Health Medical Homework Help

1-VALUE-BASED CARE WITH ALLOWANCE FOR PERIODIC UPDATES

Entering into this conversation from a pharmacy background, the ever growing costs of medications is mind-boggling. After reviewing the material for this module, I think the value-based approach to healthcare while may not be the most profitable approach, would be the best for increased longevity and improved quality of life which are two goals of public health. In my opinion, any approach that is focused on improving the health of the community, which Dr. Stefanacci explains in his lecture is the focus of the value-based approach, is the most beneficial for public health. As Benjamin Franklin so famously said, ‘an ounce of prevention is worth a pound of cure,’ the surest way of lowering costs of medical conditions is to prevent them from occurring in the first place. Obviously, we cannot prevent all medical conditions, however if we look at the broader picture of certain chronic medical conditions, namely diabetes and obesity, we can clearly see how improvements to healthcare are needed. According to the CDC, in 2017, the United States spent 90% of its total spending ($3.8 trillion) on chronic conditions, and specifically $327 billion (or ~26%) on diabetes and $147 billion (or ~11%) on obesity. I highlight these two chronic conditions because I feel, except for Type I Diabetes, these are the most preventable by practicing good nutrition, exercise and overall healthy habits. The issue is the inequality of access to the tools necessary to prevent these specific conditions. One may think access to food and safe spaces to exercise are readily available, however food deserts, increased prices on healthier options from the grocery store, and sky-rocketing crime rates prevent many people from being able to adequately (and healthily) nourish their bodies. The focus should be switched from new (expensive) ways to treat diseases and reliable (cost-lowering) ways to prevent what we can. Another more relevant example would be vaccinations against COVID. Not only are the vaccines free of charge to everyone (regardless of insurance status), the costs of treating COVID infections is continually increasing. Even more than the costs of treating the disease, people are still dying, and how can we put a price tag on someone’s life? In closing, having the focus of the healthcare system be on getting and keeping the public healthy most aligns with value-based approach.

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2-Moving away from a fee-for-service model and toward a value-based paradigm is a step in the right direction for our healthcare system. Several innovative payment structures have emerged throughout this shift and hold promise for the future of healthcare, public health, and population health.

That said, every payment structure has its vulnerabilities and shortcomings. There’s no such thing as the perfect model, but by examining the downsides of the models that have emerged, our system can continue iterating and create more robust structures in the future.

Accountable care organizations (ACOs)

According to the Centers for Medicare & Medicaid Services, “Accountable Care Organizations are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high-quality care to their Medicare patients.” 1

These organizations have the potential to enhance overall patient care, improve how our health system manages chronic disease, and reduce waste from the Medicare System, which amounted to a whopping $60 million in 2015.2 Clearly, billing for Medicare needs to change, especially as our population ages and more people use it for coverage.

However, building successful ACOs can be challenging since they are structured around free-flowing data and information. The electronic medical record is the backbone of the ACO, but not every organization has the financial resources to invest in this technology. Moreover, there’s the issue of interoperability and sharing data between physician groups and healthcare organizations — and the fact that EMRs like Epic are just flat out clunky, outdated, and hard to use. To make ACOs a viable reality for more organizations, our health system must address some of its glaring gaps in the technology infrastructure.

Bundled payments

NEJM defines bundled payments as:

“One form of alternative payment models (APMs) that are designed to move toward value-based care by incentivizing providers to advance coordination and efficiency of care while also improving quality and outcomes at lower costs. With bundled payments, the total allowable acute and/or post-acute expenditures (target price) for an episode of care are predetermined. Participant providers share in any losses or savings that result from the difference between this target price and actual costs.”3

Like ACOs, bundled payments were developed to improve patient outcomes while reducing the cost of care. This structure has the potential to achieve those goals, but as it stands today, bundled payments also create an unintended financial incentive for providers to sell more bundles to their patients. Because of this, “there is a need for evidence to evaluate the impact of episode bundles on overall spending and quality,” as Muhlestein pointed out in Health Affairs (2017).4

Value-based care has the potential to transform population health, but when it comes to finding a sustainable and scalable payment structure, we still have a long way to go. Additionally, balancing multiple payment models could be a major headache for health systems. It’s still unclear how things will shake out with value-based care over the next few years, but one thing’s for sure — it won’t be boring.

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