⦁ Week 4 Discussion
Discussion Topic
In your discussion this week, I would like you to focus on the impact of the ACA policy/law in your role as a Healthcare Administrator. You are asked to operationalized ACA for your facility.
1. Impact on Health Care Facilities (hospitals, physician practices/clinics) for Medicaid patients when reimbursement is to be increased, and Medicare, where reimbursement is to be reduced. Strategies relating to these two items
2. Impact of Health Care exchanges/ private health plans that provide coverage , and impact good or bad, on your facility. Consider that many of these plans have high deductibles/out of pocket payments so how will you address with your patients from a collections standpoint.
3. Special models developed as a result of ACA.
Discuss:
……primary care medical homes(PCMH)
…..accountable care organizations(ACO).
…Also Health Homes for patient care (not home health organizations for care in the home of the patient !)
… Value based reimbursement (medical outcomes) which is a shift from traditional fee for service reimbursement.(consumption based)
Independent research required!
⦁ Example listed below* * can be in paragraph form, just cover this topic and make sure you get the point across.
EXAMPLE:
With the passing of the Affordable Care Act (ACA), as a healthcare administrator, I have to be prepared for the affect the ACA would have on my facility.
1) In regards to Medicaid reimbursements increasing
•There is a insignificant effect on Medicaid provider participation rates according to state and Medicaid managed care officials.
•After interviews were completed in six of the eight states (California, Kansas, Massachusetts, New Jersey, New Mexico, New York, Oregon, and Texas), while payment increased there was no change in primary care service.
•Increased Medicaid patients = increased appointment availability = increased payments
•According to the eight states interviewed, increased payment = insignificant effect on new Medicaid PCPs being recruited.
In regards to Medicare reimbursements decreasing
•Medicare patients will experience shorter visits
•Medicare patients will experience quick hospital discharge
•Medicare patients will experience less face-to-face times with physicians
•Medicare patients will experience compromised care, which made lead to outcomes that are not beneficial to the patient.
2) With healthcare exchangers and private health plans being accessible through the healthcare marketplace, some plans might require individuals to have high out of pocket costs and higher deductibles. I will do my best to work with third-parties in regards to providing patients will options to select more affordable and high-quality insurance plans if finances are an issue.
3) The ACA has introduced many models that are able to help Medicare and Medicaid patients to have better access to quality healthcare. These models include:
*Patient Centered Medical Homes (PCMHs)
•Designated as an alternative payment model under MACRAC (Medicare Access and CHIP Reauthorization Act), the PCMH is an increasingly popular pay-for-performance healthcare model that emphasizes continuous, coordinated patient care. It’s been shown to lower costs while improving healthcare outcomes. More than 90 health plans and 43 state Medicaid programs utilize PCMHs.
*Accountable Care Organizations (ACOs)
•As more and more baby boomers are reaching retirement age, ACOs are making more of an impact. ACOs are “groups of doctors, hospitals, and other healthcare providers, who come together voluntarily to give coordinated high quality care to their Medicare patients.” ACOs have made positive results both for patients and physicians in different ways.
a) Open communication exists between physicians from different specialties within the same ACO to determine solutions.
b) Fewer medical tests are conducted because physicians and hospitals will be able to send records if tests were previously completed, saving both time and money.
c) There is less paperwork on patient’s medical history because information would be able to be saved electronically in the patient’s medical record.
d) Patients will not have to go to different providers to get their medical questions answered since all their physicians will be under the same provider.
*Health Homes for Patient Care
•A “health home” is a Medicaid state plan option that provides a comprehensive system of care coordination for Medicaid individuals with chronic conditions. Health home providers will integrate and coordinate all primary, acute, behavioral health and long term services and supports to treat the “whole-person” across their lifespan.
*Value Based Reimbursement (VBR)
•VBR models use reimbursement as a lever to change the way providers deliver care. VBR programs can help reduce costs significantly, improve the quality of care, and minimize the amount of money wasted on ineffective care.
Resources
http://www.medicaid.gov/State-Resource-Center/Medicaid-State-Technical-Assistance/Health-Homes-Technical-Assistance/Downloads/Health-Homes-FAQ-5-3-12_2.pdf
MACRA: New Opportunities For Medicare Providers Through Innovative Payment Systems (Updated)
https://www.macpac.gov/wp-content/uploads/2015/06/State-Experiences-Designing-DSRIP-Pools.pdf
https://www.trizetto.com/PayerSolutions/ValueBasedSolutions/PaymentBundling/
https://innovation.cms.gov/initiatives/aco/
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