The government is one of the largest purchasers of health care services and because of this, they seek out opportunities to contain costs. Recent health care policy has focused on managing costs while offering quality care and improving access to care. The Centers for Medicare and Medicaid Services (CMS) Innovation Center develops payment and service delivery models with this in mind.
Scenario
Mr. Magone, CEO of Healing Hands Hospital, has asked you to join the Future of Healing Hands Task Force. Your first assignment is to work with the hospital\’s Chief Financial Officer (CFO), Ms. Johnson, and provide a summary of how the new CMS initiatives might impact the organization’s revenue structure. More information on the innovation models can be found on the CMS Web site.
Describe an Accountable Care Organization (ACO) and the benefits of an ACO.
Describe an episode-based payment initiative and the benefits of this initiative to Healing Hands Hospital.
Reference
Centers for Medicare and Medicaid Services (CMS). (n.d.). Innovation models. https://innovation.cms.gov/initiatives/#views=models. Please cite my book under references as well. Will add citation later.
Individual Project #1: Accountable Care Organizations (ACOs) and Their Benefits
Student’s Name
Institutional Affiliations
Individual Project #1: Accountable Care Organizations (ACOs) and Their Benefits
As healthcare organizations strive to provide quality healthcare to patients, they also make efforts to increase revenue and control costs. The United States healthcare system is currently transitioning to value-based payment models that are characterized by increased coordination of care across healthcare settings by different healthcare providers. These models ensure that patients receive high-quality care at low costs (Austin & Wetle, 2016). A good example of such models is Accountable Care Organizations (ACOs). This assignment will describe the benefits of ACOs and how an episode-based payment initiative can benefit a hospital using Healing Hands Hospital as the case study,
A healthcare delivery process becomes effective when it is able to generate meaningful benefits for all the parties involved. Barath et al. (2020) define an ACO as a population-based care delivery and payment model in which groups of healthcare providers willingly work together to deliver high-quality and coordinated care to a pre-defined group of patients. Doctors, hospitals, and other providers who have agreed to work as a team under the ACOs model have a collective financial responsibility for the costs and quality of care that they provide (Centers for Medicare and Medicaid Services (CMS), n.d.; Barath et al., 2020). The primary goal of engaging in coordinated care by ACOs is to ensure that patients receive person-centered care that is not only offered at the right time but also in accordance with practice standards.
ACOs are associated with numerous benefits. For example, they are characterized by an increase care coordination which ensures that patients, especially those with chronic illnesses, receive person-centered and timely care (CMS, n.d). Besides, the healthcare delivery model enhances patient experiences through the provision of high-quality services that maximize patient safety. Since ACOs help providers to avoid unnecessary duplication of healthcare services and prevent medical errors, they promote increased savings and prevent unnecessary healthcare expenditures (Barath et al., 2020). Providers who are delivering healthcare through the ACOs model usually share the savings received from Medicare programs.
The Centers for Medicare and Medicaid Innovation has developed new episode-based payment initiatives that might affect the revenue structures of healthcare organizations. An episode-based payment initiative is a bundled payment model in which a patient’s healthcare needs are bundled into a single payment from the time of initial visit to the hospital to hospitalization and all other types of care received thereafter (Chen et al., 2020). An episode-based payment initiative that might impact the revenue structure of Healing Hands Hospital is the Oncology Care Model. The model brings together physicians who work together to administer high-quality and coordinated care to cancer patients at low costs (CMS, n.d.). It is primarily applicable to Medicare and Medicaid cancer patients who are receiving chemotherapy. The Oncology Care Model is beneficial to the Healing Hands Hospital in that it would increase cost savings and expand revenue by reducing errors and increasing patient flow respectively. According to Chen et al. (2020), the Oncology Care Model promotes an enhanced healthcare delivery process for cancer patients. Additionally, it orients clinical care to value-based patient-centered care that ensures that Medicare and Medicaid beneficiaries receive high-quality cancer care at low costs. Generally, Healing Hands Hospital should utilize an initiative that will enable it to focus on managing costs while also offering quality care and improving access to care. Ideally, utilizing the Oncology Care Model will have a positive impact on the hospital’s revenue structure.
References
Austin, A., & Wetle, V. (2016). The United States Health Care System (3rd Edition). Pearson Education (US). https://coloradotech.vitalsource.com/books/9780134297927 Here is the citation for my book, please put under references
Barath, D., Amaize, A., & Chen, J. (2020). Accountable Care Organizations and preventable hospitalizations among patients with depression. American Journal of Preventive Medicine, 59(1), e1–e10. https://doi.org/10.1016/j.amepre.2020.01.028
Centers for Medicare and Medicaid Services (CMS). (n.d.). Innovation models. https://innovation.cms.gov/initiatives/#views=models. Please cite my book under references as well. Will add citation later.
Chen, J. L., Chernew, M. E., Fendrick, A. M., Thompson, J. W., & Rose, S. (2020). Impact of an episode-based payment initiative by commercial payers in Arkansas on procedure volume: an observational Study. Journal of General Internal Medicine, 35(2), 578–585. https://doi.org/10.1007/s11606-019-05318-7