Community Health Paper

Community Health Paper

Community Health Paper

The current health care system is in dire need of health reforms that enhance better access, quality, equity, and affordability. Health care providers are encouraged to work collaboratively and effectively to enhance the quality of care and reduce health care costs. Today, there is a weak balance between cost of care and provision of satisfactory patient experiences. The focus of this paper is on population-focused care through the nursing process, collaboration, and interdisciplinary skills. The purpose of this paper is to discuss Accountable Care organization including its impacts on population health, the concept of ‘bundled care’ and the benefits of showing pricing for care.

An Accountable Care Organization and How It Impacts Population Health

Accountable Care organizations (ACOs) refer to networks of physicians, hospitals, and other health care providers who willingly commit to taking collective responsibility for providing quality and cost-effective care to patients (Pimperl, 2018). ACOs create financial motivation to collaborate, share information, and reduce health care costs while ensuring coordinated, quality care to their Medicaid patients.  Coordination of care is crucial in ensuring that patients with chronic diseases get appropriate care at the right time while preventing duplication of services.

Population health is a crucial element of an ACO. The focus of ACOs is to enhance both individual and population health which they are accountable for. Population health promotion is achieved through partnerships with community prevention efforts also known as accountable care communities (ACCs). Moreover, ACOs improve population health through population health management, which entails preventive measures and cautious management of patients with chronic diseases. Additionally, ACOs stress care coordination to minimize needless care utilization and ensure patients get appropriate and timely care (Pimperl et al., 2017). Promotion of population health by ACO also entails leveraging on value-based care redesign programs and available complex care management initiatives to create programs for the targeted population. ACOs also link patients to existing community resources and community health workers or social workers for the management of serious population health issues.

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The Concept of ‘Bundled Care’ and the Associated Risks for the Organizations

The concept of ‘bundled care’ characterizes a model of funding and service delivery that is intended to enhance broader inclusion in health care provision, motivate high-quality care, drive care efficiency, and enhance patient outcomes and experience. In the ‘bundled care model, a group of health care professionals gets a single payment to cater for all the health care needs of a patient’s entire spectrum of care for a particular health concern. According to Kanters and Ellimoottil (2018), ‘bundled care’ is meant to reduce health care spending through various mechanisms including reduction in the number of needless physician services during hospital stay, more sensible utilization of health care resources during hospitalization, and minimization of post-discharge costs such as readmissions and pointless post-discharge care services.

The potential risks for organizations participating in ‘bundled care’ include underutilization of effective services within the ‘bundled care’ and avoidance of high-risk patients. Organizations could also experience complications in defining and trailing the kinds of care that should be integrated into the bundled payments where a provider is at risk (Kadu et al., 2021). For instance, knee and hip replacement are appropriate for bundles, but when a patient has multiple chronic diseases interacting with each other, it becomes challenging to ascertain whether a bundle should integrate care for all those conditions. Moreover, bundled payments could foster unhealthy competition for patients with lucrative bundles and make it challenging for population-based payment techniques such as ACOs to succeed.

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The Benefits of Showing Pricing for Care

Showing pricing for care entails price transparency in the health care system. Currently, it is baffling for many consumers to understand the price of health care services. Rates keep changing depending on the facility, the insurance, and other factors. As a result, patients cannot easily determine the amount they need to pay for health care services (Reed, 2019). As such, price transparency is crucial in addressing such challenges by enabling patients to see the cost of a treatment they want and determine the amount they are required to pay before getting care services.

The Affordable Care Act (ACA) mandates health care settings to ensure transparency in their prices by publishing their list of prices for all care services they offer. Price transparency is crucial in enhancing competition in the health care market by enabling patients to look for the cost-effective care existing. Price transparency also helps in reducing health care costs through the facilitation of competition for the market among care providers (Reed, 2019).

Conclusion

ACOs are crucial in creating financial motivation to collaborate, share information, and reduce health care costs while ensuring coordinated, quality care to their Medicaid patients. They also promote population health through collaborating with ACCs and population health management. On its side, ‘bundled care’ reduces health care spending through a reduction in the number of needless physician services during hospital stay, more sensible utilization of health care resources during hospitalization and minimization of post-discharge costs such as readmissions and pointless post-discharge care services. Finally, showing pricing for care or price transparency is crucial in enabling patients to see the cost of a treatment they want and determine the amount they are required to pay before getting care services.

References

Kadu, M., Sutherland, J. M., Abrahamyan, L., & Wodchis, W. P. (2021). Designing Financial Incentives for Integrated Care: A Case Study of Bundled Care. In Handbook Integrated Care (pp. 939-954). Springer, Cham. https://doi.org/10.1007/978-3-030-69262-9_55

Kanters, A. E., & Ellimoottil, C. (2018). Bundled care payment models. In Seminars in Colon and Rectal Surgery (Vol. 29, No. 2, pp. 60-63). WB Saunders. https://doi.org/10.1053/j.scrs.2018.01.004

Pimperl, A. (2018). Re-orienting the model of care: towards accountable care organizations. International Journal of Integrated Care, 18(1). doi: 10.5334/ijic.4162

Reed, R. D. (2019). Costs and benefits: Price transparency in health care. Journal of Health Care Finance. http://healthfinancejournal.com/~junland/index.php/johcf/article/view/178

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This assessment is aligned with the module objective “Develop the implementation of population-focused care through the nursing process, collaboration, and interdisciplinary skills.” As part of the written assignment, you will complete the following tasks:
Describe an Accountable Care organization and how it impacts population health.
Discuss the concept of ‘bundled care’ and the risks which organizations that participate in bundle payment.
Explain the benefits of showing pricing for care.
References
Minimum of four (4) total references: two (2) references from required course materials and two (2) peer-reviewed references. All references must be no older than five years (unless making a specific point using a seminal piece of information)