Patient-centred medical homes (PCMH)

Patient-centred medical homes (PCMH)

Patient-centred medical homes (PCMH) are continuing to generate success as aspects of value-based care. These approaches to healthcare have proven their capacity to improve care quality while reducing the cost of service provision. They achieve this outcome by transforming providers’ priorities and enhancing their care processes. PCMH models focus on prevention strategies and the management of chronic conditions (Cotton, 2018). They emphasize the early detection and treatment of high-needs patients using low-costs therapies to ensure that they do not develop adverse outcomes that require high-cost care. In this way, these facilities can cut down on the costs incurred when providing healthcare to vulnerable patients. For instance, in 2018, PCMH saved Medicaid $214.10 per month in cases of HIV patients who also suffer from chronic illnesses such as diabetes and behavioral disorders (Cotton, 2018). These savings arose from reductions in services such as inpatient care and substance abuse treatments. As such, it is evident that PCMH can facilitate savings by improving preventive measures against negative results.

Similarly, PCMH improve care processes by minimizing unnecessary services and emphasizing the crucial ones. The NCQA (2019) reports that PCMH significantly reduce growth in outpatient emergency department visits for both ambulatory-care-sensitive and non-ambulatory-care-sensitive ailments. Conversely, they produce more primary care office visits, especially for vulnerable and disadvantaged populations. This is an essential component of value-based care as office visits can help prevent the worsening of health conditions as well as the future use of costly emergency services. They can also improve patient health behaviors, enhance their health outcomes, and reduce their need for professional healthcare altogether. Hence, PCMH control the cost of healthcare by supporting patient engagement and empowering them to utilize the available primary health services. It thus elevates population health and minimizes the number of individuals who require expensive care.

Post 2- Improving Medicare margins

Improving Medicare margins is a priority in today’s healthcare environment. It, consequently, requires providers to develop strategies that will sustain their profitability and relevance in the industry. This can be achieved by enhancing patient outcomes and the efficiency of an organization’s processes. Miller (2016) explains that the current state of healthcare requires providers to take risks rather than relying on traditional cost-cutting methods. As the industry shifts towards value-based care, reimbursement is increasingly tied to public health outcomes. Subsequently, providers have to emphasize measures such as initiatives that effectively address population health, promote a facility’s brand, and deliver quality outcomes. By performing favorably on these metrics, they will successfully exploit the financial opportunities created by the policy changes. Providers also need to maintain transparency with their employees on financial matters. Having open discussions with physicians will guarantee that they understand the implications of operational costs while also offering them a chance to contribute improvement ideas (Miller, 2016). It can thus lead to the creation of better strategies that target the improvement of Medicare margins.

Another approach that providers can apply when aiming to improve Medicare margins is the adoption of advanced technologies. These innovations can help them track their performance on relevant metrics and improve the quality of their care. Deloitte (2017) recognizes that digital tools can benefit organizations by streamlining administrative work, improving staff productivity, and simplifying complex payment processes. They eliminate tedious tasks that can cause time and resource wastage. Similarly, technology can improve clinical outcomes. Miller (2016) acknowledges that improving hospital margins requires providers to deliver accurate and well-timed treatments to all their patients. Technology can help in this endeavor by maintaining up-to-date and easily accessible patient records that assist physicians as they carry out their duties. It can, therefore, improve a facility’s performance in vital metrics and increase its payment margins.

Post 3 – Medicaid expansion

Medicaid expansion drastically increased the number of insured people in the country. Even though this led to significant financial benefits for both patients and their providers, it also presents some challenges that can lead to the failure of the program. The expansion increased care affordability and financial security among low-income citizens (Antonisse, Garfield, Rudowitz, & Guth, 2019). This includes those with behavioral issues, chronic conditions, and various special health needs. Manatt, Phelps & Phillips, LLP. (2019) further illustrate that Medicaid coverage is associated with higher incomes and educational attainment across the lifespan. This is attributable to the fact that people in this program end up spending less on healthcare. Consequently, its expansion has the capacity to lower poverty levels in targeted regions.

In the same way, the Medicaid expansion offers financial gains to the states that implement it. It has a positive influence on state budgets and economies because it motivates them to develop revenue-generating strategies. Since the states have to fund the remaining cost of expansion, they have to rely on tactics such as liquor and health plan taxes (Manatt, Phelps & Phillips, 2019). These measures have far-reaching consequences as they lead to job creation, increased wages, and higher state revenue.

It is essential to examine the challenges that states may face during their Medicaid expansion to guarantee they attain the above results with their Medicaid expansion. Antonisse et al. (2019) acknowledge that there is confusion among beneficiaries, providers, and advocates, and that it results in increased costs and poor services for the recipients. If patients do not understand the implications of the expansion, they will not be able to exploit its benefits fully. This will cause them to continue incurring high healthcare costs and, eventually, they may decide to exit the program. Hence, miscommunication between different stakeholders in the Medicaid expansion program could cause its failure by either minimizing its ability to attract beneficiaries or affecting its capacity to facilitate cost savings.

Post 4- Healthcare membership

The California health exchange market is called Covered California. This site offers residents of the state an easy and convenient way to shop for and purchase health insurance. As of December 2019, Covered California boasted 1.5 million enrollees, a figure that represented a 7.5% increase in the number of residents renewing their coverage and a 23.7% drop in first-time consumers (Covered California, 2019). Due to these trends, it is crucial to analyze the financial opportunities and challenges that may be contributing to them.

One of the main advantages attached to health exchange markets is the fact that they allow individuals to obtain financial advice before committing to an insurance plan. Furthermore, they offer them an opportunity to take advantage of various federal financial incentives. Covered California is the only place where the region’s citizens can get financial assistance when dealing with well-known insurance companies, learn about different offers, apply for government-sponsored health insurance, and exploit various discounts (Covered California, 2020). It can, therefore, help beneficiaries obtain the best deals on coverage plans that fully meet their health needs.

Even so, several challenges may hinder Covered California from fulfilling its objectives. The California Health Benefits Advisers (CAHBA) (2020)notes that these obstacles may include adverse selection and agent issues. It defines adverse selection as the situation whereby at-risk individuals buy more insurance and cause premiums to rise. This turns healthy, younger people away from purchasing insurance and can thus be a contributing factor in the reduction of new enrollees to the health exchange market. Agents, on the other hand, need better training and regulations to ensure that they effectively perform their duties. With these capabilities in place, they will be better suited to guide potential and new members of the program, provide them with all the information they need to make decisions and help them select insurance plans that will yield the best results.

References

Antonisse, L., Garfield, R., Rudowitz, R., and  Guth, M. (2019). Expansion under the ACA: updated findings from a literature review. Kaiser Family Foundation. Retrieved from https://www.kff.org/medicaid/issue-brief/the-effects-of-medicaid-expansion-under-the-aca-updated-findings-from-a-literature-review-august-2019/

CAHBA. (2020). Covered California challenges. California Health Benefits Advisers. Retrieved from https://www.cahba.com/challenges/

Cotton, P. (2018). Patient-centered medical home evidence increases with time. Health Affairs. Retrieved from https://www.healthaffairs.org/do/10.1377/hblog20180905.807827/full/

Covered California. (2019). Covered California plan selections remain steady at 1.5 million, but a significant drop in new consumers signals need to restore penalty. Retrieved from https://www.coveredca.com/newsroom/news-releases/2019/01/30/covered-california-plan-selections-remain-steady-at-1-5-million-but-a-significant-drop-in-new-consumers-signals-need-to-restore-penalty/

Covered California. (2020). What is covered California? Retrieved from https://www.coveredca.com/what-is-covered-california/

Deloitte. (2017). The uncertain road ahead: could technology offer hospitals relief from increasing margin pressures?

Manatt, Phelps & Phillips, LLP. (2019). Medicaid’s impact on health care access, outcomes and state economies. Robert Wood Johnson Foundation. Retrieved from https://www.rwjf.org/en/library/research/2019/02/medicaid-s-impact-on-health-care-access-outcomes-and-state-economies.html

Miller, A. (2016). 8 key strategies for improving a hospital’s margins. Becker’s Hospital Review. Retrieved from https://www.beckershospitalreview.com/hospital-management-administration/8-key-strategies-for-improving-a-hospital-s-margins.html

NCQA. (2019). Latest evidence: benefits of NCQA patient-centered medical home recognition.