What is Value-Based Healthcare?

Healthcare provision is an always evolving issue as to be at par with the technological advancements. The previous periods have seen much research on the practices of care and to the improvements that should be made to meet the demands of time. One of the ongoing solutions is the introduction of value-based healthcare ( Porter & Teisberg, 2006) . This is an approach that is gaining popularity among caregivers as one which will help increase the sustainability and efficiency of healthcare. In a business perspective, provision of care is supposed to be economical while at the same time yielding favorable and favorable outcomes on the patient’s side. 

The value-based approach has critics, and it is because it has a basis in a system of healthcare where part of the motivation for a hospital to improve outcomes is to increase its share in the market by being the best at the services they offer. The criticisms come because it is a system that would not yield much in the improvement of population health while also not translating well to the healthcare systems such as NHS that are funded by the public ( Porter & Teisberg, 2006) . But, if all the dogma is on how to support the provision of care, this approach is one that will provide a solution to the profound problems faced in the sustainability of delivering high quality service by offering some useful set of tools. 

Previously, the interventions that have been employed to help in the solution of healthcare providers have focused on increasing equity, access, and population health. These solutions have mostly led to the increase in the cost of care for most clients. It then dawned on the policymakers for such interventions to rethink their steps and come up with lasting solutions to the issues ( Adler-Milstein et al., 2017) . This led to the formation of universal healthcare access, which most critics said is not enough for the resolution of the fundamental problems. The core issues that faced the field is the value of the delivered healthcare. In other words, the patient outcomes per dollar spent on their treatment or care is the fundamental issue. There was a need for the redefinition of the system to take care of this. 

Thus, most modern policies move the healthcare providers towards the development of value-based care, whether or not they are prepared for it. This is after realizing that it is not sustainable to increase the cost of service that comes from the increased prices on equipment and drugs ( Adler-Milstein et al., 2017) . The redesigning of the system to be more durable and value-based, therefore, does not feature in any incremental improvements. Some of the restructuring initiatives are aimed at filling the gap that is left by process improvements, care pathways, safety initiatives, lean production concept, disease management and other overlays. The dysfunctional system cannot be solved by the consumer as the current condition in the competition for patients is not driven by value. 

The goal of value-based healthcare is thus to bring value for patients in contrast to the access, volume, cost containment, convenience, or equity that the traditional reforms tended to push forward. In short, the initiative is aimed at producing better health outcomes as opposed to getting more treatment. This is in line with the fact that better health is less expensive as compared to poor health that is aimed at increasing customer base. Thus, the value-based concept is governed by several principles. First, the goal of the delivery is to increase value for clients, and not to contain costs. The fundamental driver for cost management and value improvement is the quality improvement, where quality is measured by the outcomes of the patients ( Adler-Milstein et al., 2017) . 

Also, the provision of care should be focused on the medical condition of the client and given around full cycle of care (CMS, 2016). Value improvement is driven by learning, scale, and provider experience and the medical condition level. Furthermore, their focus should be on integrating the care across facilities and geography and not having duplicate services in independent units. The costs and outcomes should be measured and reported for every patient, every medical condition, and every provider. Additionally, the reimbursement should be aligned with value and innovation rewarded. In the payment, the mode should be regarding bundled up compensation for the complete cycles of care instead of those for discrete services or standalone episodes. 

When chronic conditions are included, the payment should be time-based. Finally, the use of information technology should be utilized to enable restructuring of the provision and in the measurement of results. In retrospect, this last point highlights one of the most critical aspects of value-based healthcare, which is information management or healthcare informatics. The models of value-based care aimed at reducing spending while improving outcomes and quality. This means that the industry is moving from volume to value as healthcare executives confirmed in a 2004 survey ( Adler-Milstein et al., 2017) . 

Despite the limited knowledge and experience of many US physicians with regards to value-based models, they have a feeling that fifty percent of their compensation in the next ten years will come from such initiative. Some of the issues they feel are drivers of this new approach to healthcare include stakeholders’ push for value, unsustainable costs, and the engagement of the government in supporting the original concept. Also, the regulatory agencies are playing an essential role in ensuring the new laws and regulations are adhered to, and they point towards the increasing of quality and patient outcomes. Additionally, there is the development of robust data, advancement in the sophistication of the healthcare system, and the approaches to risk mitigation have also contributed to the acceleration of the pace towards the change. 

The rationale for the shift is based on the inadequacies that are brought about by the current system of healthcare known as the free-for-service-based. In the United States, the FFS-based concept provides incentives for the facilities to increase the volume of care they offer ( Porter, 2009) . Even though the professional goals of the providers are to improve the health outcomes, this model does not provide the rewards for this achievement. In most hospitals, their focus has moved from providing quality care to the increment of volume as it is the basis to which the provider is paid. As there were increased concerns on the diminishing performance on indicators of quality and the rising costs, health reforms, employers, stakeholders, and the government purchasers of health care are advocating for the shift towards a value-based model. This is in a bid to align the hospital and practitioner bonuses and penalties with the outcome, quality, and cost measures. 

When talking about the value-based models, it is essential to understand what options there are for implementation. Currently, the organizations of healthcare are experimenting with combinations and variations of four major types of value-based models. First, they use a shared savings plan which calls for the payment of the provider to be based on the traditional FFS plan. However, at the end of the year, the amount spent is compared to the stated target. This means that if the organization has managed to spend below their targeted expenditure, then the remaining difference can be shared as a bonus. 

The second type of model is known as the bundles. In this case, instead of paying for a particular physician, hospital, or other services, the payment is made in packages for the services that are linked to a specific condition, a period, and the reason why the client is in the hospital ( Porter & Teisberg, 2006) . This model enables the provider to keep the money saved through the reduced expenditure on some of the health components which are featured in the bundle. Thirdly, there is the shared risk model. As the name suggests, the organization shares the savings but with other included rules. When the healthcare provider spends more than the targeted amount, then it has to repay some of the deficits as a penalty. This will make the organization to be more focused on only spending what is targeted. Finally, there is the model of global capitation. In this model, the provider gets payments based on per-person, per-month (PP/PM) basis. In providing the payment this way, the payer intends to settle for all individuals’ care, without consideration in the type of services used ( Porter & Teisberg, 2006) . 

The advancement of the concept comes from the recommendations by state authorities and agencies of regulation. State leaders recommend several strategies for the reforms based on the four value-based types above and also follow four principles. The principles include improving the regulatory framework, allowing the creation of innovative health solutions by the states, re-stabilizing the insurance market by allowing competition, and overall improving the affordability of healthcare. The government agency that is vested the powers of furthering the proposal of the officials is the Centers for Medicare & Medicaid Services (CMS). To make sure that the healthcare providers are paid for the healthcare services rendered, the agency has introduced several models to support value-based care which include Pioneer Accountable Care Organization (ACO) model and Medicare Shared Savings Program (CMS, 2015). This has made private payers be able to adopt similar accountable, value-based models of care. 

The bottom line in this whole introduction of value-based models is that the federal officials actively being able to measure the performance of the provider in a fair way taking into consideration the technicality involved ( Adler-Milstein et al., 2017) . They should thus rely on quality information and use incentives to assist healthcare providers in upgrading their quality while at the same time transitioning them to holistic coordination of care. Of importance is the way healthcare consumers make decisions being a critical factor for the success of a nationwide move to the value-based care and by the state agency enhancing consumerism, there will be a catalyst to the embrace of this concept. 

The introduction of this plan thus calls for the use of consumer-facing technology to aid in decision making and to use financial incentives to push for cost-effective healthcare, while offering educational resources to the clients to make better choices and decisions. By increasing the competition in health insurance competition, CMS states that there will be improved affordability and access to healthcare for all the consumers (CMS, 2016) . The federal government is keen on the issue of insurance as it seeks to include encouraging competition among payers and to improve data sharing for the sake of informing the public of the available options. With this in place, there will be a reduction in the anti-competitive practices in the field of healthcare and organizations. By carrying out reforms in the insurance markets, the priority of the value-based care bases its argument on the use of a mix of state and federal mobilization tactics that could improve the affordability of healthcare. This means that the agencies and the government have to re-implement the insurance market protection while on the other hand encouraging the target audience to seek out the covers actively. 

The plan to incorporate value-based care is by several regulation acts. For instance, the Affordable Care Act (ACA) of 2010 highlights the concerns of the payer about the costs incurred and their objectives for better quality. These entities include individuals who are increasing in number, government payers, health plans, and employers. This act also included a permanent program in Medicare that left the parties to choose to take part in the accountable care organizations (ACOs) (CMS,2015). They will be able to do this by using the shared savings or shared risk payment models and the ones for bundled payments. These are those concepts that are meant to improve coordination and quality while at the same time stem spending. The other way is to include pay for performance in the conventional and managed programs of Medicare and the reintroduction of penalties in hospitals. 

ACOs are equally accountable for the quality of care and the spending within their jurisdiction during the process of service provision for their client group. They must consistently and correctly measure the performance of the entire cycle of care as the rewarding system for the providers are based entirely on incentive payments which are also a function of how they have performed regarding the quality of care that the patients have received. ACOs call for the sharing of outcome measurements openly with the providers in a manner that is transparent (CMS, 2015) . It is therefore imperative to measure the goals of value-based care by taking into consideration the accurate data for statistical calculations. Allscripts EPSi is an essential tool in the assistance of the ACOs to meet the compliance of the regulatory frameworks. It does this by vending the best health information technology (HIT) systems in the industry so far. It is beyond any reasonable doubt the US healthcare providers require software that captures the correct measurements that are necessary to carry out value-based programs that are proposed by the federal and state governments as indicated by the Office of the National Coordinator. 

Allscripts software enables the Hospital to have a predictive analytics platform that can be useful in optimizing efficiency through data-driven performance improvement. The EPSi platform helps the organization capture every activity within the clinical part of the healthcare practice to offer predictions on the budgetary allocations and the cost it would need to carry out such processes ( EPSi, n.d.) . In the long run, the entire patient path will be captured, including the patient reported outcomes that have been dragging the practice for far too long now. The platform leverages operations of research and the science of collecting data including the predictions that take place in real time. 

The efficiency will be optimized by simulating the “what-if” scenarios and thus automating the business intelligence to aid in the optimization of dealings within the full cycle of care. The platform makes it possible for the organization to align the resources including inpatient beds, operating rooms, staff, and care equipment, with the predicted and the actual flow of patients in and out of the hospital. EPSi is an answer to the many problems that an organization has concerning the financial and logistic pressure ( EPSi, n.d.) . 

The assistance the system offers the facility can be seen as a way of enabling them to be able to leverage their resources in other platforms of technology to improve the operational efficiency and make the organization thrive in the somewhat stressful environment. Allscripts EPSi offers its users the unique capacity to attain the enterprise-level objectives regarding finances by creating and integrating the dynamic tools of operational planning into the strategic process of budgeting ( EPSi, n.d.) . Hence, it becomes useful in creating a target that the hospital can work with to obtain the necessary base of comparison with the actual expenditures that will be used for reimbursement. 

The current systems of healthcare information management face high risk and complexity in the demands of their financial organizations. The requirements of the new market force the providers to collect and analyze more data than ever. The complicated business side of the hospital needs to be addressed. Some of the complicated aspects of the organization that should be taken care of are the integration of costs across product lines, increasing labor costs, population health, value-based care, accountable care organizations, and bundled payments ( Porter & Teisberg, 2006) . The current situation is that of a rush towards sustainable practice. In the market today, the business part of a hospital, operations, and clinical decisions push leaders to need incorporating, analyzing, and utilizing data across entire cycle of care to drive for the transformation required for the organization to succeed. The move towards value-based care and payments calls for the demand on comprehensive infrastructure for obtaining, sharing, and analyzing information data for every segment of the population in the entire full cycle of care. These systems of health informatics should be equipped to aid the users to share common standards of data and architecture for them to function effectively. EPSi, an Allscripts company develop such a product (EPSi, n.d.). 

Allscripts EPSi is a system that is entirely integrated and web-based which provides a solution by loading and processing data from nearly any software system found in healthcare. This system contains features such as budgeting, integrated analytics, decision support that is knowledge-based. Also, it joins together various components of financial management including capital and operational budgeting, cost accounting, product line budgeting, and planning. On the same note, Allscripts EPSi brings together disconnected functions and in the process allowing budgeting, reporting, strategic planning, cost accounting, and clinical and financial analytics in the bridged functions to be aggregated into a unified source (EPSi, n.d.). This is thus in harmony with the required to address the issues about increasing costs and reducing quality as the system will be able to solve some of the fundamental problems. 

All the organizations within the healthcare realm who seek to rationalize and unify their perfect business management software systems are thus selecting Allscripts EPSi performance management to address the financial difficulties that are always evolving within the growing transforming field, regulatory and care frameworks. The infrastructure has enabled the client (hospitals) and their patients to claim high standards of operation and functionality while managing the financial side of the decision for the businesses. One of how it brings this benefit is through cost. It makes the organizations understand the actual costs and opportunities for future development through the integration and incorporation of physician and ambulatory data in unison with the provider’s data across the full cycle of patient care (EPSi, n.d.). Allscripts EPSi also helps in the tracking of a wide variety of quality indicators to measure value and indicate the cost that accompanies it. It does this through the measurement and optimization of margins after the move from volume- to value-based care as it monitors and measures the outcomes. When using this software, the databases are structured in such a way that the organization can attach multiple (in tunes of hundreds) fields to a single record of a patient. In the end, this gives the hospital and all the parties involved the capacity for profound analysis regarding the client data and enable them to customize the report in whatever case they need (EPSi, n.d.). 

The journey to the implementation of the software models in the value-based care is one that has some stakeholders who play an essential role in the day to day activities. First, the client organization is a major one because it forms the basis on which the installation and data management processes are done. In these organizations, there are other sub-categories of stakeholders including physicians. The function of this group is to ensure that the data required for analysis is provided. The doctors, nurses, and other medical practitioners handle the patients and record the situation in which their clients are and the journey in which they travel from the point of sickness to recovery. They are responsible for the production of information in the full cycle of care and in the time-based scenario for the chronic illnesses. The other stakeholders are the patients of which are the focus of the entire system of operations and infrastructure. These form the group from which the data is obtained. Their personal information is vital in creating, analyzing and projecting the trends in which the cycle will take. Although they are stakeholders, they do not control the actions of the side of the installation and management but are instead the beneficiaries of such activities. It is the data from the patient outcomes that will make the reimbursement basis, and in the long run, their results are enhanced. On the side of the vending company (Allscripts) the critical stakeholders in the application of the EPSi software transcend various levels and professions. They include the management team which makes the decisions on behalf of the entire company and makes the rules. Then the implementation team (which I am in), is responsible for the rolling out of the infrastructure within the client organization. They develop the necessary and appropriate systems to adopt in every organization. The other role they play is to support the implementation process and deliver the best-standardized software to the client. The third party stakeholders which include the government agencies (for instance CMS) ensure that the practice is by the regulations (for example HIPAA). They must regulate the day to day activities by offering security to the protected data of patients (CMS, 2016). 

All the data that is managed by the software of EPSi is onsite. This means that it remains in the custody of the institution that created them while the web-based software manages and helps with the planning activities. This is true in all situations except when Allscripts is hosting. In the latter case, the company has to comply with the regulations that are stipulated within the frameworks. Allscripts is an organization that is required to abide by the rules that the CMS pushes. One of these regulations is that included in the Health Insurance Portability and Accountability Act of 1996 (HIPAA). These frameworks come with the obligations of the company to comply both under law and contracts (CMS, 2016) . 

The rules that affect the operations of the company are contained in the Allscripts HIPAA Privacy Policy and influence the actions of the company as a covered entity and a business associate. In other words, the policies cover Allscripts as a vendor of the HIT and as an entity within the frameworks of the HIPAA regulations. The Privacy Policy contains the obligation of the company and how it should react to matters of privacy and breach. The rule stipulates the steps that should be taken when addressing the breach notifications as it applies to the single identifiable health data created, obtained, managed, or shared by the organizations that deal with the care. This is applicable in circumstances that make the hospitals have certain electronic transactions, health plans, health transactions, healthcare clearinghouses, and also includes the associates with whom they do business ( Allscripts Healthcare, 2018) . 

Allscripts HIPAA Privacy Policy outlines the set of steps and procedures of operation for different individual groups within the organization ( Allscripts Healthcare, 2018) . They include the business units, human resources, management, and the general workforce. The policy gives the detailed instruction, provide timelines, and record specific behaviors for the employees who are required to comply and how they should do so with the procedure. 

This comes in a time when the patient information is a highly delicate entity that requires to be protected by all means possible. The rules thus instruct the entire Allscripts workforce to maintain several physical safeguards for the protection of the privacy of patient health information in addition to confidentiality availability and integrity of the electronic health records. The first is for the company to make sure all the facilities that are containing these data are secured using keycard in the entrance ( Allscripts Healthcare, 2018) . Thus, the access to such facilities is only limited to the individuals with the rights and authorization to enter the facility. Also, the workforce for which the policy is written is required to refrain from allowing access to non0workforce members or to those who are not granted the authority to do so. The only situation that a member can enable another party to enter is when there are guaranteed safety and appropriate security for all the patient health information within the working area. The policy also requires the workforce to notify the manager or the security personnel in case of a presence of an unauthorized individual within the area where the patient information is located. This makes the individual member working in the company to be responsible for the security of the data in their workspace. Therefore, the member should take appropriate and reasonable caution to ensure that the access to the information is secure and safeguarded. 

The HIPAA Privacy Policy also affects how Allscripts carries out the deals with other business associates through what is known as Business Agreements ( Allscripts Healthcare, 2018) . These associates may be vendors, subcontractors, agents, suppliers, or consultants. The regulations require the company to get a reasonable assurance with any entity they conduct business with through the legal contracts and agreements that the associate will use correctly and disclose the patient health information by following some stipulations. Whichever the associate the company engages with, they have to offer policies and procedures that take into consideration and enhance the security of the protected health information (PHI) of the patients ( Allscripts Healthcare, 2018) . 

HIPAA also creates the policy responsible for the disclosure of the PHI to the employees of Allscripts in cases where the customer organization gives the company the responsibility of hosting their data. In such scenarios, the data may be disclosed under several rationales. First and foremost, the information released should be intended to offer support for treatment, healthcare operations or payment in the organization client. While this is happening, the two companies should act by the business agreement or by the HIPAA Privacy Policy ( Allscripts Healthcare, 2018) . The other rationale that supports the disclosure of the data is when there is incident permission granted by the policy. 

The issue of disclosure is a legal one, and thus any means aimed at using or releasing the data is subject to approval from the security personnel within Allscripts. The usage of the PHI within the organization may be due to several reasons ( Allscripts Healthcare, 2018) . First, it is necessary to use the data when Allscripts is undertaking quality assurance activities. But, this move should be made only when the client organization permits the vendor to use the information. The other reason for Allscripts using the PHI is when there is a necessary legal or financial review of the operations of the company and finally when there are internal administrative activities. However, automatic permissions for the disclosure of the data pertaining patients can be granted to Allscripts in three circumstances ( Allscripts Healthcare, 2018) . First, when there is a need for disclosure about victims of domestic violence, neglect, or abuse. Secondly, there is permission when there is a need for exposure for court or administrative proceedings. Thirdly, is if the state or federal laws require the company to do the disclosure. 

One of the key features in the value-based healthcare is the costing which should be done for the entire journey of the patient. The importance is because it is not possible for the value to be quantified on singularly but instead has to be assessed regarding the results delivered in comparison to the investment ( Porter, 2009) . The outlay is made for all possible interventions for a specific population, be it a finite event of care such as a transplant or the investment attached to a section living with a chronic condition such as Parkinson’s disease. In the case where the disease is incurable, the plan is to have a ‘year of care’ approach during the costing process. This is because there is recognition of the subpopulations that are present within the overall caseload and those whose needs are varying ( Porter & Teisberg, 2006) . Of importance is the identification of the cohorts of patients such that their needs which are unmet can be categorized and quoted regarding quantity. The approach that is often employed is a ‘one-size fits all’ service that is aimed at taking care of all the groups. Consequently, this always results in the impossibility of meeting the need of a population in entirety and thus brewing an unsatisfactory ordeal for the clients and their care providers. The data on outcomes, which include those reported by the patients, can confirm the situation. 

The different ways of improving value for clients by improving outcomes and reducing costs is by applying flexible approaches that meet the needs. These can be achieved by avoiding under- and over- interventions, two of which can lead to poorer experience and outcomes of care. There are two primary methods of costing, and if a full picture is required, then a blend of the two is probably essential ( Porter & Teisberg, 2006) . Fist, there is the patient-level costing. This is done by allocating costs, where and if possible, to a singular patient. By doing this, it is possible to have an opportunity to have a much greater understanding of how the costs add up with time. This information can be gathered by infrastructure known as patient-level information and costing systems. 

Secondly, there is the time-driven activity-based costing method. TDABC is a method that is used by organizations to increase the level of accuracy in cost estimates in processes and interventions ( Porter, 2009) . In this case, the approach requires the organization to estimate the staff, equipment, and time utilized in every step of a response which will then reflect the total costs that are associated with the practitioners involved and the period the client spends in each part of the process. 

It is particularly helpful to blend the two approaches of PLIC and TDABC and getting cohorts. Despite there being talks of clinical processes regarding pathways of diseases, experiences of individuals in healthcare is often non-linear, unpredictable, and sophisticated. Therefore, there is a need to have an overall program spend however challenging it is ( Porter & Teisberg, 2006) . It is vital if the players and all stakeholders are to allocate resources appropriately for the sake of improving outcomes in the long run. It has been an issue to have such a plan as the decision makers always fail to do as they still decide on resource allocation by looking at the targets instead of need. This is the reason why most hospitals were keen on increasing the numbers while putting quality at bay and government, on the other hand, increasing investment in primary care. 

To understand the meaning of value-based care, it is essential to define the sense of the term “outcome.” More often than not, what the practice describes an outcome is not what it intends to establish as such from the perspective of the patient ( Rowly, 2013) . The result can be described as a consequence, an endpoint, or a milestone that matters to an individual. A complete outcome contains four types of datasets including, case-mix variables, treatment variables, clinically reported results, and patient-reported issues. In general, all the four elements must be collected together for the achievement of robust analysis of a big dataset whose risk is appropriately adjusted. 

Mostly, the reports are given based on the three set of data while leaving the part of the patient-reported outcomes. This is because most practitioners conclude that after applying for a specific role in the recovery of a patient, then the process is complete. But this is not the case as most clients tend to think that their views are left out. The cause for the neglect is due to a load of assumptions that are built in the treatment process ( Rowly, 2013) . In the overall, the quality of care is jeopardized as the practitioners concentrate on the application of their expertise regarding numbers instead of value. 

Thus, there is a great need to have tracking methods that can record the amount of data and the quality that is required to ensure that the sets do not have the unwanted condition. This calls for the employment of health informatics systems. Up to this point, it is clear that there is much momentum towards the healthcare delivery that needs to check the accountable quality as a measure of value and in the long run keeping records of the total costs of the services rendered. The field of healthcare has come a long way regarding documentation. The move from paper to electronic systems in the past decade has seen a swift change in how the information is handled in the entire industry. In 2007, the number of ambulatory doctors using Electronic Health Records (EHRs) accounted for a mere seven percent and these were majorly associated with the organizations and the medical facilities that offer them (CMS, 2016). In 2013, the number increased to 50 percent of doctors using certified EHR systems. The move from paper to this infrastructure has been a significant step for the benefit of the healthcare sector as a whole (CMS, 2016). Though, there are still some glitches as health data remains siloed, meaning they are kept in the institutions that made them. There have been ways to help in solving this scenario. One means has been through consolidation. In this approach, the hospitals are linked to community practitioners in most cases using mechanisms of local community health information exchange. The other way is by creating enterprise charts for clients within harmonized delivery systems. 

My professional field is one that has two segments. One is that I am in the implementation team of the consultancy side in Allscripts EPSi, and the other is that I am a professional nurse. The combination of the two fields has led to my widening of the view in the health sector and the myriad challenges that are encountered in the process. The healthcare sector is one field that has undergone tremendous changes in the past couple of years, and with the advent of technology, we seem to be even further from achieving the perfect model to deal with the fundamental challenges we face. This is despite the several developments that have been made to make sure the sector is sanitized and operates in an enhanced environment. As a consultant in Allscripts EPSi, there was a high demand for professionalism in all the endeavors that the workers deal. With the sensitivity that the type of information we were supposed to handle calls for, the levels of accuracy, privacy, and security were to be high. This made me appreciate the efforts put in place to enhance the protection of several pieces of data and the implication it can have on the failure of doing so. 

With the advent of technology in the current practice, several challenges face the delivery of services from the practitioner’s point of view. In other words, there are challenges in the way the providers view the fast-moving connection of technology. This means that most of the professionals in the medical field, lacking in the technical knowledge in this change, face a lot of troubles working with them. This makes some institutions lagging behind regarding technology as the practitioners are the ones who are supposed to create an interface with the systems. As for me, the case is a little different. Being a nurse and also on the consultancy side equipped me with the essential skills to understand the technical bit of the technology required to manage the data regarding value-based care. As the models of this concept are varied based on the intended result, it is essential in my profession to appreciate the understanding that such work has enabled me to have concerning the various models that are present and the ones that can be used in multiple stages. 

Finally, the job in Allscripts EPSi has provided me with the essential skills in presentation and communication. During the consultancy period, we had to present to several stakeholders thus helping me develop my presentation skills. The job allowed me to act the C-suite and make myself a renowned person in the field of consultancy. In short, the roles I played in the organization helped me build my portfolio in the business of consultancy. 

In the field of consultancy, one ethical challenge that is imminent is the fair billing of hours. It is always believed that billing customers based on the time spent on their project instead of the value given are a sign of unethical behavior ( Camden, 2009) . The issue that leads to this notion is that the consultant may delay the job even if the task is one that is a problem being remedied fast, or an improvement that takes a shorter time to install. The critics of hourly billing suggest that even though the interest of the client is served when the remedy is carried out shortly, the demands of the consultant is achieved by prolonging the project. This would lead to deliberate delays in the process of consultation to attain maximum benefits on the side of the provider. Thus, the solution should be to bill based on the value of service provided because the service is in the eye of the receiver and thus the client gets the say ( Camden, 2009) . 

It is imperative to note that the consultancy job is a demanding one that requires a myriad of competencies for a successful career. First, the job demands critical thinking and analytics. The client offers the problem for the consultant to advice accordingly. Through critical thinking, the professional will analyze the situation with ease and get to the smallest impacts possible. Secondly, the person should possess excellent presentation skills. Not everyone is born with the ability to show people how a situation looks and make them understand. Thus, a consultant should practice this competency. Also, my nursing license is essential for success in the field of nursing as I am also a professional nurse. Another necessary credential is the Registered Health Information Administrator ( RHIA ) which is essential for my job as a health information manager. Being a HIT consultant requires such a license. Lastly, a professional who wants to succeed in this field should be informed with all the CMS guidelines and regulations. This agency controls the entire area of health systems, and thus an individual must know when not to breach such rules as they may end in a legal battle. 

References 

Adler-Milstein, J., Embi, P. J., Middleton, B., Sarkar, I. N., & Smith, J. (2017). Crossing the health IT chasm: considerations and policy recommendations to overcome current challenges and enable value-based care:  Journal of the American Medical Informatics Association ,  24 (5), 1036-1043. 

Allscripts Healthcare, (2018). Information Privacy & Security Policies: Hipaa Privacy Policy . Allscripts Healthcare, LLC. 

Camden, C. (2009, July 6). Is billing by the hour unethical? Retrieved July 16, 2018, from https://www.techrepublic.com/blog/it-consultant/is-billing-by-the-hour-unethical/ 

Centers for Medicare and Medicaid Services. (2015). Accountable care organizations (ACO).  nd http://www. cms. Gov/Medicare/Medicare-Fee-for-Service-Payment/ACO/index. html . 

Centers for Medicare and Medicaid Services. (2016). Medicare and Medicaid EHR incentive program basics. 

EPSi. (n.d.). Home: About. Retrieved July 16, 2018, from https://epsi.io/about-epsi/ 

Peltier, T. R. (2016).  Information Security Policies, Procedures, and Standards: guidelines for effective information security management : Auer Bach Publications. 

Porter, M. E. (2009). A strategy for health care reform—toward a value-based system:  New England Journal of Medicine ,  361 (2), 109-112. 

Porter, M. E., & Teisberg, E. O. (2006).  Redefining health care: creating value-based competition on results . Harvard Business Press. 

Rowly, R. (2013, November 20). Value Based Healthcare Payments. Retrieved July 16, 2018, from https://www.hitechanswers.net/value-based-healthcare-payments-kind-needed/