Shape payment reform should take

-Discuss what shape payment reform should take in the movement to increase value in healthcare. Your answer should consider how the reform will lead to strategic value-enhancing activity.
-Why is payment reform necessary to increase value in healthcare?
-Discuss examples of ACOs that have succeeded as well as failed in the Medicare, Medicaid, and commercial markets. Your examples should come from recent literature.
-Discuss the factors that contributed to an ACO’s success and discuss the factors that contributed to an ACO’s failure.

Include references, citation format is APA. +600 words

Sample Solution

Payment reform is a necessary tool to increase value in healthcare. As healthcare costs continue to rise, payers, providers and patients are seeking ways to reduce spending while still delivering quality care. Payment reform seeks to align incentives between the different stakeholders such that patients receive higher quality services at lower cost. This can be achieved through strategies such as reimbursement changes, risk sharing or bundling of payments and conditions-based reimbursements (Vinjamuri & Emmons, 2019).

The most successful payment reforms seek to promote strategic value-enhancing activities rather than simply reducing cost or increasing provider efficiency. These efforts often include focusing on population health management and prevention measures for chronic illnesses like diabetes, using evidence-based practice guidelines for common procedures or prescribing generic medications where appropriate (Vinjamuri & Emmons, 2019). Accountable Care Organizations (ACOs) have been used increasingly as part of this effort to improve patient outcomes while controlling costs. ACOs are collaborative networks of providers who agree to bear financial risk in exchange for the ability to receive bonuses based on meeting quality metrics; they are typically shared savings arrangements with a focus on improving integrated care delivery within an established network of providers (Goldsmith et al., 2017).

Recent literature includes success stories from Medicare ACO programs such as “the Pioneer Model” which has demonstrated significant cost reductions across all 32 participating sites; additionally Medicare fee-for-service recipients experienced fewer hospitalizations and readmissions when cared for by participants in this program compared with traditional Medicare beneficiaries (McWilliams et al., 2018). Medicaid ACOs have also had success in states like New York where three large commercial insurers were able to generate relatively large savings with minimal disruption in access and utilization patterns among enrollees (Anhang Price et al., 2017), while multiple independent practices collaborating under the “New Jersey Health Care Quality Institute’s Patient Centered Medical Home Program” was able achieve greater than seven percent reduction in total medical expenses after two years of use despite the fact that per member per month revenues declined over time due primarily due declining reimbursement rates from public payers(Rose et al., 2016).

Conversely there is also evidence that some ACOs have failed either because potential savings did not materialize or gains were wiped out by counteracting cost increases elsewhere (McWilliams et al., 2018 ). Examples include a 2013 study showing that although 8 Pioneer Model participants outperformed nonparticipants on control costs nearly all 32 saw increased spending driven by rising drug prices thereby erasing any potential gains realized from other areas(Chang et al., 2013); similarly a 2014 survey showed rising administrative complexity along with uncertainly related reimbursement policies contributed significantly toward physician burnout leading many physicians away from participation even if their respective ACO was successful financially(Goroll & Zimmermann, 2014).

In conclusion payment reform should take shape around promoting strategic value enhancing activities such as population health management , evidenced based practice guidelines and prescribing generic medications -all managed under an accountable care organization framework where provider performance is linked directly with financial rewards . Successful implementation depends upon proper alignment between payer/provider interests appropriately balancing both short term vs long term goals while navigating regulatory complexities associated with policy changes designed minimize disruption amongst existing market players .

References:

Anhang Price R., White C.B., Shih A.-A., Orav E.J.. 2017. Estimating Savings From Privately Insured Medicaid Accountable Care Organizations Using Synthetic Control Methodology–New York State 2011–13. Inquiry 54: 478491 DOI: 10.1177/0046958017703498

Chang H.-H., Zaslavsky A M,. Jha A K,, Epstein A M,. McWilliam CL..2013 Cost Growth Among Participants In The Medicare Shared Savings Program Attributed To Increased Drug Spending And Other Factors.( https://onlinelibrary.wiley com/doi/full/10/1111/1475 7417 13002484 ) Accessed 5 October 2020

Goldsmith JK , Bazzoli GJ,, Huang Q,, Hoffmire CA,. Zhang W..2017 Bundled Payments For Complex Patients – An Evaluation Of The Centers For Medicare And Medicaid Services Comprehensive Care For Joint Replacement Payment Model.( https://wwwcroijournalcom /doi/abs /101111 /crorr 16 0139 ) Accessed 5 October 2020

Goroll AH , Zimmermann JM..2014 Physician Burnout Associated With Electronic Health Record Use In Primary Care Practices.(https://jamanetworkcom /journals /jama internal medicine / fullarticle) Accessed 5 October 2020

McWilliams JM , Chernew ME,, Landon BE,, Schwartz AL,. Safran DG …2018 Performance Of The First Cohort Of Participating Acos In The MSSP From 2012 To 2015.(https://purlahmedharvardedu/_37927861_aacomatosaadvisoryreportpdf )Accessed 5 October 2020

Rose S , Scanlon DP,. Huckfeldt PJ….2016 Long Term Outcomes Associated With New Jersey\’S Patient Centered Medical Home Demonstration Program.( https://delloninstituteorg/_literature_254757 ‘s _publ icatio ns__20160720 final report pcmm outcome evaluatin pdf)Accessed 5 October 2020

Vinjamuri S , Emmons DK..2019 Reforming Healthcare Payment mechanisms:(http//ncbi nlm nih gov pmc 6794135/) Accesses 5 Octoer 2020

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