Healthcare is one of the most fundamental aspects of ensuring the wellbeing of a country's citizens. According to a report by The National Center for Health Statistics (NCHS), in 2017, 4.8 % of Americans failed to obtain healthcare because of cost-related variables. In the same year, 87.6% of Americans had a usual place they could visit for medical care. Although the above statistics point to the improvements that have been instituted in the near past to ensure universal healthcare coverage for all Americans, there are still several multidimensional factors that influence the efficiency of medical personnel and hence, access to healthcare by different demographics. Accountability in healthcare is one of the factors that directly impact the quality of service by healthcare providers. To obtain a better understanding of accountability in healthcare, a comprehensive understanding of other factors intertwined with accountability is crucial. The collaboration of hospitals with primary care providers, accountability care organization (ACO) undertakings, health information technology (HIT) payment modes in healthcare, reimbursement, among others, are indispensable.
Accountability Care Organization (ACO) and its impact on healthcare providers .
Accountability Care Organization (ACO) is a term used to refer to entities that consist of integrated healthcare workers who work towards specified common goals that positively influence healthcare outcomes among different demographics. Some of the goals are high efficiency, quality healthcare, and better patient care. These goals are often achieved by means of a common pathway (Gossman et al., 2019). The affordable care act has tenets that are engrained in its system and which directly influence (ACO). They include disbursing payments that positively change healthcare quality and results in cost reduction, reliable measurement of performance while incorporating sophisticated and improved approaches as well as ensuring provider-led entities that give a strong emphasis on primary care and accountability.
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When properly instituted into the healthcare system, accountability care organizations positively impact healthcare providers. They have more freedom in creating comprehensive healthcare plans. Based on the level of integration, such providers have the autonomy to serve the general public in different capacities. They can coordinate care for better performance on their side as well as better service provision to their clients. Besides, through the alignment of incentives, clinics, hospitals, social security departments, and other healthcare providers can lower healthcare costs (Gossman et al., 2019).
The Difference between ACOs and Health Maintenance Organizations (HMOs) of Early Years.
Although there are several ways in which HMOs mirror ACOs, there are notable differences that set them aside. One of the aspects that makes ACOs different from HMOs is the simplification of service provision by ACOs. The fundamental intent of ACOs is making them highly simplified and local, unlike HMOs, which were based on large bureaucracies that were responsible for high complexity and healthcare costs. Unlike in the 1980s and 1990s, where HMOs did not foster collaboration among healthcare providers, ACOs are instituted on principles that encourage integration among healthcare providers. ACOs have hence reduced solo or small group practices and have encouraged better engagement in large groups of care providers. Besides the above, the major principles of both entities notably differ. ACOs' primary objectives are the creation of value for clients in different healthcare systems, ensuring accountable care, and prioritizing patients' satisfaction. On the other hand, however, HMOs were founded on high risk as well as high-cost settings (Marmor et al., 2012). The primary focus by such organizations hence shifted into the management of aspects such as healthcare costs, most of which did not significantly positively impact healthcare seekers.
The Role of Healthcare Information Technology (HIT) in Newer Models of Care.
One of the significant roles of healthcare information technology is streamlining healthcare provision while at the same time eliminating complexities that increase healthcare costs (Zeng et al., 2009). Although there is no amicable consensus on the definition of HIT, it can be regarded as a broad base of information technologies, for example, robotics surgery, which can be made available for utilization by a client in a way that ensures higher safety and quality of healthcare. Another role in newer healthcare models is providing patient-centered care as well as evidence-based care. Such technology has provided a different approach to healthcare in various settings. Digitization of information, for example, has ensured the availability of a wide range of big data in healthcare. This has guaranteed better and faster research undertakings as well as discoveries. In addition to the above, patients' safety is improved because information can be compressed in a way that is easy to retrieve and make healthcare decisions. In the newer model of care, hence, HIT has ensured an improvement in service provision (Zeng et al., 2009).
The Benefits of Hospitals Partnering with Primary Care Providers.
The development of partnerships between hospitals and primary care providers is indispensable in ensuring improved patients' outcomes (Nguyen et al., 2014). Although primary healthcare providers are at the forefront of dealing with patients and hence have a better understanding of their healthcare problems and concerns, hospitals have the necessary infrastructure that ensures the complete provision of care to patients. Another benefit that is linked with the collaboration between primary care providers and hospitals is better-coordinated care. This provides better patient outcomes, reduces medical errors, and facilitates the reduction of healthcare costs. Besides the above, transitioning care planning is one of the most critical areas that are less focused on but critical in ensuring a holistic impact on patients. When hospitals partner with primary care providers, transitional care strategies are likely to succeed. Readmission rates, for example, are expected to reduce, and patients' follow up after being discharged from the hospital will ensure the achievement of the objectives behind such undertakings (Nguyen et al., 2014).
How Bundling Payments Contains Healthcare Costs.
Bundling payments help in the containment of healthcare costs in that providers are incentivized to provide services at a lower price for conditions that are clustered. B undled payment involves a lump sum payment to healthcare providers for the provision of certain predetermined services placed under the same group. One characteristic of this form of payment is the different types it could take and the various payment possibilities for the client. The different options provide an opportunity for the client to choose a bundle that best suits their needs and cost. Besides the above, the primary approach to bundling payment ensures the containment of costs. The different healthcare providers involved in the bundled payment system collaborate with payers to set the prices of bundled services. The price for target conditions is usually set based on episode severity. After looking at the different dynamics that influence the conditions in question, mean pricing is done. Payers are then involved in active discussion and negotiations with the providers to set a target price for a given particular bundle. Although providers are incentivized to provide better care at a reduced cost, the negotiation approach goes a long way to ensure the containment of costs (Shih et al., 2015).
How Pay for Performance (P4P) Improves Quality Care
In pay for performance approach to compensation, healthcare providers are either rewarded or penalized based on their performance and their efforts in ensuring quality healthcare for patients. The rewards work as an incentive that encourages providers to ensure they provide quality care to their clients. On the other hand, penalties deter them from acting in ways that are not acceptable. In addition to this, the pay for performance approach also rewards particular medical acts (Kyeremanteng et al., 2019). This encourages providers to take on complex patients. Even when dealing with such patients, the main objective when pay for performance is in play is to provide the best care to ensure rewards and not penalties.
The Value-Based Purchasing Program
The value-based purchasing program offers rewards to acute care hospitals with the aim of ensuring high-quality care in such critical healthcare settings. One of the objectives of this program is to make hospital stays a better experience for patients admitted. The program implements some strategies that encourage hospitals to be more efficient, improve quality of care and patient's experiences and ensure safety. This is through the provision of incentives, recognizing hospitals that provide quality care, and ensuring infrastructure that reduces adverse effects. Some of the measures used to measure the quality of healthcare are mortality rate, patient safety, patient experience efficiency, and cost reduction, among others (Centers for Medicare and Medicaid Services, 2018).
Effects of Value-Based Purchasing (VBP) Programs on Reimbursement to Hospitals.
The value based-purchasing (VBP) programs hold providers accountable by controlling their undertakings through reimbursement. The effects such programs have on hospital reimbursement is either positive or negative. By rewarding the best performer in a different way from those who do not meet specific quality measurement standards, the program ensures reimbursement varies from one hospital to another. It implies that while some hospitals might get high compensation, others could get low.
Who Benefits the Most from Value-Based Reimbursement and Why?
The patients or healthcare recipients benefit more from value-based reimbursement. One of the most crucial objectives of the program is to cut down rising healthcare costs. Most of the time, patients pay large sums of money to obtain healthcare services. This is through out of pocket payment, healthcare insurance and other modes of payment. When systems that aim at reducing healthcare costs such as the above are instituted, patients are impacted positively the most. Besides this, another goal behind this program is the improvement of healthcare quality. While providers might benefit when they are incentivized to provide better care, the patient benefits more. With quality care, medical errors are likely to reduce drastically, safety improved, and improvement of patients' satisfaction realized.
How the VBP Program Measures Hospital Performance.
To determine which provider deserves rewards related to the improvement of services, performance is measured and rated on a 10 point scale. There is a threshold score for consideration. Achievement and improvement are two critical considerations. Some of the measures used are the process of care measure, patient experience measure, mortality measures, hospital-acquired condition measure, the clinical process of care measure, surgical care improvement, patient experience of care measure, among others (Shoemaker, 2011).
Conclusion
In conclusion, accountability is an indispensable factor in healthcare provision. There are different factors that directly or indirectly influence accountability. Accountability Care Organization (ACO) are entities that ensure integration of providers in groups in a way that improves healthcare quality for patients. They differ from HMOs in that while HMOs are majorly concerned on the quantity of service, ACOs are concerned with the quality. Healthcare Information Technology (HIT) has reinforced quality provision undertakings by ACOs and other healthcare providers. In addition to improvement of care by HIT, collaboration of healthcare providers and hospitals has also ensured better services. With payment approaches such as pay for performance, value based purchasing programs and bundling of payment, the it has been possible to positively influence quality of care while reducing cost. The measures used to determine the most qualified providers are varied and are mainly based on patient's outcomes. Such reimbursement benefit the patient more than any other stakeholders. Even then, although such undertakings mainly focus on how patients can be impacted positively by different healthcare undertakings and systems, in the end, other stakeholders are also directly or indirectly impacted.
References
Centers for Medicare and Medicaid Services. (2018). The hospital value-based purchasing (VBP) program.
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Kyeremanteng, K., Robidoux, R., D’Egidio, G., Fernando, S. M., & Neilipovitz, D. (2019). An Analysis of Pay-for-Performance Schemes and Their Potential Impacts on Health Systems and Outcomes for Patients. Critical Care Research and Practice , 2019 .
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Nguyen, O. K., Kruger, J., Greysen, S. R., Lyndon, A., & Goldman, L. E. (2014). Understanding how to improve collaboration between hospitals and primary care in postdischarge care transitions: A qualitative study of primary care leaders' perspectives. Journal of hospital medicine , 9 (11), 700-706.
Shih, T., Chen, L. M., & Nallamothu, B. K. (2015). Will bundled payments change health care? Examining the evidence thus far in cardiovascular care. Circulation , 131 (24), 2151-2158.
Shoemaker, P. (2011). What value-based purchasing means to your hospital: CMS has devised an intricate way to measure a hospital's quality of care to determine whether the hospital qualifies for incentive payments under the Hospital Value-Based Purchasing program. But is it a fully reliable comparative measure?. Healthcare Financial Management , 65 (8), 60-69.
Zeng, X., Reynolds, R., & Sharp, M. (2009). Redefining the roles of health information management professionals in health information technology. Perspectives in Health Information Management/AHIMA, American Health Information Management Association , 6 (Summer).
