Healthcare Industry – Industry Overview

 

 

 

https://innovation.cms.gov/innovation-models#views=models

The government is one of the largest purchasers of health care services and because of this, they seek out opportunities to contain costs. Recent health care policy has focused on managing costs while offering quality care and improving access to care. The Centers for Medicare and Medicaid Services (CMS) Innovation Center develops payment and service delivery models with this in mind.

Scenario

Mr. Magone, CEO of Healing Hands Hospital, has asked you to join the Future of Healing Hands Task Force. Your first assignment is to work with the hospital’s Chief Financial Officer (CFO), Ms. Johnson, and provide a summary of how the new CMS initiatives might impact the organization’s revenue structure. More information on the innovation models can be found on the CMS Web site.

Describe an Accountable Care Organization (ACO) and the benefits of an ACO.
Describe an episode-based payment initiative and the benefits of this initiative to Healing Hands Hospital.
Reference

Centers for Medicare and Medicaid Services (CMS). (n.d.). Innovation models. https://innovation.cms.gov/initiatives/#views=models

 

Sample Solution

Healthcare Industry – Industry Overview

Accountable care organizations (ACOs) are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to the Medicare patients they serve. Coordinated care helps ensure that patients, especially the chronically ill, get the right care at the right time, with the goal of avoiding unnecessary duplication of services and preventing medical errors. When an ACO succeeds in both delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program. Episode-based payments are structured to provide a discounted payment or set a pre-determined price against which actual payments are retrospectively reconciled, that is specific to conditions for a discrete timeframe (referred to as a target price).

e, a neurological disease, as well as cardiovascular disease, was evaluated and it was found that genetic information combined with personal health status affected levels of anxiety, as well as further short-term depletion of risk factors for cardiovascular disease. It was discovered that patients with neurological impairments or manifesting Huntington disease symptoms experienced depression at a higher level, and a lower level of quality of life. Conflicting results were found pertaining to cancer. One study reported that there were no levels of distress and anxiety based on the presence or absence of a disease within the family history. However, another two studies found higher levels of distress in people who have already experienced a diagnosis or a cancer. Coping strategies were enacted more by women with a personal cancer history more than women without experience with cancer. Receiving results increased the cognizance of risk, as well as increased screenings and checkups. These studies assisted in understanding how psycho-behavioral reactions could lead to better ways of organizing personal care plans (Oliveri, Ferrari, Manfrinati, Pravettoni, 2018). The research done for the genetic testing of cardiovascular disease, neurodegenerative diseases and cancer allows researchers to better understand how users’ perceptions of developing these diseases affect their lifestyle and psychological well-being. The studies allowed researchers to explore how the application of genetic testing can affect how personal care plans are organized, as well as influence patients in their lifestyle and choosing appropriate situations for their health. Cancer affects the human body in many ways. The cardiovascular and nervous system are both heavily affected by cancer. They are both extremely important systems in the human body and are susceptible to diseases, such as Alzheimer’s disease for the nervous system and cardiovascular disease for the cardiovascular system. Cancer survivors are at a higher risk of cardiovascular morbidity and mortality that is disease related (Adams, Schondorf, Benoit, Kilgour, 2015). The treatments for cancer can affect the body as well. Antibodies, such as trastuzumab, can be related to cardiomyopathy in breast cancer patients when it is used with additive and helpful chemotherapy (Jancin, 2008). A leading cause of morbidity and mortality in cancer survivors has become chemotherapy related cardiotoxicity (Pradeep, et al., 2018).

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