Address each bulleted item (topic) in detail including the questions that follow each bullet. There should be three (3) sections in your paper; one for each bullet below. Separate each section in your paper with a clear brief heading that allows your professor to know which bullet you are addressing in that section of your paper. Include a “Conclusion” section that summarizes all topics.
This week you will reflect upon accountability in healthcare and address the following questions:
• Briefly define an Accountability Care Organization (ACO) and how it impacts health care providers:
1 How do ACOs differ from the health maintenance organizations (HMOs)
of earlier years
2 What role does health information technology (HIT) play in the newer
models of care?
• What is the benefit of hospitals partnering with primary care providers?
1 How does bundling payments contain healthcare costs?
2 How does pay for performance (P4P) improve quality care?
• Briefly discuss the value-based purchasing program?
1 How do value-based purchasing (VBP) programs affect reimbursement to
2 Who benefits the most from value-based reimbursement and why?
3 How does the VBP program measure hospital performance?
Structure: Include a title page and reference page in APA format. These do not count towards the minimal word amount for this assignment. Your essay must include an introduction and a conclusion.
References: Use the appropriate APA style in-text citations and references for all resources utilized to answer the questions. A minimum of two (2) scholarly sources are required for this assignment.
Accountability in Healthcare
The nursing field has gradually evolved towards enhancing user outcomes. The main objectives of the approach include a high quality of lives, affordability of healthcare services, and enhanced community healthcare. Accordingly, some of the developments in this area are Accountability Care Organizations (ACO), a partnership between hospitals and primary care providers, and a value-based purchasing program, which purposely enhance user experience. While the conventional concepts of healthcare have been considered useful, the advanced approaches, including ACO, pay for performance (P4P), and value based-purchasing (VBP), can have justifiably several benefits that will ultimately improve the quality of health outcomes.
Defining ACO and How It Impacts Health Care Providers
ACO differs from health maintenance organizations (HMOs) in various ways. ACO implies the association among health professionals (doctors, nurses, and specialists) and hospitals to provide a coordinated approach to treatment processes. On the other hand, HMO precisely means the acquisition of health insurance coverage, whereby the policyholder is limited to a particular network of professionals. The significant difference is that ACO is not discriminatory since it allows the patient to receive services from the readily available professionals. Besides, it implies that the patient under the program is not restricted to a particular set of individual professionals (Alotaibi & Federico 2017). Since HMOs have been greatly restricted, it is less preferable to the ACO.
The contemporary approaches to healthcare have been significantly influenced by health information technology (HIT). Alotaibi and Federico (2017) note that HIT is crucial to patient safety because it indicates that the safety incorporates avoidance and prevention of injuries that can result from healthcare provision process. The authors describe that HIT has impacted safety in helping to gather all the necessary information about the patient, which then informs treatment approaches. In addition, HIT has helped in the relay of information among professionals, thus helping in the provision of personalized and affordable care. Overall, HIT has overriding benefits on health care users and providers.
Benefits of Partnering with Primary Care Providers
Various benefits are associated with partnerships between hospitals and healthcare providers, such as bundling payments. Bundled payment differs from fee-for-service since the former involves the hospitals charging services as a comprehensive package, unlike the latter in which each procedure is individually billed. Such a payment approach is considerate of the entire process because it eliminates auxiliary costs that are associated with fees for single services, such as taxation and attendance from a variety of professionals. According to Agarwal et al. (2020), whenever the case is collectively approached, it leads to reduced costs of healthcare. Hence, the user benefits from affordable services, and ultimately quality care.
The partnership further facilitates a P4P model in healthcare, during which payments are based on outcomes and healthcare user satisfaction. The hospital collaborates with providers to ensure that they offer their best services for the patients. Consequently, they are given the most appropriate equipment and systems to ensure that the users enjoy the value of their fees. Furthermore, P4P has the advantage of enhancing collaboration among the professionals as they integrate their activities for a common goal of helping patients (Kondo et al., 2016). Another merit of the approach is that it increases the professionals’ satisfaction in the execution of their duties since teamwork is enhanced, and each performs to their optimal levels. Indeed, the P4P has significantly improved healthcare with its contribution through the partnership.
The Value-Based Purchasing Program
VBP significantly influences the reimbursements to hospitals by concentrating more on the quality than the quantity of services. The program involves holding a percentage of the money associated with Medicare, which is then distributed to the member hospitals depending on performance. According to the Centers for Medicare & Medicaid Services (CMS) (2020), an adjustment factor is derived from the net of incentive, and reduction is applied to determine the allocations. Overall, the model encourages hospitals to incorporate the most consistent and productive processes so that they can be recognized.
The party that most benefits from VBP is the healthcare user since one of the provisions is that the quality of health facilities have to be improved. Therefore, the appropriate medical professionals are further employed, so that the facilities can receive incentive payments. The outcome among patients is one of the factors that the VBP considers, while the equipment and skills available are significant variables to the results. Moreover, the hospitals seek to eliminate adverse effects that can cause further harm to patients (CMS 2020). As a result, the satisfaction of patients is one of the metrics that VBP considers during its incentive allocation. Ultimately, the approach shifts the care process to person-centered, during which patients receive the maximum benefits.
Although various measures can be applied when evaluating hospital satisfaction, both weighting and comparison aspects can help to identify the most efficient hospitals. While the mortality rates indicate the competence of the hospitals in handling acute diseases, infections related to healthcare are used to determine the way the hospital is cautioned against worsening a patient’s condition. Patient safety is another factor, though it could relate to the physical, psychological, and medical aspects of a given facility as the measures extend to the processes and procedures of care (CMS 2020). Furthermore, the cost and time implications are evaluated as they can relate to the quieting time of the patients, the cost of services, and ease of operations among the professionals. Overall, the more streamlined activities are, the better the outcomes expected, and thus a better ranking in the VBP reward program.
As is evident from the analysis, the patient is the primary stakeholder in healthcare, who supports the existence of facilities, professionals, and regulatory bodies. There are various contributors to the desired outcomes for the patient, of which the ACO can be attributed to the integrated approach by professionals to improve health. The organization directs that the services should not be treated in isolation but as components of a whole unit, thereby making HMOs obsolete. HIT has been active in endorsing ACO due to its contribution to the advancement in systems. The objective of the organization can be achieved by enhancing a partnership between hospitals and caregivers since such collaboration encourages bundle payment. The professionals do not have to charge as individuals because collaborations with hospitals can provide for integration of services. P4P can lead to quality services, given that the patients pay for the value they receive from a hospital, thus implying that coupled with VBP, patients become principal beneficiaries. Hospitals have to implement objectives that will ensure their recognition and the satisfaction of the patients and professionals. While previous healthcare models that enhance healthcare continue to exist, incorporating advanced systems can result in better outcomes.
Agarwal, R., Liao, J. M., Gupta, A., & Navathe, A. S. (2020). The impact of bundled payment on health care spending, utilization, and quality: A systematic review. Health Affairs (Project Hope), 39(1), 50–57. https://doi.org/10.1377/hlthaff.2019.00784
Alotaibi, Y. K. & Federico, F. (2017, December 1). The impact of health information technology on patient safety. Saudi Medical Journal. Saudi Arabian Armed Forces Hospital. https://doi.org/10.15537/smj.2017.12.20631
Centers for Medicare & Medicaid Services. (2020). The Hospital Value-Based Purchasing (VBP) Program. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/HVBP/Hospital-Value-Based-Purchasing
Kondo, K. K., Damberg, C. L., Mendelson, A., Motu’apuaka, M., Freeman, M., O’Neil, M., Kansagara, D. (2016). Implementation processes and pay for performance in healthcare: A systematic review. Journal of General Internal Medicine, 31, 61–69. https://doi.org/10.1007/s11606-015-3567-0