Payment Models

 

Scenario

Metropolitan Memorial is seeking to expand its service offerings into underserved rural communities. The Board of Directors has expressed concerns given the emergence of new payment models, low reimbursement from Medicare and Medicaid, and uncertainty in terms of provider incentives offered through the Affordable Care Act. The Board of Directors has requested an executive summary outlining the organization’s financial viability given the challenges facing health organizations, particularly those operating in rural communities.

Instructions
The CEO has asked you to prepare an executive summary to present to the Board of Trustees, discussing the following information:

Identify the different types of healthcare payment models that could be utilized by Metropolitan Memorial.
Research the Triple AIM and discuss ways the organization can achieve the goals of the Triple AIM (improving the experience of care, improving the health of populations, and reducing per capital costs of health care ).
Discuss possible ways the payer mix may impact hospital revenue.
Explain how value-based healthcare delivery could be utilized to save money

Sample Solution

Frowe suggested combatants must be identified as combatants, to avoid the presence of guerrilla warfare which can end up in a higher death count, for example, the Vietnam War. Moreover, he argued they must be part of the army, bear arms and apply to the rules of jus in bello. (Frowe (2011), Page 101-3). This suggests Frowe seeks a fair, just war between two participants avoiding non-combatant deaths, but wouldn’t this lead to higher death rate for combatants, as both sides have relatively equal chance to win since both use similar tactics? Nevertheless, arguably Frowe will argue that combatant can lawfully kill each other, showing this is just, which is also supported by Vittola, who states: ‘it is lawful to draw the sword and use it against malefactors (Begby et al (2006b), Page 309).’
In addition, Vittola expresses the extent of military tactics used, but never reaches a conclusion whether it’s lawful or not to proceed these actions, as he constantly found a middle ground, where it can be lawful to do such things but never always (Begby et al (2006b), Page 326-31). This is supported by Frowe, who measures the legitimate tactics according to proportionality and military necessity. It depends on the magnitude of how much damage done to one another, in order to judge the actions after a war. For example, one cannot simply nuke the terrorist groups throughout the middle-east, because it is not only proportional, it will damage the whole population, an unintended consequence. More importantly, the soldiers must have the right intention in what they are going to achieve, sacrificing the costs to their actions. For example: if soldiers want to execute all prisoners of war, they must do it for the right intention and for a just cause, proportional to the harm done to them. This is supported by Vittola: ‘not always lawful to execute all combatants…we must take account… scale of the injury inflicted by the enemy.’ This is further supported by Frowe approach, which is a lot more moral than Vittola’s view but implies the same agendas: ‘can’t be punished simply for fighting.’ This means one cannot simply punish another because they have been a combatant. They must be treated as humanely as possible. However, the situation is escalated if killing them can lead to peace and security, within the interests of all parties.
Overall, jus in bello suggests in wars, harm can only be used against combatants, never against the innocent. But in the end, the aim is to establish peace and security within the commonwealth. As Vittola’s conclusion: ‘the pursuit of justice for which he fights and the defence of his homeland’ is what nations should be fighting for in wars (Begby et al (2006b), Page 332). Thus, although today’s world has developed, we can see not much different from the modernist accounts on warfare and the traditionists, giving another section of the theory of the just war. Nevertheless, we can still conclude that there cannot be one definitive theory of the just war theory because of its normativity.

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