Category: Affordable Care Act

Introduction

According to the background of the Affordable Care Act, this paper would analyze the effect of policy A that raises the age for which young adults could stay on their parent’s employer-sponsored health plan. Section 1 would review the background and young adults’ coverage of the ACA. Thus, section 2 and section 3 would give some potential benefits and concerns of policy A, respectively. Finally, section 4 would analyze the effects of policy A based on experimental results, using descriptive statistics and the Difference-in-differences method.

Coverages of the ACA

There are four main coverages in ACA legislation. Employer-Sponosred Coverage will be discussed in more detail below. Other coverages are through social programs, such as Medicaid, which is supported by the federal government. In this case, medical care is provided to people with incomes below the official poverty line. Finally, subsidized marketplaces can also provide coverage. Their responsibility extends to people with moderate income.

Employer-Sponsored Health Insurance and Young Adults in the ACA

Employer-sponsored health coverage refers to the health insurance for employee obtained by employer. In the U.S., it is normally Affordable Care Act that requires the employers insure their employee’s minimum essential health coverage with at least 50 full-time employees or full-time equivalents (Edward G., Craig A., Elonda C., & Emily M., 2010). Meanwhile, the ACA also protects the minimum essential health coverage of employees’ family. Plans and issuers of plans could not remove adult children from their parents’ coverage until they reach the age of 26, whatever married or unmarried. Once the young adults reach 26 and age out of their parents’ coverage, they could choose to enroll in any other employer plan that they are eligible.

Statistics

Benefits

From private perspective, policy A that raises the age for which young adults can stay on their parents’ employer-sponsored health plan from age 26 to age 27 might provide at least the following benefits:

• The young adults could have less concerns about the situation that they out of the minimum health coverage due to unemployment if graduating from school. Staying on their parents’ employer-sponsored health plan, they could obtain the required health coverage, even through they were not enrolled in the other employer health plan.
• On the other hand, policy A could also lower the financial risk of young adults or the family with a young adult. According to the statistics of Center for Medicare & Medicaid Services (CMS), almost one in six young adults suffer a chronic illness (cancer, diabetes or asthma etc.). Moreover, around half of uninsured young adults report those health problems. If staying on their parents’ employer-sponsored health insurance, those young adults or their family could face less financial risk due to physical problems.

Heath Insurance Premiums

From social perspective, the largest benefit of policy A is the efficient addition of health insurance coverage. Based on the statistics of CMS, almost 30% of young adults are not included in any health insurance. With the highest uninsured rate among any age group, uninsured young adults who are age at 20 to 30 represent over 20% of total population uninsured. The implementation of policy A could efficiently raise the health coverage in the U.S.

Concerns

The implementation of policy A would also affect the employment decisions of both employee and employer as the following:

• The employers are required to offer the health insurance to their employees. If policy A has been implemented, they would afford a larger administration costs for their employees. Employers might choose to employ less labor with a consideration of costs. Thus, policy A might affect the demand in labor market.
• On the other hand, employees and potential employees would have less incentive to enter the labor market for a job with a more comprehensive social welfare. Thus, the supply of labor would also decrease.

Unemployment Rates

Therefore, the labor market would reach a new equilibrium in which less population would be employed with a higher welfare in the aspect of the whole society. Moreover, it is proved that a higher social welfare would bring an increase in unemployment rate. Compared to the U.S. where the most of people must afford the whole or a part of healthcare costs, most of European countries provide their people with universal health care by tax revenues. Nonetheless, the unemployment rate of the U.S. in 2019 is 3.8% while this figure of the EU is 6.9%. Facing a higher cost of labor, employers would definitely cut off their employment scale. Moreover, they might also instead the full-time employment of the part-time employment. Both of the two choices would decrease the total employment scale.

Impacts from Policy A Based on Empirical Treatment

As showed in the following graph, control group have a higher average number of physician visits in each quarter before the implementation of policy A, compared to treatment group (Treatment group stays on parent’s health plan between the ages of 26~27 years while control group does not). But the situation has been reversed by policy A. The average number of physician visits of treatment group increases rapidly and deviates far from this figure of control group. This phenomenon might mean that the abuse of public medical resources due to moral hazard of the insured.

In contrast, the health status of treatment group also deviates upward far from that of control group. In other words, the policy A might really improve the health status of treatment group. But measuring the success of a policy should consider both its costs and results.

Difference-in-Differences Method

With a Difference-in-Differences method, this paper analyzes the impacts from policy A on the utilization of medical resources and health status. There are the general view of this method, including the graph and regression model for calculations. This method is often used for this kind of tasks and is relevant (Saeed et al., 2019).

As showed in the following table, the average number of physician visits of both treatment group and control group have increased. But this figure increased with a higher velocity for treatment group. Moreover, the deviation between these measurements of both groups has been raising. Thus, it is obvious that the implementation of policy A might increase medical demand of the insured. However, the reason of increasing medical demand is complicated.

It might result from over-usage of medical resources due to patients’ moral hazard even they were not in serious physical conditions. On the other hand, it might also refer to the potential demands’ meeting. Out of employer-sponsored health insurance, some young adults may not obtain necessary medical treatments before the implementation of policy A. However, their demands have been met because of policy A.

In contrast, the treatment group also shows a better self-reported health status under the same method. The average points of the treatment group are higher than that of control group by 8 points. Thus, it is proved that policy A actually improves the health status of young adults as showed in the following table.

Conclusion

In a summary, this policy is relatively successful, although it brings some problem due to patients’ moral hazard. Nonetheless, policy A makes more medical demand of young adults has been met and improve the overall health status of the whole treatment group. But it does not represent that policy A is perfect. Many facts (over-usage of medical resources, impacts on unemployment rate etc.) should be investigated and measured for amendment of policy A.

References

Claxton, G. (2018). Annual average premiums graph 1999–2018 [Diagramm]. Health Affairs. Web.

Erica. (2019). Difference-in-differences estimation [Illustration]. Aptech. Web.

Eurostat. (2021). EU unemployment rates [Diagram]. Euroindicators. Web.

Gerwyn, N. (2019). Mechanical description [Illustration]. Medium. Web.

Long, M., Rae, M., Claxton, G., & Damico, A. (2016). Trends in Employer-Sponsored insurance offer and coverage rates, 1999–2014 [Diagramm]. Kaiser Family Foundation. Web.

Saeed, S., Moodie, E. E., Strumpf, E. C., & Klein, M. B. (2019). Evaluating the impact of health policies: Using a difference-in-differences approach. International Journal of Public Health, 64(4), 637-642.

Tolbert, J. (2015). Key coverage elements in the ACA. Kaiser Family Foundation. Web.

US Bureau of Labor Statistics. (2020). US unemployment rate. BBC. Web.

The ratification of the Affordable Care Act (ACA), also known as “Obamacare,” has become one of the major milestones in the context of the development of modern health care in the US. Having been introduced in 2010, this act was primarily predetermined by the issue of the socio-economic gap in terms of health care fundamentals accessibility for the vast majority of the state population. Essentially, the ACA places emphasis on the following federal provisions:

• Expand access to insurance coverage by encouraging employers to cover insurance for their workers with little exception, securing insurance for people with income below the federal poverty guidelines, and expanding insurance accessibility for children and young adults;
• Increase consumer insurance protections by prohibiting the coverage cancelation of plans and monetary caps;
• Emphasize prevention and wellness by creating national resources to allocate payments and financial aid on the aspects of primary health prevention and public health promotion;
• Improve health quality and system performance by investing in the development of medical information technology and scholarly medical research;
• Promote workforce development by providing more options for continuous professional growth and training, as well as creating more accessible tertiary education options for potential medical students (Patient Protection and Affordable Care Act, 2010)

Considering the aforementioned provisions, it would be reasonable to conclude that the ratification of the ACA depends greatly on the qualifications of nurses, as they are the ones to secure empirical data collection. Indeed, nurses are educated and trained with the purpose of proper interaction with both the patients and public institutions in order to convey relevant data. Hence, to secure the further positive outcomes of the ACA, nurses are to communicate relevant health states of the population that would eventually regulate the patterns of insurance coverage and finance allocation.

Reference

Patient Protection and Affordable Care Act of 2010, Pub. L. No. 111–148, 124 Stat. 119. (2010).

The Affordable Care Act (ACA) was signed by former President Barrack Obama on March 3rd, 2010.

The timeline of the events that culminated in the ACA commenced in 2009. In September 2010, the earliest provision of the Affordable Care Act was put in effect, while on June 8th, 2012, the Supreme Court endorsed the law and enforced ruled the single debated obligation as a tax. October 1st, 2013, marked the launch of an online exhibition for purchasing health insurance coverage. From 2014 through 2017, the ACA attracted several rulings and provisions. For instance, the act considerably transformed the healthcare structure in the United States, decreasing the number of persons and families rewarded with uncompensated healthcare. The ACA supports individuals who cannot afford an insurance plan and obliges each American to obtain health insurance.

One of the primary objectives of the ACA was to magnify health insurance coverage, reduce healthcare costs, and eventually improve access to healthcare. Among its many improvements, the ACA extended medical insurance coverage to adults with incomes lower than 133% of the federal poverty level (FPL) within the participating states (Courtemanche et al., 2018). While the act provided vital benefits for home healthcare, its amendments also the quality of care may have been endangered. Some of the mandated benefits had been proposed to inspire care for the elderly. Accordingly, home healthcare practitioners were cut off by $60 million in 2015 as part of the long-term plan to reduce healthcare costs under the ACA (Courtemanche et al., 2018). Also, few healthcare professionals would be available to care for patients. These reductions may have resulted in low-quality care for the beneficiaries.

The ACA embodies the effort to transform the financial association between America’s healthcare system and its citizens. Increasing comprehensive insurance and launching formal marketplaces have not only reduced the number of individuals who are not insured but have extensively enriched the quality and access of care to the insured (Sherry et al., 2017). The Affordable Healthcare Act lays down centralized principles for health insurers. Qualified health benefit devices are required to meet the federal standards defined under the act. Additionally, qualified health subsidy plans are obligated to create performance evidence compatible with the state measurement standard accessible to beneficiaries. This policy encourages the provision of quality care to patients and recipients (Sherry et al., 2017). The ACA institutes the Organization for Comparative Clinical Effectiveness Research to endorse the kind of study necessary to recognize the most suitable and resourceful healthcare delivery method for different patient groups.

All health guarantors have an appeal procedure that enables the insured to request compensation for a claim denied. In cases of an insurance company refusing or denying payment to a healthcare claim, one has a right to petition the resolution in two ways. First, one may request the insurance company to carry out a full review of its decision. This procedure is carried out through a written letter stating the appeal and communicating the appropriate information to have the claim reviewed. It is essential to evaluate one’s coverage and establish the purpose as to why a claim was deprived. Following the review, one can take the plea to a liberated third party for appraisal. As a result, the insurance company no longer has the final say over the claim.

References

Courtemanche, C., Marton, J., Ukert, B., Yelowitz, A., & Zapata, D. (2018). Effects of the Affordable Care Act on health care access and self-assessed health after 3 years. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 55.

Sherry, G., Ma, S., & Borja, A. (2017). Effect of the Affordable Care Act on health care access. Issue Brief-Commonwealth Fund. Web.

Introduction

Medicaid expansion falls under the Affordable Care Act’s (ACA) overall effort to improve care quality and curb rising costs. Other benefits of Medicaid expansion include broadening care access in rural areas and for people with disabilities, plus reducing racial disparity in coverage rates. As reported by Ku and Brantley (2021), approximately 11 million adults enrolled for Medicaid by 2016. However, Medicaid expansion remains controversial as states continue to assess whether or not to pursue the expansion. ACA critics argue that Medicaid expansion would result in significant shortages in the healthcare workforce due to increased demand from newly insured individuals and reduced care quality. The ACA Medicaid expansion affects nurses’ role in the provision of care.

Medicaid Expansion

In an era of constant change, healthcare has become a global concern. While studies have detailed the benefits of Medicaid expansion from health outcomes to fiscal impacts, unanimity remains elusive (Levy et al., 2020; Searing & Ross, 2019). States like Mississippi, North Dakota, Texas, Tennessee, Florida, Kansas, and Alabama resist the expansion (Searing, & Ross, 2019). A cited concern of the expansion by these states and policymakers is its impact on the state budget. While Medicaid expansion allows states to cut spending on traditional Medicaid, they finance a share of the expansion, which increases state spending despite federal assistance. However, Rudowitz and Antonisse (2018) argue that Medicaid expansion helps a state to save. Advocates believe that the benefits of Medicaid expansion are far-reaching.

The stakeholders engaged in successful Medicaid expansion include the advocacy and patient community, healthcare providers, and legislation. Each of the stakeholders provides a viewpoint on Medicaid expansion in relation to each other. After the ACA, Medicaid provided low-cost healthcare coverage to several Americans, including the elderly, low-income earners, people with disabilities, families, and children, plus pregnant women. Sugar et al. (2021) highlights that the American Rescue Plan Act (ARP) encourages states to expand Medicaid to cover individuals aged up to 65 living at the federal poverty level. Furthermore, states that implement the expansion receive federal funding authorized under the ARP. Ideally, Medicaid expansion maximizes public health within a state’s resource constraints.

Factors Surrounding Medicaid Expansion

Socioeconomic

The ACA Medicaid expansion has the potential to mitigate income-based inequality regarding healthcare access. As Kino and Kawachi (2018) state, socioeconomic inequality in healthcare access is a prevalent issue in the United States compared to other developed countries. Among the fundamental economic functions of ACA expansion is the protection of financial assets against costly medical bills. Moreover, public insurance coverage provides financial benefits to previously uninsured individuals. Subsequently, greater financial security stimulates social behavior like political activism, volunteering, and community representation. Similarly, Medicaid expansion represents unprecedented importance to subpopulations of low-education, ethnic or racial minorities, low-income, people with disability, plus the formerly incarcerated. For instance, apart from racial injustice, the incarcerated are at a greater risk of substance abuse and mental illness (Beck, 2020). Thus, expanding Medicaid to the formerly incarcerated impacts individual families and the wide-reaching community.

Political

The ACA created a framework for expanding healthcare insurance and addressing issues in the private insurance market. While states have shaped the expansion agenda, it remains unlikely. Delegation of crucial aspects of Medicaid expansion to the states has resulted in substantial uncertainty on health insurance especially when political polarization adversely affects policy implementation. For instance, governors and state legislators of some Republican-controlled states have delayed initiatives to implement Medicaid expansion (Rocco et al., 2020). Plus, the criticism of ACA expansion discourages progressive coalitions and administrators in policy change. The ACA was to settle the political issue surrounding Medicaid expansion, which has proven otherwise.

Cultural

Racism and limitations on immigrants’ eligibility for health coverage have resulted in disparities in care access and health outcomes. Lee et al. (2021) provide substantive data on the prevalence of diabetes, obesity, and overall poor health among Hispanics and Blacks. Significant reduction in uninsured Americans occurred among non-elderly, Hispanics, and Blacks in ACA expansion states, which dropped from 9.8 to 3.2 percentage points (Chaudry et al., 2019). Furthermore, the COVID-19 pandemic made the underlying ethnic disparities in healthcare more visible. Compared to non-expansion states, expansion states addressed the crisis’ impact on people of color more effectively (Cross-Call, 2020). Thus, the ACA expansion has an equalizing effect in reducing cultural disparities in healthcare coverage. Nonetheless, factors outside Medicaid expansion prolong the disparities in healthcare outcomes.

Ethical

The ethical issue surrounding Medicaid expansion has gained great importance through the ACA that widened care coverage using market systems. Individuals previously unable to obtain healthcare insurance because of low income or pre-existing health conditions can now access coverage through Medicaid expansion and the reformed private insurance market (Levy et al., 2020). However, ethical conflict becomes apparent when financial and political factors place barriers between the access and cost of care. For example, while Medicaid expansion improves care access, individuals are limited in receiving care within their residential state since the health coverage varies widely. Therefore, providers, legislations, and society must align personal responsibility and incentives to effectively enable access, quality, and equitable healthcare.

Professional Health Organizations

The social, political, and professional contexts into which Medicaid expansion is introduced may further facilitate or prohibit implementation. Therefore, the expansion must contain professional and individualized strategies to ease implementation across states. The American Nurses Association (ANA), American Medical Association (AMA), and American Hospital Association (AHA) jointly emphasize evidence-based practices, information technology adaption in healthcare, health outcomes, and recognize the debate over ACA expansion. Talutis et al. (2019) highlight that AHA supports the coverage principles and the goal to expand financial assistance and options for more Americans. Likewise, AMA works with federal and state advocates to fund Medicaid expansion and improve provider participation with policies to support and streamline care programs.

Moreover, Medicaid expansion has uniquely advanced the healthcare system toward realizing ANA’s fundamental principles. ANA commits to advancing the nursing profession by advocating on healthcare issues affecting nurses and the public. The increasing demand for care services because of the expansion means an increase in the nursing workforce, subsequently affecting total nursing hours (Leszinsky & Candon, 2019). However, ACA Medicaid expansion fails to provide specific details on the effect of a demand shock on nursing hours and employment. Plus, even with the demand increase, healthcare organizations may delay wage increases to avoid attracting a low-quality nursing workforce. Nurses have a critical role in the debate, and ANA commits to expanding access to quality and affordable care while protecting nurses.

Conclusion

In summary, nurses are at the center of ACA Medicaid expansion. Nursing practice has experienced a significant transformation over the years as healthcare regulations also evolve. The expansion of Medicaid including a renewed focus on access and quality of care is coupled with an expected increase in nurse labor force compounded by a rise in the number of newly covered patients. Subsequently, shortages of nurses and decreased care quality present as major concerns of the expansion. Furthermore, the political, cultural, ethical, and socioeconomic issues on Medicaid expansion continue to heighten. Therefore, the ACA Medicaid expansion should provide specific details on the effect of a demand shock on nurses and healthcare organizations to prepare providers for comprehensive care.

References

Beck, A. (2020, February 20). Medicaid enrollment programs offer hope to formerly incarcerated individuals and savings for states. Health Affairs: Leading Publication of Health Policy Research & Insight. Web.

Chaudry, A., Jackson, A., & Glied, S. A. (2019). Did the affordable care act reduce racial and ethnic disparities in health insurance coverage. Web.

Cross-Call, J. (2020). Medicaid expansion has helped narrow racial disparities in health coverage and access to care. Center on Budget and Policy Priorities. Web.

Kino, S., & Kawachi, I. (2018). The impact of ACA Medicaid expansion on socioeconomic inequality in health care services utilization. Web.

Ku, L., & Brantley, E. (2021). The economic and employment effects of Medicaid expansion under the American rescue plan. Web.

Lee, H., Hodgkin, D., Johnson, M. P., & Porell, F. W. (2021). Medicaid expansion and racial and ethnic disparities in access to health care: Applying the national academy of medicine definition of health care disparities. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 58, 0046958021991293. Web.

Leszinsky, L., & Candon, M. (2019). Primary care appointments for Medicaid beneficiaries with advanced practitioners. The Annals of Family Medicine, 17(4), 363-366.

Levy, H., Ayanian, J. Z., Buchmueller, T. C., Grimes, D. R., & Ehrlich, G. (2020). Macroeconomic feedback effects of medicaid expansion: Evidence from Michigan. Journal of Health Politics, Policy and Law, 45(1), 5-48.

Rocco, P., Keller, A. C., & Kelly, A. S. (2020). State politics and the uneven fate of Medicaid expansion: An examination of mechanisms that affected Medicaid expansion, including electoral competition, ballot-box initiatives, interest-group coalitions, and entrepreneurial administrators. Health Affairs, 39(3), 494-501. Web.

Rudowitz, R., & Antonisse, L. (2018). Implications of the ACA Medicaid expansion: a look at the data and evidence. Henry J Kaiser Family Foundation.

Searing, A., & Ross, D. C. (2019). Medicaid expansion fills gaps in maternal health coverage leading to healthier mothers and babies. Washington, DC: Georgetown University Health Policy Institute Center for Children and Families.

Sugar, S., Peters, C., De Lew, N., & Sommers, B. D. (2021, June 10). Medicaid churning and continuity of care: Evidence and policy considerations before and after the COVID-19 pandemic. US Department of Health & Human Services.

Talutis, S. D., Chen, Q., Wang, N., & Rosen, A. K. (2019). Comparison of risk-standardized readmission rates of surgical patients at safety-net and non–safety-net hospitals using Agency for Healthcare Research and Quality and American Hospital Association data. JAMA Surgery, 154(5), 391-400.

Reduce escalating healthcare costs

The Affordable Care Act (ACA) aims to reduce escalating health costs by tightening control regarding healthcare rates and procedures while prioritizing primary care, prevention, and efficient interventions (French et al., 2016). Americans’ accessibility to prior healthcare treatments and drugs, care affordability, and self-reported conditions improved significantly. It demonstrated that broader coverage through insurance premium payments by employers or individually had enhanced physician accessibility.

Expand Access to Insurance Coverage

The Act requires employers to insure their employees or face punishment. The government provides tax breaks to certain smaller firms and mandates that individuals have health care coverage. Consequently, the percentage of uninsured Americans declined, notably among non-students, the unmarried, and men (French et al., 2016). It increased the number of people visiting health facilities and additional working hours spent by health practitioners.

Promoting Health Workforce Development Is a Key

The Affordable Care Act (ACA) addresses labor force concerns with measures, such as reform proposals in graduate medical training education, additional health profession loans and scholarship programs, and assistance for nurse practitioners’ training courses. Additionally, assistance for fresh models in primary care like medical residences and management teams for chronic illnesses (French et al., 2016). Healthcare professionals gained additional training and education, allowing them to perform better and manage resources in healthcare institutions.

Healthcare Administration Complexity

Coding and billing inefficiency, as well as practitioners’ effort invested in reporting on quality metrics, are examples of administrative complexity and wasteful spending in the healthcare industry. Due to the peculiar nature of the healthcare industry in the United States, any customer unsatisfied with their treatment has few options other than hiring a lawyer, which increases cost while providing no benefit (Tseng et al., 2018). If it is repealed, price lists will be made available to the public, and Americans will have affordable access to care.

References

French, M. T., Homer, J., Gumus, G., & Hickling, L. (2016). Key Provisions of the Patient Protection and Affordable Care Act (ACA): A Systematic Review and Presentation of Early Research Findings. Health Services Research, 51(5), 1735-1771.

Tseng, P., Kaplan, R. S., Richman, B. D., Shah, M. A., & Schulman, K. A. (2018). Administrative costs associated with physician billing and insurance-related activities at an academic health care system. JAMA, 319(7), 691.

The Affordable Care Act (ACA) is a healthcare act that was brought into power in 2010, during President Obama’s term. The Act’s main goals focused on reforming the private area of the insurance market and expanding Medicaid to the poor working population. Considering that due to racial and social stereotypes, language barriers, and bigotry, minorities often struggle with finding adequately paying employment, ACA’s impact on their lives was largely positive. However, not every stratum of the American population has been affected by equality, and white citizens are the main beneficiaries of the Act.

For years, it has been a major struggle for Hispanics and people of color to access proper healthcare. The Affordable Care Act allowed minorities to advance in life expectancy and examination for chronic illnesses. Before ACA, the percentage of uninsured African Americans stood at approximately 20%, while all Americans were at approximately 16%. This number has been decreased for people of color to 12%, showing that measures taken to manage ethnic and racial disbalance in healthcare have been more or less successful. On the other hand, the number of uninsured general American population also decreased: it has lowered to 9.7% (Lee & Porell, 2020). In addition, the Act does not consider that minorities often cannot find employment, rendering them ineligible for the Act’s agency. Thus, the disparity remains despite the fact that the uninsurance gap has been reduced almost by fifty percent.

In conclusion, the Affordable Care Act has been effective in establishing healthcare equity with various degrees of success. People in minority groups are often unable to access good jobs, and ACA provides help to those with low income. Nonetheless, it is also true that African Americans and ethnic minorities have difficulties finding a job, so there is still a gap in the distribution of insurance protection.

Reference

Lee, H., & Porell, F. W. (2020). The effect of the Affordable Care Act Medicaid expansion on disparities in access to care and health status. Medical Care Research and Review, 77(5), 461–473.

Introduction

The Affordable Care Act (ACA) included accountable care organizations (ACOs) to advance the Triple Aim of raising healthcare quality and patient satisfaction while cutting costs. Changes in payment incentives were intended to achieve this goal, with ACOs eventually being expected to take on adverse risks.

Discussion

According to Trombley et al., through the prepayment of shared savings, AIM offers qualifying Medicare Shared Savings Program (MSSP) ACOs financial assistance (2019). The determination to move away from volume-based payment depended on the nation’s willingness to accept such risk. Doctors are now accountable for wellness issues outside their usual practice areas due to increased patient loads. A value-based system’s requirements may result in a more demanding and unforgiving work environment for doctors.

The model’s objectives include lowering costs while maintaining or improving the quality of care, encouraging the formation of new ACOs in underserved or rural areas, and encouraging smaller current ACOs to take on more financial risk. According to the Centers for Medicare and Medicaid Services (CMS), between 2015 and 2018, the Shared Savings Program (SSP) served as the operating framework for the Accountable Care Organization (ACO) Investment Model (AIM) (2022). Selected ACOs received upfront funding from AIM to invest in staffing and infrastructure. It targeted small, existing ACOs to support their sustained involvement and transition to two-sided financial risk and new ACOs to encourage their formation in rural or low ACO penetration areas.

Conclusion

By transferring varying degrees of financial responsibility for patient outcomes to the provider level, such as doctors and hospitals, rather than the payer level, such as Medicare and managed care organizations (MCOs), where these responsibilities traditionally lie, ACOs are intended to achieve the Triple Aim. Two things cause this shift: The most extraordinary people coordinating care for the patients they serve efficiently are care providers and care teams. Second, providers will strive to enhance patient care coordination and make cost-effective decisions regarding treatments and procedures if their financial compensation is more closely correlated with efficiency and health outcomes. A delivery paradigm can support these traits, lowering costs while improving patient outcomes.

References

CMS Innovation Center (2022). ACO Investment Model. Innovation. Web.

Trombley, M. J., Fout, B., Brodsky, S., McWilliams, J. M., Nyweide, D. J., & Morefield, B. (2019). Early Effects of an Accountable Care Organization Model for Underserved Areas. New England Journal of Medicine, 381(6), 543–551. Web.

The Affordable Care Act (ACA) was enacted to protect consumers from fraud, waste, and abuse in the healthcare system. The ACA’s primary requirement is that healthcare providers establish and maintain an effective compliance program to prevent and detect fraud, waste, and abuse. To meet this requirement, healthcare organizations must implement a compliance program. For example, the organization must appoint a compliance officer and committee, develop written policies and procedures, provide staff training, conduct internal monitoring and audits, enforce disciplinary rules, and regularly evaluate and improve the program. The Saratoga Hospital program includes all of these components, focusing on racial equity in health care. According to Michener (2020), ACA policies aim to address racial disparities in the healthcare sector. Therefore, the inclusion of this item in the programs of medical institutions is an important step.

Another requirement of the ACA is to prevent false diagnoses and treatments for profit. To avoid this, healthcare organizations should regularly provide compliance training for all staff, including physicians, nurses, and administrative staff (Sullivan & Hull, 2019). This training must include not only a medical perspective but also a legal one. The organization should establish a hotline to report potential fraud or abuse and investigate any reported incidents thoroughly.

In addition, the ACA requires reducing opportunities for fraud, waste, and abuse in healthcare. According to Sullivan and Hull (2019), one way to achieve this is to use “cloud-based computing to maintain medical records for everyone” (p. 55). Automation of processes and information technology in patient care will reduce the ability to correct information in records for fraud or waste. In addition, this approach will help to identify and stop existing violations faster by improving data analytics.

References

Michener, J. (2020). Race, politics, and the affordable care act. Journal of Health Politics, Policy and Law, 45(4), 547-566. Web.

Sullivan, C., & Hull, H. (2019). Preserving life and health by preventing fraud in healthcare. Journal of Business and Behavioral Sciences, 31(1), 48-58. Web.