages ACO entry. Hospital concentration generally has a negative effect. HMO
penetration is a strong predictor of ACO entry, while physician-hospital organiza-
tions have little effect. Small markets discourage entry, which suggests economies
of scale for ACOs. Predictors of public and private ACO entry are different. State
regulations of nursing and the corporate practice of medicine have little effect.
Keywords Health care competition � Antitrust � Entry � Integration � Accountable
care organizations � Transactions costs � Obama plan
JEL Classification L 14 � I11 � L44 � I18 � L41
1 Introduction and Overview
The US health car ...
Running Head HEALTHCARE STAKEHOLDER CONFLICTS1HEALTHCARE .docx
Running Head: HEALTHCARE STAKEHOLDER CONFLICTS
1
HEALTHCARE STAKEHOLDER CONFLICTS
5
Stakeholder Conflicts in Healthcare Visions
Kendra Smith
Grand Canyon University: HCA 675
Introduction
The stakeholders in the healthcare service in any jurisdiction entail the government, the healthcare providers or the physicians, the payers, the patients as well as healthcare professional organizations.
These stakeholders work hand in hand to ensure efficiency and professionalism in healthcare delivery (Blair et al, 1988). They do this by developing succinct policies and effectively implement them for the sole purpose of improving healthcare services. However, there have been serious conflicts in opinion regarding enhancing healthcare service practices and proper administrative mechanisms for the achievement of better services, among the stakeholders.
Conflicts in Health Vision
One of the major health reform visions which have generated considerable debate concerns the accommodation of evidence-driven healthcare service practice, which the government of the United States has instructed all healthcare service providers or organizations to adopt. The major emphasis on this aspect of medicine is the requirement by the government that all healthcare service providers or organizations should document which healthcare services they provide and why they provide such healthcare services to the communit
y.
The argument behind this requirement is that it will enable the government, or it will be generally helpful in gauging the benefits the community gains from such healthcare services. In addition, establishing evidence-driven healthcare practice according to healthcare practitioners will help in identifying specific health problems within a community, and subsequently, design the most appropriate medical response. Some healthcare stakeholders also believe that this is an avenue that the government intends to use in creating and forging a closer working relationship between private and public healthcare providers. However much most stakeholders, both private and public, appreciate this evidence-based healthcare practice, as a vital component in improving healthcare services, the major concern is about how such data should be obtained. Some healthcare providers have reasoned that these data should be generated from the already existing data, due to the costs associated with activities that may lead to acquiring and establishing sound data or information domain. In response to this requirement, most of the healthcare organizations have established community-based information or data collection and management mechanisms, which enable them to collect data concerning community health concerns and threats, then define effective ways of response.
With the introduction and implementation of a series of healthcare reforms in the United States, such as the Obamacare and Trumpcare, there is general expectation that there will be enhanced access to healthcare service ...
Achieving Stakeholder Engagement: A Population Health Management Imperative
To succeed in population health management (PHM), organizations must overcome barriers including information silos and limited resources. Due to the systemwide nature of these challenges, widespread stakeholder engagement is an imperative in population-based improvement.
An effective PHM stakeholder engagement strategy incorporates the following:
Includes as many stakeholders as possible at the beginning of the journey.
Meets the unique analytics and reporting needs of the organization.
Enables users to measure, and therefore manage, PHM outcomes.
Provides the real-time analytics value-based care requires.
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Healthcare Data Aggregation is crucial in streamlining information, improving patient care, and enhancing overall healthcare outcomes. Aggregating healthcare data allows for the creation of comprehensive patient profiles by pulling information from various sources such as electronic health records (EHRs), wearable devices, and diagnostic tools. This holistic view enables healthcare professionals to make more informed decisions about patient care.
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Healthcare providers face various challenges in maintaining financial stability, and one critical aspect is the accurate assessment and management of risks. Implementing an effective risk adjustment solution, particularly combined with advanced technologies, can significantly contribute to financial stability.
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DQ 3-2Integrated health care delivery systems (IDS) was develope.docx
DQ 3-2
Integrated health care delivery systems (IDS) was developed to initiate excellence health care access and quality of care to entire populations and community by collaborating and coordinating diverse healthcare professionals. Main driving force of IDS is patient centered care by using resources such as collaborating care from physicians and allied health care professionals to construct continuum of care, to deliver care in the most cost-effective way, utilize trained and competent providers by utilizing evidenced -based practice and combine innovation such as EHR (Electronic Health Records) system and team work to produce improved healthcare system.
Excellence in care is attainable by incorporating allied healthcare professional, as high quality care is possible when coordination is unified and covers all areas of responsibilities. For an example-combining resources and coordination of care by involving physicians, dietitian, physical therapy or occupational therapy to work with patient diagnosed with obesity by promoting teamwork approach and ultimately delivering endurance in care and utilizing various resources.
Barriers to IDS can be a huge block in delivering quality care. Among many one limitation is physicians not participating in integrated healthcare system, which disconnect physicians from team based approached by deterring continuous quality improvement (essentialhospitals.org, n.d). This is because, system such as EHR or new innovative quality assurance programs are time consuming and overwhelming, thus decline in physicians support in IDS programs. By implementing user friendly system approach, enforcing focused based care and accepting the necessity of evidenced based practice can improve these barriers. Hence, increasing clinical expertise to produce better service and quality of care in integrated delivery system.
Essentialhospitls.org (n.d). Retrieved from: http://essentialhospitals.org/wp-content/uploads/2013/12/Integrated-Health-Care-Literature-Review-Webpost-8-22-13-CB.pdf
Dq 3-1
1.
In the US, there is not one type of health care system but rather a subset of systems, some of them catering to specific populations. These subsystems include managed care, military, and vulnerable populations. Managed care is a health care delivery system that seeks to achieve efficiency by integrating the basic functions of health care delivery, employs mechanisms to control utilization of medical services, and determines the price at which the services are purchased and how much the providers get paid, military health care system is available free of charge to active duty military personnel and covers preventative and treatment services that are provided by salaried health care personnel and this system combines public health with medical services, and vulnerable population subsystem offers comprehensive medical and enabling services targeted to the needs of vulnerable populations and government health insurance programs provide.
ACO Results: What We Know So Far
Dr. David Muhlestein and Mathew Petersen, both of whom participate with Leavitt Partners' research on Accountable Care Organizations, co-authored the article ACO Results: What We Know So Far in Health Affairs Blog column on May 30th, 2014.
From Fee-for-Service to Fee-for-Value
Medicare’s big announcement on payment models is an inflection point in the transition from volume to value.
mHealth Israel_Dr Dana Safran_Payment Reform Successes and Challenges_Nov 25,...
Presentation for mHealth Israel by Dr Dana Safran, SVP, Performance Measurement and Improvement at Blue Cross Blue Shield of Massachusetts, about "Payment Reform Successes and Challenges", with an emphasis on lessons learned from their Alternative Quality Contract (AQC)
Webinar: Unleashing the Capabilities of MAOs to Deliver Health Innovation for...
Webinar: Unleashing the Capabilities of MAOs to Deliver Health Innovation for...Centers for Medicare & Medicaid Services (CMS)
As part of a broader partnership, CMMI, the Office of the Assistant Secretary for Health (OASH) and the Administration for Community Living (ACL) are jointly sponsoring a webinar titled, Unleashing the Capabilities of MAOs to Deliver Health Innovation for Older Adults in Underserved Settings on October 7 from 2:30-4:00 PM ET to highlight the emerging, numerous opportunities for MAOs to support beneficiaries in more fully meeting their care needs and goals through novel approaches and services enabled by technology.
The webinar will provide an overview of the data supporting these opportunities and will include a panel of three speakers from payer organizations, each of whom will provide an overview of their experience and results in innovating in the use of technology to address unmet enrollee health needs. Panelists include Mona Siddiqui MD, MPH, Senior Vice President for Enterprise Clinical Strategy and Quality at Humana, who will discuss Humana’s approach to the use of data and predictive modeling to proactively engage and provide care for the highest risk and most vulnerable populations; John Wiecha, Medical Director, Senior Products Division at Point32Health, representing the newly combined organizations of Harvard Pilgrim Health Care and Tufts Health Plan will provide an overview of a recent pilot project to improve dementia care through a digital caregiver support program; and Caesar A. DeLeo, MD, MHSA Vice President & Executive Medical Director Strategic Initiatives, Highmark Health Enterprise Clinical Organization, Highmark BCBS who will discuss Highmark’s experience with telemedicine to approach substance use disorders during the pandemic and results from a five-year data driven program addressing appropriate opiate prescribing through profiling and academic detailing.
The webinar offers attendees the opportunity to gain a better understanding of the evidence and potential of several technology-enabled services in improving access, quality and outcomes of care, including, importantly, for underserved populations and will provide MAOs with insights more broadly on the challenges and solutions in design, implementation and evaluation of innovative and technology-enabled service. MAOs that are considering such innovations who may wish to target the use of technology-enabled and/or other services based on chronic illness and/or Low-Income Subsidy (LIS) status through the VBID Model are encouraged to attend.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.htmlHospital/Community Partnership resource list
This document for communities and hospitals contains examples of successful partnerships, information about new models of care, and tips for making the case to hospitals for funding and support for population health work.
NCBI Bookshelf. A service of the National Library of Medicine,.docx
NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.
Institute of Medicine (US) Roundtable on Value & Science-Driven Health Care; Yong PL, Olsen LA, McGinnis
JM, editors. Value in Health Care: Accounting for Cost, Quality, Safety, Outcomes, and Innovation.
Washington (DC): National Academies Press (US); 2010.
5 Approaches to Improving Value—Provider and Manufacturer
Payments
INTRODUCTION
Payment design, coverage policies, reimbursement rules, and other financial incentives and
disincentives are powerful motivators when attempting to steer the healthcare system toward
more desirable care patterns (Guterman et al., 2009). Experiments with payment design and
coverage and reimbursement policies are currently going on in both public and private healthcare
sectors, with varying results. Speakers in this session of the workshop explored current payment
design experiments and discussed the efficacy of utilizing these reimbursement tools to improve
the value received from health care.
In this chapter, Carolyn M. Clancy details the pay-for-performance (P4P) model, an effort to
more explicitly link provider payments to quality of care. She highlights the lack of coherent
approaches to P4P and the variable success this approach has had in fundamentally changing
provider practice patterns. For example, while financial incentives for individual physicians have
shown that P4P can induce quality improvements for diabetic patients (Beaulieu and Horrigan,
2005), group-level incentives have had no impact on mammography screening or hemoglobin A
testing rates (Rosenthal et al., 2005). After underscoring that the current incentive system and
healthcare infrastructure fail to accommodate the achievement of real efficiency and quality, she
outlines recommendations for rethinking medical training, measurement, system design, and the
reward system.
Building on Clancy’s recommendations, Donald A. Sawyer identifies how the current healthcare
system stymies innovation in product development. He suggests refocusing the myopic view of
innovation on the horizon of long-term health improvements and financial savings. Reed V.
Tuckson discusses the alignment of manufacturers, technologists, payers, patients, and providers
necessary to establish a system that continues to provide incentives for innovation and maintains
an open market for the development of promising but unproven interventions. He elaborates
specifically on a joint effort between UnitedHealth Group and the American College of
Cardiology to develop appropriateness criteria for cardiac single-photon emission computed
tomography myocardial perfusion imaging—a new and very expensive technology—based on
best evidence as an example of how the interests of diverse stakeholder groups could be aligned.
In conclusion, Steven D. Pearson likens coverage and reimbursement tools to a blunt knife that
lacks subtlety in effecting value improvements, bu ...
Payment Rules are Changing. Are You?
Learn how NextGen Healthcare solutions can help you to prepare for the changing rules of reimbursement and care delivery.
photo 1.JPGphoto 2.JPGLESSON 16 Transition to Elec.docx
photo 1.JPG
photo 2.JPG
LESSON 16
Transition to Electronic Health Record
LEARNING OUTCOMES
______________________________________________________________________________
In this lesson, you will do the following:
Evaluate the factors that drive an organization to adopt a strategy to create an electronic health
care record.
READINGS
The following reading assignments are for Lessons 13 through 16:
Gartee Text:
Chapter 2, pp. 27 - 41
Chapter 7, pp. 152 - 181
Chapter 8, pp. 182 - 206
ACTIVITIES / ASSESSMENTS
The following activities/assessments are for Lessons 13 through 16:
1. Read the assigned pages from the Gartee text, Unit 4 PowerPoint, and Lecture Notes.
2. Participate in the weekly discussion question.
3. Complete the written assignment.
WRITTEN ASSIGNMENTS
Research and discuss three challenges facing an organization, and review how the conversion to
a full electronic health record could address the challenges identified.
PLEASE NOTE: All graded assignments for the lessons in this unit should be grouped together
and submitted as ONE document using the Assignment Submission form accessed from your
course homepage or http://www.sjcme.edu/gps/assignments.
All activities/assignments for this unit should be as follows:
1. Should include a cover sheet for each assignment stating the following:
Course (HA 214)
Your Name
Unit and Lesson Number
Date Submitted
2. Each individual assignment number and copy of the assignment directions should be
included in the submission as the starting header of each lesson.
3. Carefully check grammar and spelling.
4. Use APA format for any research or sources that are being used or quoted.
5. Email the instructor if you have questions regarding the assignments.
http://www.sjcme.edu/gps/assignments
LESSON 16
Transition to Electronic Health Record
LECTURE NOTES
______________________________________________________________________________________
The push for the conversion from paper-based to electronic health records is clear and definite.
The mandate comes from the federal government in terms of regulatory requirements, financial
incentives, and a desire to reduce costs and improve quality. Research and experience has
indicated that a fully deployed electronic health record system will achieve these desired
outcomes. The ability to enhance the productivity of personnel is another business outcome that
health care providers will need to consider. However, there are major challenges and barriers to
achieving full implementation of interoperable electronic health records.
Costs of Care
The costs of health care in the United States are reported to be almost 17% of the gross national
product (GNP), or about $7000 per capita for every person in the country. The costs for health
care continue to rise faster than consumer inflation.
This makes the cost of h.
California health care markets vary significantly by metropolitan ar
California health care markets vary significantly by metropolitan area. Some are highly consolidated, while others are markedly less so. Kaiser Permanente has a large presence in some areas, but a smaller one in others. The degree of commitment to population health and ACO contracting varies, and populations are different, varying by age, income, health, and access to care.
Recent developments—including ACA insurance expansions, changes in Medicare and Medicaid provider payments, ACOs, and increases in patient cost-sharing—affect the delivery of care in California markets. These developments challenge the viability of hospitals, physician groups, and other health care organizations, and they threaten to hinder access to local health services as premiums and insurance prevalence grow. In 2013, a group of health care leaders from across the state convened to address the health care delivery issues facing California. They came up with a report that sketched out a vision for health care in California in the early 2020s:
A New Vision for California's Healthcare System: Integrated Care with Aligned Financial Incentives
(Review the Executive Summary on pages 6-9 and the Vision found on pages 12-13.)
The objective of this exercise is to develop a set of recommendations for provider organizations in each of the following California markets to change in ways consistent with the vision expressed in the Berkeley report:
Orange County
Recent CHCF reports provide details regarding the diversity of organizational models and affected populations within several California markets:
California Health Care Almanac: Regional Markets
. Another resource to consider for ideas on how change is happening is a California Health Care Foundation Report:
“Many Routes to the Top: Efforts to Improve Care Quality, Coordination, and Costs through Provider Collaborations.”
Create 3-4 slides answering the following:
1. Analyze and describe the structure of the health care delivery in OC
2. What services are delivered by various providers in OC?
3. How do the services relate to each other in OC?
Please cite and reference:
1. The links in the instruction (above)
2. Feldstein, P. J. (2015).
Health policy issues: An economic perspective
.
Using speaker notes too.
...
White Paper - Building Your ACO and Healthcare IT’s Role
The tools needed to capture, organize, and share healthcare data are truly evolving at the speed of light. Patient Centered Medical Homes play a vital role in the path toward accountable care and technology, staff, and workflow transformation are necessary to achieve PCMH recognition. This transformation allows healthcare providers to deliver higher quality coordinated care by streamlining and rationalizing the patient experience.
CMS Reveals ACO Reach Program What You Need To Know!.pptx
The healthcare landscape in the US is constantly evolving, and the CMS have recently unveiled a significant development - the ACO Reach Program. It marks the next evolution of Direct Contracting, a model aimed at enhancing the attractiveness of the program and focusing on health equity. Direct Contracting is part of CMS's strategy to transition away from fee-for-service reimbursement and towards value-based models. It seeks to improve the quality of care while reducing costs.
Empowering Individuals to Be Better Healthcare Consumers
An assessment of how consumerism and innovation in healthcare are redefining how consumers engage with the healthcare system.
Market Power, Transactions Costs, and the Entryof Accountabl.docx
Market Power, Transactions Costs, and the Entry
of Accountable Care Organizations in Health Care
H. E. Frech III.1 • Christopher Whaley2 •
Benjamin R. Handel3 • Liora Bowers4 •
Carol J. Simon5 • Richard M. Scheffler6
Published online: 15 July 2015
� Springer Science+Business Media New York 2015
Abstract ACOs were promoted in the 2010 Patient Protection and Affordable
Care Act (ACA) to incentivize integrated care and cost control. Because they
involve vertical and horizontal collaboration, ACOs also have the potential to harm
competition. In this paper, we analyze ACO entry and formation patterns with the
use of a unique, proprietary database that includes public (Medicare) and private
ACOs. We estimate an empirical model that explains county-level ACO entry as a
function of: physician, hospital, and insurance market structure; demographics; and
other economic and regulatory factors. We find that physician concentration by
organization has little effect. In contrast, physician concentration by geographic
Earlier versions of this paper were presented at the International Industrial Organization Conference in
Boston, the International Health Economics Association meeting in Sydney, the Allied Social Science
meetings in Philadelphia, the ACO Workshop in Berkeley, and the Bates White Health Care and Life
Science Seminar in Washington, D.C. Thanks are due to the participants of those meetings, especially
Martha Starr, Dean Rice, and Martin Gaynor for helpful comments. Thanks are also due to Sandra
Decker, Abe Dunn, Robert Obstfeldt, Jim Rebitzer, Michael Morrisey, Jessica Foster, and Lee Mobley
for helpful comments on earlier versions and to the referees and editor of this journal for more recent
useful comments.
& H. E. Frech III.
[email protected]
Christopher Whaley
[email protected]
Benjamin R. Handel
[email protected]
Liora Bowers
[email protected]
Carol J. Simon
[email protected]
1
Department of Economics, University of California, Santa Barbara, Santa Barbara, CA 93106,
USA
123
Rev Ind Organ (2015) 47:167–193
DOI 10.1007/s11151-015-9467-y
http://crossmark.crossref.org/dialog/?doi=10.1007/s11151-015-9467-y&domain=pdf
http://crossmark.crossref.org/dialog/?doi=10.1007/s11151-015-9467-y&domain=pdf
site—which is a new measure of locational concentration of physicians—discour-
ages ACO entry. Hospital concentration generally has a negative effect. HMO
penetration is a strong predictor of ACO entry, while physician-hospital organiza-
tions have little effect. Small markets discourage entry, which suggests economies
of scale for ACOs. Predictors of public and private ACO entry are different. State
regulations of nursing and the corporate practice of medicine have little effect.
Keywords Health care competition � Antitrust � Entry � Integration � Accountable
care organizations � Transactions costs � Obama plan
JEL Classification L 14 � I11 � L44 � I18 � L41
1 Introduction and Overview
The US health car ...
Running Head HEALTHCARE STAKEHOLDER CONFLICTS1HEALTHCARE .docx
Running Head: HEALTHCARE STAKEHOLDER CONFLICTS
1
HEALTHCARE STAKEHOLDER CONFLICTS
5
Stakeholder Conflicts in Healthcare Visions
Kendra Smith
Grand Canyon University: HCA 675
Introduction
The stakeholders in the healthcare service in any jurisdiction entail the government, the healthcare providers or the physicians, the payers, the patients as well as healthcare professional organizations.
These stakeholders work hand in hand to ensure efficiency and professionalism in healthcare delivery (Blair et al, 1988). They do this by developing succinct policies and effectively implement them for the sole purpose of improving healthcare services. However, there have been serious conflicts in opinion regarding enhancing healthcare service practices and proper administrative mechanisms for the achievement of better services, among the stakeholders.
Conflicts in Health Vision
One of the major health reform visions which have generated considerable debate concerns the accommodation of evidence-driven healthcare service practice, which the government of the United States has instructed all healthcare service providers or organizations to adopt. The major emphasis on this aspect of medicine is the requirement by the government that all healthcare service providers or organizations should document which healthcare services they provide and why they provide such healthcare services to the communit
y.
The argument behind this requirement is that it will enable the government, or it will be generally helpful in gauging the benefits the community gains from such healthcare services. In addition, establishing evidence-driven healthcare practice according to healthcare practitioners will help in identifying specific health problems within a community, and subsequently, design the most appropriate medical response. Some healthcare stakeholders also believe that this is an avenue that the government intends to use in creating and forging a closer working relationship between private and public healthcare providers. However much most stakeholders, both private and public, appreciate this evidence-based healthcare practice, as a vital component in improving healthcare services, the major concern is about how such data should be obtained. Some healthcare providers have reasoned that these data should be generated from the already existing data, due to the costs associated with activities that may lead to acquiring and establishing sound data or information domain. In response to this requirement, most of the healthcare organizations have established community-based information or data collection and management mechanisms, which enable them to collect data concerning community health concerns and threats, then define effective ways of response.
With the introduction and implementation of a series of healthcare reforms in the United States, such as the Obamacare and Trumpcare, there is general expectation that there will be enhanced access to healthcare service ...
Achieving Stakeholder Engagement: A Population Health Management Imperative
To succeed in population health management (PHM), organizations must overcome barriers including information silos and limited resources. Due to the systemwide nature of these challenges, widespread stakeholder engagement is an imperative in population-based improvement.
An effective PHM stakeholder engagement strategy incorporates the following:
Includes as many stakeholders as possible at the beginning of the journey.
Meets the unique analytics and reporting needs of the organization.
Enables users to measure, and therefore manage, PHM outcomes.
Provides the real-time analytics value-based care requires.
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California health care markets vary significantly by metropolitan ar
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The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
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ACO Reach Program An Advanced Value-Based Payment Model.pptx
- 2. The healthcare landscape in the United States is ever-evolving, and the introduction of the Accountable Care Organization (ACO) Realizing Equity, Access, and Community Health model stands out as a milestone. As cited in CMS's "A Year in Review June 2021-May 2022," the ACO REACH program is a key accomplishment in advancing strategic initiatives. Key Accomplishments of the ACO Reach Program The ACO Reach is designed to test an innovative payment approach that better supports care delivery and coordination, particularly for patients in underserved communities. It aligns with CMS's commitment to advancing health equity, the first pillar of its strategic plan Pillars of the Strategic Plan A perspective published in the New England Journal of Medicine sees the program as a departure from regressive value-based payment models. The report suggests that previous models not only failed to reduce healthcare expenditures or improve care quality but also perpetuated disparities. In contrast, it aims to be progressive, prioritizing health equity in its design and implementation. Comparison with Previous Value-Based Payment Models Failures of Previous Models The report in the New England Journal of Medicine criticizes traditional value-based payment models for their inability to meaningfully reduce healthcare costs or enhance care quality. It highlights how these platforms unintentionally perpetuated structural racism, hindering the pursuit of health equity.
- 3. The Shift Towards a Progressive System In contrast, the program explicitly identifies equity as a central goal. This marks a shift from previous platforms and offers a promising approach to advancing health equity. Role in Advancing Health Equity Health Equity Benchmark Adjustments One of the distinctive features is the inclusion of "health equity benchmark adjustments." This innovative approach supports ACOs caring for socioeconomically disadvantaged patients, recognizing that providers may need increased resources for marginalized communities. Health Equity Benchmark Adjustments One of the distinctive features is the inclusion of "health equity benchmark adjustments." This innovative approach supports ACOs caring for socioeconomically disadvantaged patients, recognizing that providers may need increased resources for marginalized communities.
- 4. Data Collection on Social Determinants of Health To further emphasize its commitment to health equity, CMS mandates ACOs to collect and submit data on patient-reported demographics and social determinants of health. This data- driven approach ensures a comprehensive understanding of the challenges faced by different patient groups. Learn more about the most advanced versions of the ACO Reach Program at Persivia.