affordable and quality healthcare

affordable and quality healthcare

Introduction

Accountable care organizations (ACOs) is a new policy developed to provide affordable and quality healthcare to the people. The strategy is aimed at reducing the cost of Medicare, improving the quality of medication, and general good health to the public. Hospitals under the accountable care organization share the consequences concerning the patient outcome and the expenditures. The ACOs enter into a contract with the payer, who pays the treatment bills. The organization helps in the provision of improved healthcare, reduced cost, and better healthcare.

The public and private healthcare have adopted the accountable care organization to improve the quality of health by making it affordable to the clients. The Medicare shared savings program enables the clinicians to provide improved healthcare to the patients. The policy led to the improved healthcare sector, which is inclusive and affordable to the people (Weissert, Weissert & Weissert, 2012).

For example, in America, it has over five million subscribers who have joined the organization. The health reform has been backed up by many people through the benchmarked contract. However, some limitations encounter the success of organizations to thrive well. Challenges cut across ethical behaviour and the organizational structure of the health facilities. For instance, there is an unconscious provision of incentives that are not well structured. The challenges will be discussed in the policy memo to establish the main problems encountered.

The organization’s benefits are essential in the healthcare sector. For example, decreased healthcare, improved healthcare, and quality medicare to the patients have been achieved. The memo will also discuss the recommendations which, when put in place, will make the organization thrive forth while in providing affordable and quality healthcare.

Background

The program currently has 744 organizations, both private and public sectors in America. The healthcare program was pioneered by President Obama, who revived its performance since it had backslid in the 19th century. The accountable care organization was incorporated in the American constitution to provide financial incentives to the people. The program caters to all treatments, including chronic and terminal diseases.

The health practitioners and hospitals under the program cater for each test and procedure they carry out. It’s a mechanism of providing rewards to the practitioners and a sense of motivation to practitioners. Doctors and hospitals are supposed to meet specific qualities for the benchmark in preventing chronic diseases. The incentives provided motivate doctors in providing better healthcare and ensuring a low mortality rate (Weissert, Weissert & Weissert, 2012).

The organization is obliged to meet a set of conditions. Malpractices by the doctors should not arise as they limit the success of the ACOs. According to Weissert, W.G, and Weissert, C.S. (212), explained that medical malpractices occur when practitioners cause harm to the health of the patient. They proposed that malpractices arise due to neglect or oversight by the doctors. Once there is misconduct by the practitioners, the following guidelines are followed. First, how was the patient-doctor relationship during the ordeal?

Secondly, the patient defines how the breach of the healthcare standards occurred. Thirdly, determination of the impact of healthcare violation to the patient. Finally, to what extent did the unprofessional act harm the patient? Management ascertains if a breach of healthcare standards occurred and once confirmed, the court initiates compensation regularities.

The ACO design below shows its stakeholders and the regulatory environment.

Evidence

The literature for the memo is extracted from the Weissert, W. G. & Weissert, C. S. (2012). Governing health: The politics of health policy (4th Ed.). Baltimore, MD: Johns Hopkins University Press. Book chapter 6 and other clinical articles.

Problem facing ACO

The challenges involved include the management, patient’s decision, and clinicians. Leaders should have achievable goals and objectives of the ACO. They have obligations to provide better healthcare to patients and society. Problems associated with leaders include the following; First, resource allocation. The ACOs are faced with the best method to allocate resources relative to the different conditions affecting patients. For example, some chronic diseases such as diabetes require trade-offs to allocate resources better. Some health complications require more funds than others.

Finding the exact amount to allocate to different diseases poses a significant challenge to the leaders. Therefore, leaders are supposed to make decisive approach before allocating resources to ensure accountability and transparency prevails.

The savings are the core determinant of how they are supposed to be shared among different clinicians.ACOs should advise the patient on the incentive program, which should be ethically carried out to avoid high incentives to a particular clinician. Secondly, ACOs are faced with the challenge of controlling the professional, ethical standards. For example, diabetic and cancer patients require great referrals to contain the condition. For example, a clinician may opt to reduce the cost of healthcare by lowering patient referrals. It’s unethical for ACO physicians to offer substandard services for selfish gain. It affects the health of the patient posing more significant harm to the patient (Weissert, Weissert & Weissert, 2012).

Thirdly, the development of ethical decision-making approaches affects excellent ACO performance. Leaders are faced with challenges in making sound decisions, especially in the ethical allocation of resources. The sound agreement between the ACO leaders and the medicare beneficiary should promote a health decision-making approach.

The second section of the challenges is being attributed to clinicians unethical behaviour. Professional autonomy of the health practitioners sometimes infringes professional rights when it’s contrary to the patient’s interest. For example, the clinicians might decide to limit patient interventions for selfish gain.

Secondly, dual responsibilities pose a challenge to the practitioners. Dual responsibility occurs due to the patient and ACO mandates to the clinicians. Patients who find the physicians more concerned with the reduction of the costs might lose trust in the patients and opt-out for the service. The patient-doctor relationship should be maintained for the benefit of standard healthcare (Weissert, Weissert & Weissert, 2012).

Thirdly, competition might arise from the management. It’s accompanied by the primary healthcare and the specialists portraying unfair competition.

It can also occur between the clinicians and the hospitals, especially on the provision of the incentives. Inpatient and outpatient clinicians’ competition occur due to incentive provision. Finally, patients can pose challenges while implementing the program. The freedom and the choice of the patient poses a significant challenge to the health providers. Patients lack the knowledge of ACO regulations causing a more substantial problem in implementing the program.

Secondly, the confidentiality and privacy of the patient should be considered. Clinicians might share critical patient data to the payers and the ACO’s. Once patients realize that their health records circulate over different people may lose trust for the facilities. Finally, patient engagement by clinicians poses a significant challenge to the healthcare sector. ACO leaders might portray unethical behaviour when relating with patients (McWilliams, Chernew, Landon, & Schwartz, 2015).

Advantages of an Accountable Care Organization

ACO benefited patients and the public in several ways. First, the program provides affordable healthcare by reducing the costs of treatment. Patients get access to healthcare anytime they require it. Secondly, the provision of incentives to the physicians makes them perform their duties efficiently in providing quality healthcare. Finally, ACO provides good healthcare to the general public since everybody is entitled to the program.

Recommendations

Healthcare management should establish a professional mechanism to deal with the unethical behaviours posed by the clinicians. Leaders should monitor all the activities to ensure there is no breach of contract, especially on the payments. ACO should come up with a concrete decision-making approach to control further challenges.

ACO should work in collaboration with the clinicians to ensure there are guiding principles in safeguarding the patient’s interests. ACO should ensure that there are sound strategies to reduce the competition and foster teamwork among the physicians. (Hacker & Walker, 2013).

Conclusion

In conclusion, ACO has achieved in providing quality and affordable HealthCare to the public. The organization has reduced the mortality rate. People can access treatment at a fair cost. The program should be adopted worldwide. Healthy population is productive, and it will boost the economy of the states, primarily the developing and underdeveloped countries. ACO faces several challenges cutting across from management, patient, and clinicians. Provided recommendations will avert the obstacles and offer long-lasting solutions to the problems highlighted in the policy memo.

References

Hacker, K., & Walker, D. K. (2013). Achieving population health in accountable care organizations. American journal of public health, 103(7), 1163-1167.

McWilliams, J. M., Chernew, M. E., Landon, B. E., & Schwartz, A. L. (2015). Performance differences in year 1 of pioneer accountable care organizations. New England Journal of Medicine, 372(20), 1927-1936.

McWilliams, J. M., Hatfield, L. A., Chernew, M. E., Landon, B. E., & Schwartz, A. L. (2016). Early performance of accountable care organizations in Medicare. New England Journal of Medicine, 374(24), 2357-2366.

McWilliams, J. M., Landon, B. E., Chernew, M. E., & Zaslavsky, A. M. (2014). Changes in patients’ experiences in Medicare accountable care organizations. New England Journal of Medicine, 371(18), 1715-1724.

Nyweide, D. J., Lee, W., Cuerdon, T. T., Pham, H. H., Cox, M., Rajkumar, R., & Conway, P. H. (2015). Association of Pioneer Accountable Care Organizations vs traditional Medicare fee for service with spending, utilization, and patient experience. Jama, 313(21), 2152-2161.

Weissert, W., Weissert, C., & Weissert, C. (2012). Governing health. Baltimore: Johns Hopkins University Press.