Essay Example: Healthcare Payment Reforms

Published: 2023-04-02
Essay Example: Healthcare Payment Reforms
Type of paper:  Essay
Categories:  Money Healthcare policy Public health
Pages: 7
Wordcount: 1831 words
16 min read

Healthcare payment reforms have become elicited to the point of payers, providers, among other stakeholders shifting from the traditional fee-for-service reimbursement system to value-based care payments. For instance, the government of the United States spends a lot of money on health care as compared to other developed countries despite the nation having some of the worst consequences related to health care such as increased child mortality rate and a reduction in life expectancy (Papanicolas et al., 2018).

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According to surveys that have been carried out in the country, it has been established that a good number of people are not insured. While over twenty million people are underinsured which implies that the expenditure of their incomes towards medical costs is not well accounted for. Therefore, it is the responsibility of the government and the concerned stakeholders to immediately intervene and find the most appropriate remedy lest the unacceptable situation continues.

The knowledge of the health payment system suggests prompt intervention. Professionals in the field argue that it is essential to restructure how individuals make payments for health care. It will aid in slowing down the growth of costs that are involved whereas improving the health care that is offered to the citizens.

The above is because the current healthcare payments system takes into account the reimbursement of doctors, hospitals, and other healthcare providers concerning the number of visits or procedures that they make to the patients. It is translated into an increment in the cost of health care since the revenues of the health care providers rise in addition to their profits when they are assumed to deliver more services.

Increased services are, however, not a reflection of better health care. The services are detrimental and are linked with producing worse outcomes. For instance, a lot of patients with chronic illnesses who contribute more than seventy percent of costs related to health care are advised to spend more time face-to-face with real people. It is because it helps them to go through the health care system to attain the best outcome in the course of improving their and reduction of health care costs.

Currently, people are being offered services that they are paying for. When people make payments for high-tech services and procedures, the health care system provides them volume, which does not consider the value they are to be provided with. However, if the order is changed by altering the health care reimbursement system to find the value and not the volume, there will be slow growth in thein the health care costs. The health care reforms provide the above.

Some of the health payment reforms that could be adopted in the country include the rewarding of the delivery of primary care through approaches such as incorporating a medical home. The above, together with other methods, can be of the essence in coordinating programs aimed at reimbursing the practices in primary care that provide and correlate the care f the patients.

The instances where an individual seeks for health care services should be bundled together in payment as opposed to amount of individual visits or procedures in a bid to coordinate care and improve outcomes. Consequently, medical practices should be moved into an integrated system of health delivery organizations. Here, payment arrangements are inclined towards global capitation where a single value is paid for all the health care services that the patient is offered in any health facility.

In shared savings, the medical program by Accountable Care Organization which incorporates the Affordable Care Act makes use of the shared savings payment model (McWilliams et al., 2016). The providers of the same enhance a yearly spending goal at the same time trying to conform to the quality of the standards.

As much as the models encompass some of the traditional infrastructures of fee-for-service, the model advocates for incentives that align and encourage the improvement of quality and controlling of costs involved in health care delivery. The same model is also rapidly being incorporated in the private sector across the nation.

In the episodic or bundled payment, bundled payment ensure that providers have a right amount of money which takes care of the costs of a particular episode of health care like a chronic disease instead of a reimbursement of a single service. The above form of payment is associated with encouraging providers to do away with services and tests that are not mandatory in the process of trying to achieve the best results in the health issues of the patients.

On the other hand, models of payments that are capitated give providers a flat per-patient fee. As such, they encourage providers to remain within the budget constraints and be conscious of the costs involved. The initial model discouraged providers from high-cost patients. Today, the model accommodates effective care coordination, risk adjustment mechanisms that are better and can facilitate fair compensation to the providers that are attached to patients in adverse conditions (Keiser Family Contribution, 2018). The model also facilitates improved information technology and the sharing of data for greater clinical efficiency. The above alternatives associated with quality care payments place capitation the most preferred method.

Healthcare payment reforms will ensure that there is proper protection of patients in places of vulnerability, such as where the population cannot access healthcare services after being discharged. The system also ensures that there is a diagnosis of hospital readmission, which is associated with reduced or care that is inadequate, especially after discharge or in particular hospitals.

Certain readmissions have been confirmed to result in problems of transition. No health professional after discharge is usually in charge of the patient when he or she is brought back. As such, the payment reforms should somehow focus on promoting the delivery of care that would have been done so during the transition.

Therefore, the policy relating to the payment of the services should be reviewed to accommodate the transition care for the patients since the majority of the people will be taken care of. It would ensure the coordination and perpetuation of health care, particularly when patients move from the hospitals to their homes or other settings.

Healthcare payment reforms encompass the alteration of healthcare delivery approaches. As such, they are designing new health care delivery platforms could enhance better patient engagement and contribute to more successful treatment procedures and processes. Examples of the above include improvement of the care coordination between multiple medical teams, incorporating digital tools and any form of remote monitoring technology, and the investment in data analytics.

Modern facilities are embracing the substitutes to fee-for-service payment. The adoption is to ensure that the alternatives are aligned to financial support for the reforms in health care that are aimed at improving quality and efficiency. Many health care organizations have established that analysis of the current treatment patterns and designing of care pathways are associated with helping patients to be engaged in their health care and be treated in outpatient settings more effectively or instead in their homes.

The new care models usually use care teams and digital health tools that are responsible for the maintenance of better monitoring and intervention, which considers investments in analytics and support systems. The fee-for-service system does not support all the above. The new models can also ensure that there is an appropriate use of costly technologies, which had been previously adopted by the fee-for-service system (Barnes, 2012). Such is comprised of breakthrough medicines, and health care devices that are under increasing pressure to portray value in the practices or rather risk facing limitations of being accessed.

In the United States, the Centers for Medicare and Medicaid Services invested in value-based care payment models which contributed to the achievement of more than fifty percent of their alternative payment models. Health organizations transitioning to value-based care which was initiated by the Centers for Medicare and Medicaid Services in the United States has stimulated commercial payers to shift to the bandwagon and invest in healthcare payment reforms more as compared to the previous times.

There are various challenges that payers and health care providers have faced in the implementation of value-based health care reimbursement. Mixed outcomes have been witnessed in the formative stages in the first years. Some of the health care providers established that performance measures that had been put in place by payers did not accurately reflect the anticipated quality for improvement.

Clinicians and some of health care professionals are cited for encountering administrative load that is related to the complexities of conforming to varying value-based performance measures, especially from multiple players. Since it is a gradual transition of the payment reforms, healthcare facilities are said to lack sufficient data and analytic systems which are mandatory for ensuring quality improvements in the healthcare delivery process.

The above obstacles have led to the development of concerns among stakeholders in respect to the quality of health care services that will be availed to patients in need of high-cost treatment services amidst the implementation of health care payment reforms which are focused on minimizing medical spending among patients (Chernew & Frakt, 2018). Therefore, payers and healthcare service providers in their quest to address the challenges to create a successful value-based healthcare payment reform model, are mandated to align the healthcare payment reform with quality improvement efforts.

When the reforms are adopted, there will be a reduction in the burden felt by providers, especially one required in meeting benchmarks that are different. It will also be expected that payers will work to aid in the creation of quality measures that will be translated to results and better outcomes of treating patients that possess complicated medical conditions.

For healthcare payment reforms to be successful, payers should embrace supporting their provider networks through sharing data and information with their hospitals, clinics, and other healthcare facilities. By sharing, doctors will be able to reduce the gap between care and improvement of quality performance. In this case, it will be mandatory that healthcare providers align data and resources that are necessary to enhance the coordination of care services and best practices cutting across medical teams.

Insurance companies should also invest in value-based healthcare models. The investment should be targeting the need to minimize the ever-rising healthcare spending in the country together with advocating for the delivery of better patient healthcare services. Healthcare payers have already witnessed significant savings as a result of value-based care reimbursement.

Payers could succeed more in value-based care models as compared to fee-for-service on the verge of becoming the main form of reimbursement between providers and them when they considered the goal for the Centers of Medicare and Medicaid Services. Here, healthcare delivery will be quicker and more efficient at the same time.

Application of fee-for-service payment usually contained provider for reimbursement for a long where both providers and payers lacked the experience of making value-based care succeed. In the course of taking financial risks through alternative contracts of payment.

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