02 May Then, respond to at least two other peers who have chosen topics different from yours. Include the following in your response: Discuss at least two possible ways that your peers’ chosen

Jana Discussion:

      The costs of healthcare are continually rising, and consumers are struggling to keep up with increasing deductibles and ever-rising out-of-pocket expenses while simultaneously trying to adjust to inflation-induced high costs of living (Lyford & Lash, 2019).   The Centers for Medicare and Medicaid Services (CMS) has over the years attempted to control healthcare costs by adjusting reimbursement rates and moving toward a value-based payment system.  The healthcare system has traditionally been a fee-for-service model that incentivizes offering more services to increase reimbursement by third-party payers or to minimize treatment for those insured by government payers due to prospective payment systems (Lyford & Lash, 2019).  Therefore, providing care based on value rather than who is paying the bill is vital to ensuring equal access for all consumers.  Value-based reimbursement promotes an emphasis on quality outcomes, efficiency, and preventive care.  Providers who excel in these categories receive higher rates of reimbursement and are rewarded for their positive outcomes and lower treatment costs.

            Value-based payments sound easy on paper but are still challenging to achieve.  Providers and facilities are required to report on a variety of quality metrics to CMS (CMS, 2023).  However, the complex reporting system sometimes forces providers’ focus on metrics rather than individualized care.  And for smaller healthcare facilities, the costs to implement evidence-based practices is often higher than the amount of reimbursement for those investments, making it difficult to achieve these quality outcomes.

            As a healthcare leader, creating a culture that connects clinicians to their ultimate purpose of healing is crucial (Teisberg et al., 2020).  Just as providers have a duty to do no harm, they also have a fiscal responsibility to their patients.  Aligning care with patient’s ability to pay for treatment should be a priority of providers and requires a great deal of empathy.  Leaders should work to create this culture of empathy and care while also providing resources such as financial counseling and price transparency.

References

Centers for Medicare and Medicaid Services (2023).   CMS quality reporting and value-based programs and initiatives.  U. S. Department of Health and Human Services.   https://mmshub.cms.gov/about-quality/quality-at-CMS/quality-programs

Lyford, S., & Lash, T. A.  (2019).  America’s health care cost crisis.   Journal of the American Society on Aging, 43, 7-12.  ISSN 0738-7806.

Teisberg, E., Wallace, S., O’Hara, S.  (2020).  Defining and implementing value-based health care:  A strategic framework.   Journal of the Association of American Medical Colleges, 95(5), 682-685.   https://doi.org/10.1097/ACM.0000000000003122

Dustin Discussion:

Hello Class,

Congrats on a Hardworking Term

Medicaid Expansion is a provision in the Affordable Care Act called for the expansion of Medicaid eligibility to cover more low-income Americans (Health Insurance.org, 2024). This future health trend is important to monitor because 41 states have adopted the Medicaid expansion to help more low-income populations with a Federal Poverty Level of 20,783 (KFF, 2024). Health insurance is extremely important for populations who may have a pre-existing health condition to be covered by Medicaid. This will help with any reimbursement options when visiting healthcare services and decrease healthcare disparities. With millions of Americans not insured with health insurance due to the cost, the Medicaid expansion can help those Americans be covered with the exception of how much they make and other eligibility. 

The potential challenges within the healthcare industry will be that 10 states did not expand on Medicaid which puts communities at risk with no options of being covered by Medicaid. As a Healthcare leader, sitting down with local or state lawmakers discussing potential options for Medicaid expansion to vulnerable communities is very crucial. Not everyone will agree with Medicaid Expansion but with millions of Americans not insured and high cost of healthcare services can be a negative impact to their financial stability and health. The more people are insured with health insurance, the better health outcomes will occur and prevent health disparities as well as death rates.

Reference

HealthInsurance.Org. (2024). Medicaid Expansion. Retrieved from:    https://www.healthinsurance.org/glossary/medicaid-expansion/

KFF. (2024). Status of State Medicaid Expansion Decisions: Interactive Map. Retrieved from:   https://www.kff.org/affordable-care-act/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map/