Enhancing Healthcare Delivery Through Personalization and Innovation
Healthcare delivery is the concept of providing citizens with access to high-quality, personalized healthcare services. As technology advances and consumers become more engaged in their health care, there are many opportunities for businesses to offer personalized services, such as remote monitoring and interactive tools that respond to a patient’s specific needs. Health care involves managing and curing diseases, preventing diseases, diagnosing and treating injuries and illnesses, counseling patients and their families, providing emergency services, and more.
Accountable Care Organization (ACO)
Model Components
Accountable care is an evolution of health care in which providers and healthcare organizations collaborate with payers to manage the care of a specific population or class of patients. Accountable care organizations (ACOs) are groups of health systems, physicians, nurses, and other providers that work together to improve quality, reduce costs, and improve outcomes for their constituents. ACOs are a cutting-edge approach to improving healthcare quality and lowering costs (Kaufman et al., 2019). They combine elements of accountable care, which focuses on avoiding unnecessary care, with other innovations that have been shown to improve outcomes and efficiency in the insurance model.
ACOs are designed to improve care delivery and reduce costs by using data and technology to coordinate care across multiple providers and payers while providing value-based care coordination support. The complexity of delivering affordable, high-quality, and reliable care demands the involvement of high-level IT professionals, who can adapt existing systems or create new ones to integrate data sources, systems, and processes across the organization.
Application to Delivery of Care
Accountable care organization applies to the Geisinger Health System. This system has a financial program that stores data electronically for health records. Geisinger’s health system also stores information on team-based care for nurses; the system supports cost-effective care to patients and the well-being of nurses.
Patient-Centered Medical Home (PCMH)
Model Components
Patient-Centered Medical Home is a model of care that emphasizes patients and delivers care in an integrated and coordinated manner. The PCMH approach features comprehensive, coordinated care for every patient (John et al., 2020). This includes all components of a medical home: accountable care organizations (ACOs) and other models. It is an approach to delivering personalized, coordinated, and consumer-centered care. The goals of the PCMH are to prevent healthcare disparities, improve patient health and wellness by integrating preventive services into primary care, lessen the cost to hospitals and other providers, and improve the quality of care provided.
Application to Delivery of Care
State Medicaid Medical Home is an application of PCMA that has community health teams whose function is to provide comprehensive, patient-centered care. This is done through coordinated care that has accessible services that are of high quality and are safe.
Payment for Performance (P4P)
Model Components
Payment for performance is the idea that medical care providers will receive monetary compensation when they reach certain levels of performance. This concept was developed by investors seeking to gain more accountability and transparency into how healthcare is delivered, reimbursed, and paid for (Roberts et al., 2018). P4P can be implemented in multiple ways – a P4P contract may be put in place between a hospital or health plan and its provider network; a state may pass laws mandating P4P relationships; payers like insurance companies may adopt the model to improve their bottom line, or a doctor could engage in voluntary P4P behavior to gain positive recognition in his community.
Application to Delivery of Care
Payment for Performance (P4P) is an approach to healthcare delivery that allows healthcare providers to be paid based on how well they deliver patient care and prevent patient harm. It is commonly used to reward quality of care. Still, it can also be used to incentivize other measures, such as reducing costs or increasing the proportion of Medicare beneficiaries who receive a given treatment and increasing productivity. Spot bonuses are a typical application of payment for Performances (P4P). Medics or medical providers are appreciated with rewards instantly “on-spot” for their recognition of their achievement for the services they have offered.
Value-Based Purchasing (VBP)
Model Components
Value-Based Purchasing (VBP) is a model for purchasing and managing healthcare services that seek to provide the highest quality of care at the lowest cost possible. It balances patient needs, provider productivity and quality, and provider finances (Obucina et al., 2018). The ultimate goal of VBP is to meet the patient’s needs with the least restrictive use of resources. Value-based purchasing (VBP includes five key concepts: the right to be well, the right to healthy environments, the right to receive high-quality care, access to information and education, and access to public health services. This new system provides incentives for providers to continuously improve the quality of their care to avoid performance penalties from the payer. In modern healthcare systems, it is often unclear who will control this market in the future. The system may change depending on which provider will provide the best service at a lower cost.
Application to Delivery of Care
Value-based purchasing can be applied to healthcare delivery in a medical home. This is because Medicare does not exist in silos, but rather, they are with acute care of specialty. This helps lower costs, higher patient satisfaction, and reduce medical errors.
Triple Aim
Model Components
A Triple Aim is a healthcare delivery model that includes three related objectives for patient care: effective prevention, illness management, and quality of life. Under this triple aim model, providers are required to deliver a core set of services called the essential package, which covers all aspects of health care (Scott et al., 2018). The model includes four elements: prevention, promotion, and early detection; mitigation of harm from exposure to risk factors; and enhancement or maintenance of function or well-being.
Application Delivery of Care
The proposed application of the model is to further develop an organization that can deliver healthcare in a manner that meets its Triple Aim for patient care. It has been found that the model can help organizations understand how certain characteristics of an organization directly affect its ability to achieve the Triple Aim (Obucina et al., 2018). An organization should be willing to embrace change and adopt new models when it’s necessary, not because they are afraid or intimidated by changes or feel uncomfortable. Triple aim is applicable in health care delivery by helping to improve the individual’s experience of care. This model is adopted and applied to all patients as it improves the health of populations and the percentage of cost that is effective for patients.
Bundled Payments
Model Components
In 2015, the Modernizing Health Care Initiative called for a fundamental redesign of care delivery systems. Current models of care delivery involve episodic, fragmented, and disjointed interactions between patients, providers, and payers. Brought on by the Patient Protection and Affordable Care Act (ACA), bundled payments seek to address this process by adopting a patient-centered design that ensures all participants contribute to achieving quality outcomes across a continuum of care through a single delivery system overall (Agarwal et al., 2020). As one example, bundled payments may involve oversight leading to measures such as requiring certain time allocated for physician visits for Medicare beneficiaries, which increases the perceived quality or value of their care.
Application Delivery of Care
Retrospective payment is one mode of application adopted in bundled payment. The retrospective payment system is done when patients retain fee-for-service (FFS) arrangements and continue to compensate the health providers directly. All this is done by tracking the total payment for them to reach the cost target.
Managed Care Organization (MCO)
Model Components
The managed care organization (MCO) is an umbrella term describing a collection of businesses that provide healthcare benefits, often alongside other services. MCOs may also refer to the employee-owned company that provides you with these benefits and/or manages them. MCOs are large organizations that provide their employees with a wide array of health insurance plans and other services (Ginter et al., 2018). The goal is to provide affordable, accessible care to all people regardless of age, income, or health condition.
Application to Delivery of Care
The application of managed care organizations is in the form of health maintenance organizations (HMOs). In an HMO, individuals usually only pay for care within their network. Patients can choose the primary care doctor who will coordinate most of their health care.
Preferred Provider Organization (PPO)
Model Components
The preferred provider organization (PPO) concept has developed over the years to provide an alternative to the traditional fee-for-service medical billing system. The PPO generates revenue by charging patients an annual fee based on their pre-negotiated health plan with one or more providers, usually a hospital and its associated physicians (Bai et al., 2018). The patient pays this fixed monthly fee directly to the hospital/physician, even if no services are rendered. Preferred Provider Organization is a type of health insurance plan that allows the insured to receive coverage from providers contracted with their organization. For example, there can be a preferred provider for orthopedic surgery and another preferred provider for pediatricians.
An application of a preferred provider organization (PPO) is the use of modern digital cards that allow patients to have a health plan that contracts with medical providers. The contract will allow the creation of a network of participating providers. Card usage allows patients to pay less in their health jurisdiction, but for services outside the contract, they will pay an additional cost.
References
Agarwal, R., Liao, J. M., Gupta, A., & Navathe, A. S. (2020). The Impact Of Bundled Payment On Health Care Spending, Utilization, And Quality: A Systematic Review. Health affairs (Project Hope), 39(1), 50–57. Web.
Bai, G., & Anderson, G. F. (2018). Market Power: Price Variation Among Commercial Insurers For Hospital Services. Health affairs (Project Hope), 37(10), 1615–1622. Web.
Ginter, P. M., Duncan, W. J., & Swayne, L. E. (2018). The strategic management of health care organizations. John Wiley & Sons.
John, J. R., Jani, H., Peters, K., Agho, K., & Tannous, W. K. (2020). The Effectiveness of Patient-Centred Medical Home-Based Models of Care versus Standard Primary Care in Chronic Disease Management: A Systematic Review and Meta-Analysis of Randomised and Non-Randomised Controlled Trials. International journal of environmental research and public health, 17(18), 6886. Web.
Kaufman, B. G., Spivack, B. S., Stearns, S. C., Song, P. H., & O’Brien, E. C. (2019). Impact of Accountable Care Organizations on Utilization, Care, and Outcomes: A Systematic Review. Medical care research and review: MCRR, 76(3), 255–290. Web.
Obucina, M., Harris, N., Fitzgerald, J. A., Chai, A., Radford, K., Ross, A., Carr, L., & Vecchio, N. (2018). The application of triple aim framework in the context of primary healthcare: A systematic literature review. Health policy (Amsterdam, Netherlands), 122(8), 900–907. Web.
Roberts, E. T., Zaslavsky, A. M., Barnett, M. L., Landon, B. E., Ding, L., & McWilliams, J. M. (2018). Assessment of the Effect of Adjustment for Patient Characteristics on Hospital Readmission Rates: Implications for Pay for Performance. JAMA Internal Medicine, 178(11), 1498–1507. Web.
Scott, A., Liu, M., & Yong, J. (2018). Financial Incentives to Encourage Value-Based Health Care. Medical care research and review: MCRR, 75(1), 3–32. Web.
