Beyond legislation, payers and quality organizations have recognized the value of consumer-centered healthcare, where the National Committee for Quality Assurance (NCQA), and Blue Cross and Blue Shield of Michigan (BCBSM) have accreditation and incentives for providers who demonstrate patient-centered medical health home (PCMH) practices, in primary care services. The PCMH model holds seven core principles for providers; these seven core principles are (1) the consumer has a personal physician, (2) the physician is part of a medical care team, (3) the treatment is whole-person care, (4) the care is coordinated or integrated across the healthcare system and community resources, (5) the focus on quality and safety of care, (6) access to care
Due to the increasing financial implications, patient satisfaction has become a growing priority for health care organizations, as well as transitioning the health care organization’s philosophy about the delivery of health care (Murphy, 2014). This CMS value based purchasing initiative has created a paradigm shift in health care in which leaders and clinicians must focus on patient centered care and the patient experience which ultimately will result in better outcomes. Leaders and clinicians alike must be committed to the patient satisfaction. As leaders within the organization, these groups must be role models and lead by example for front-line staff. Ultimately, if patients are satisfied, they are more likely to be compliant with their treatment plans and continue to seek follow up care with their health care provider, which will result in decreased lengths of stay, decreased readmissions, increased referrals and decreased costs (Murphy, 2014). One strategy employed by health care leaders to capture the patient experience, is purp...
Margaret E. O’Kane is the founder and president of the National Committee for Quality Assurance (NCQA). NCQA is one of the nation’s leading advocates for improving healthcare through measurement, reporting, and accountability. NCQA is the foremost accrediting organization for health plans including HMOs, PPOs, and consumer directed plans. (Margaret) “Our goal is to increase the value of NCQA accreditation both to organizations pursuing accreditation and to the audiences who seek help in assessing the quality of health care provided by those organizations”. NCQA has developed, maintained, and expanded the nation’s most widely used health care quality tool, which is known as the Healthcare Effectiveness Data and Information Set (HEDIS). HEDIS is responsible for evaluating whether and how well
Patient Credentialing identifies people who have a certain diagnosis and have achieved certain levels of competency in understanding and managing their disease (Watson, Bluml, & Skoufalos, 2015). Patient Credentialing (PC) was developed to meet 3 core purposes: (1) enhance patient engagement by increasing personal accountability for health outcomes, (2) create a mass customization strategy for providers to deliver high-quality, patient centered collaborative care, and (3) provide payers with a foundation for properly aligning health benefit incentive (Watson et al., 2015). The goal is for patients to achieve a proficiency in managing their chronic conditions to promote chronic conditions competencies and self-management.
Furthermore, in the case of comparing the Patient Centered Medical Homes against Obamacare services the odd speak for combining some of the techniques that are used in the PCMH to build a more stable health care system. “Maria Vezina (2013) reports knowledge about the Patient Protection and Affordable Care Act (PPACA) passed in March 2010 and upheld by the Supreme Court in June 2012, is key in understanding the varied regulatory changes that have been made to our U.S. health care system. PPACA is the most significant regulatory overhaul of U.S. health care since Medicare and Medicaid in 1965. The entire health care team needs to be prepared for initiatives introduced to better manage the care for a greater population of people with improved
One of the vital aspect of the philosophical approach of the Osteopathic Medicine centers around patient-centered care. Patient-centered care involves respecting patients’ values, understanding the patient as a whole person, and ensuring that patients’ values guide all clinical decisions. This idea of patient-centered care is at the heart of my journey and fortunately this idea perfectly aligned with the mission and vision of the Philadelphia College of Osteopathic Medicine (PCOM).
The current health care reimbursement system in the United State is not cost effective, and politicians, along with insurance companies, are searching for a new reimbursement model. A new health care arrangement, value based health care, seems to be gaining momentum with help from the biggest piece of health care legislation within the last decade; the Affordable Care Act is pushing the health care system to adopt this arrangement. However, the community of health care providers is attempting to slow the momentum of the value based health care, because they wish to maintain their autonomy under the current fee-for-service reimbursement system (FFS).
It is no secret that the current healthcare reformation is a contentious matter that promises to transform the way Americans view an already complex healthcare system. The newly insured population is expected to increase by an estimated 32 million while facing an expected shortage of up to 44,000 primary care physicians within the next 12 years (Doherty, 2010). Amidst these already overwhelming challenges, healthcare systems are becoming increasingly scrutinized to identify a way to improve cost containment and patient access (Curits & Netten, 2007). “Growing awareness of the importance of health promotion and disease prevention, the increased complexity of community-based care, and the need to use scarce human healthcare resources, especially family physicians, far more efficiently and effectively, have resulted in increased emphasis on primary healthcare renewal…” (Bailey, Jones & Way, 2006, p. 381). The key to a successful healthcare reformation is interdisciplinary collaboration between Family Nurse Practitioners (FNPs) and physicians. The purpose of this paper is to review the established role of the FNP, appreciate the anticipated paradigm shift in healthcare between FNPs and primary care physicians, and recognize the potential associated benefits and complications that may ensue.
The person pursues healthcare service with great expectations such as quality health care, latest technological interventions and low cost for their service. Nowadays, one of the challenges facing by the health care providers is providing appropriate care and identifying their needs in a cost effective and comprehensive way without compromising the quality of care. Center for Medicare and Medicaid Services (CMS) reported “an rise in healthcare spending from $2.34 trillion in 2008 to $ 2.47 trillion in 2009, the largest one year increase since 1960” (Pickert, K, 2010). “The action to improve the American health care delivery system as a whole, in all of its quality dimensions such as efficiency, effectiveness, equitability, timeliness, patient-centeredness, and safety for all Americans” (IOM, 2011).
Given the fact that one-third of all healthcare expenditures is for ambulatory care, it is safe to say that patients spend most of their time in an ambulatory care setting (Carper, 2013). This setting has a significant impact in the overall assessment of the healthcare industry and how care is delivered. It is important to address data collected by surveys to implement strategies for quality improvement. Affecting care in Ambulatory settings will have the largest significance in the health outlook.
A mandate will be made through this health care reform plan that will make providers more involved in the care of their patients. Steps will be taken to help increase the number of physicians in areas experiencing shortages along with incentives for physicians to become family practitioners. Preventative care will be the focus therefore annual checkups and routine procedures will be covered by all insurances. A coordination track where doctors, nurses, and other providers work effectively and efficiently in teams, analyzing the outcomes and processes of care to rid the system of waste will be created (Cortese & Korsmo, 2009).
Patient-centered care is a broad topic that can be discussed on a daily basis within the healthcare world. Patient-centered care is when healthcare providers and facilities provide care that is respectful to the patient’s preferences, needs and values. It can also be described as physicians who practice patient-centered care can improve their patients’ clinical outcomes and satisfaction rates by improving the quality of the doctor-patient relationship, while at the same time decreasing the utilization of diagnostic testing, prescriptions, hospitalizations, and referrals (Rickett, 2013). Unfortunately, ideal patient-centered care is hard to come by, especially in all 50 states because there is a shortage of money and proper resources needed
...lthcare system is slowly shifting from volume to value based care for quality purposes. By allowing physicians to receive payments on value over volume, patients receive quality of care and overall healthcare costs are lowered. The patients’ healthcare experience will be measured in terms of quality instead of how many appointments a physician has. Also, Medicare and Medicaid reimbursements are prompting hospitals, physicians and other healthcare organizations to make the value shifts. In response to the evolving healthcare cost, ways to reduce health care cost will be examined. When we lead towards a patient centered system organized around what patients need, everyone has better outcomes. The patient is involved in their healthcare choices and more driven in the health care arena. A value based approach can help significantly in achieving patient-centered care.
Patient-centered care recognizes the patient or designee as the source of control and full partner in
Today, many Americans face the struggle of the daily hustle and bustle, and at times can experience this pressure to rush even in their medical appointments. Conversely, the introduction of “patient-centered care” has been pushed immensely, to ensure that patients and families feel they get the medical attention they are seeking and paying for. Unlike years past, patient centered care places the focus on the patient, as opposed to the physician.1 The Institute of Medicine (IOM) separates patient centered care into eight dimensions, including respect, emotional support, coordination of care, involvement of the family, physical comfort, continuity and transition and access to care.2
As a result, a growing number of Medicare and Medicaid recipients were transferred into capitated or fixed payment plans to save on costs, but this created a problem in the collection of data because under the fee-for-service plans Medicare was the largest payer of services provided by home health care agencies at 44 percent; Medicaid came in a close second at 38 percent; private insurance and other third-party payers made up 10 percent; and the final 8 percent came from patients who paid directly out-of-pocket. Capitated plans limit the ability to collect data on home health care services because the physician is given one flat fee per the number of patients covered regardless of how many patients he actually provides services to. This makes it difficult to document the specific services provided to the patient, thus making it difficult to justify the need to expand and modify the current program. Another reason data for home health services is so difficult to track is, Medicaid programs in fifteen states have implemented self-directed services which permit patients to coordinate their own home health services and compensate family members who provide care. The implementation of self-directed services in these fifteen states have had positive results in decreasing the amount of unmet patient’s requirements and enriching health outcomes, quality of life, and beneficiary satisfaction at a rate equivalent to that of the traditional home health agency directed service