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Please make a comment.reference less than 5 years
A few months ago, it appeared as though American healthcare providers were, if anything, overcompensated (Blumenthal, D., 2020). Many of the most affluent and prestigious healthcare organizations and practices in the country are still likely to be able to absorb and endure the immediate losses brought on by Covid-19 (Blumenthal, D., 2020). The pandemic also demonstrates that some hospitals and healthcare providers are far too susceptible under the current financial framework, and their failure could result in significant gaps in vital health care services (Blumenthal, D., 2020). This naturally prompts the question of whether the United States requires a financing system that protects crucial health care from market upheaval (Blumenthal, D., 2020).
Adopting payment structures that break the connection between remuneration and the amount of services delivered may be a part of the solution (Blumenthal, D., 2020). Capitation, in which a provider organization receives anticipated, monthly payments for providing all necessary treatment to groups of patients, is the most promising as a means of ensuring more secure funding for the healthcare business (Blumenthal, D., 2020). The Medicare Advantage program already uses this framework (Blumenthal, D., 2020).
Capitation for specific services (such as primary or specialty care) or a combination of capitation and fee-for-service for specific types of care (such as preventive services) that might otherwise be undersupplied or are particularly valuable are just a few examples of the many variations on this theme (Blumenthal, D., 2020). A capitation equivalent for hospitals might be a projected annual budget for offering all required hospital services to patients in specific geographic locations (Blumenthal, D., 2020).
There is no ideal system for paying providers (Blumenthal, D., 2020). Prospective budgeting and full or partial capitation have the benefit of providing hospitals and medical professionals with a steady source of income that is unrelated to the amount of services rendered (Blumenthal, D., 2020). Capitation would have given time to carefully consider their amount and distribution while also shielding many providers from the severe short-term losses they are currently experiencing as a result of Covid-19. It would also have lessened the need for immediate federal subsidies, which are currently costing hundreds of billions of dollars (Blumenthal, D., 2020). Global upfront payments also give service providers the freedom to innovate (Blumenthal, D., 2020). For instance, they could use online care instead of in-person care without being concerned about how telemedicine is reimbursed in accordance with fee-for-service regulations (Blumenthal, D., 2020).
Describe the principal drivers of change that will take place in the health system over the next 10 years
Strong drivers are needed for transformation (Eyal Z.,, 2020). The digital health revolution will be one of them (Eyal Z.,, 2020). As it has in banking and retailing, we anticipate that the digital revolution will change health care. As people get more knowledge and take an active role in their care, consumerism is expanding (Eyal Z.,, 2020). The healthcare sector must become more client-centered, individualized, and open (Eyal Z.,, 2020).
Unsustainable cost structures in the developed world are another significant factor, producing a “burning platform” for service providers, insurers, customers, and policymakers. There are significant changes affecting the health care workforce. New medical specialty will call for new medical professions. Numerous countries are experiencing a labor shortage, which will compel the use of new technology (Eyal Z.,, 2020).
Covid-19 has significantly increased the availability of telemedicine and other aspects of digital health (Eyal Z.,, 2020). Additionally, it has resulted in a generalized worldwide economic slowdown and declining revenues for service providers. It could be a turning point in the development of health care because of both considerations (Eyal Z.,, 2020).
Regions with a high proportion of accountable care and organizations like Kaiser that are in charge of population health are likely to experience change early in the United States (Eyal Z.,, 2020). It will happen in other countries’ organizations connected to prestigious institutions, such as the Global Digital Exemplars initiative in the UK (Eyal Z.,, 2020). The quantity of informatics-trained individuals in these institutions is expected to be a constraint on the pace of digital transformation in enterprises. The degree to which companies value development in this area may be determined by the availability of regional health information exchange that enables systems to accept full responsibility.
What are some of your best ideas to improve quality and contain costs going forward?
Develop A High-Value Workforce.
The US benefits from having a highly qualified healthcare workforce and top-notch training facilities. However, the need for primary care, behavioral health, and dental care workers is acute and expanding. Access, quality, and value can only be enabled by a coordinated approach to recruit, educate, and support a diverse health care workforce, especially in underserved areas (Shrank, W. H.,, 2021). Regulations continue to be a major roadblock to development. The possibility to use technology and advanced practice providers to alleviate workforce shortages, enhance access, and deliver the most cost-effective care is limited by current licensure and credentialing regulations and state-by-state variation in scope-of-practice rules. The impact of COVID-19 has demonstrated the value of loosening such frameworks. During the pandemic, regulatory organizations and payers moved swiftly to expand the capacity of the in-person workforce in areas where COVID-19 cases were surging and to allow telehealth to take the place of in-person care. Numerous state medical boards exempted telehealth from their licensing requirements and granted expedited, interim licenses to out-of-state providers. It will be crucial to formalize these changes outside of the pandemic (Shrank, W. H.,, 2021). To support care delivery in particularly effective, efficient, and culturally appropriate ways, it will be necessary to make better use of community members and less specialized individuals (such as community health workers and navigators). This will go hand in hand with lowering regulatory barriers (Shrank, W. H.,, 2021).