HCM 672 Unit 1 Individual Project 1

Unit 1 Individual Project 1

Quality Improvement in Healthcare (HCM672-1904A-01)

Colorado Technical University

This assignment is on the Patient Protection and Affordable Care Act (PPACA). It discusses its relativity between the cost of healthcare services and the quality of care patients receive. How the pair help to reduce the costs of healthcare services and to improve on the quality of care patients receive. I will also be discussing if the PPACA, has accomplished its goal of reducing cost and patients receiving quality care. Obstacles the US healthcare system experienced with implementing the Affordable Care Act will be discussed to. Concluding, that this paper creates an argument for the success of implementing the PPACA.

The relationship between quality and cost in health care in the United States.

Quality and cost are touchy subjects in the US as of present day. Healthcare in the US is very expensive, and the cost is not going down. Americans want good quality care at a reasonable price. Since the PPACA was introduced and the emergence of price transparency, Americans can find out cost of care before services are rendered. “Fifty-six percent of Americans say they have tried to find out how much they would have to pay out of pocket—not including a copay—or how much their insurer would have to pay a doctor or hospital, before getting care.” McCue, M. J., & Hall, M. A. (2015)

Seventy one percent of Americans do not believe that higher cost equal better care. Forty three percent of Americans say if they knew the price of the cost of care beforehand, they would choose a healthcare provider that charges a lower price. Because of the information technology available to us a lot of people can look up and do a price comparison and check the reviews of multiple healthcare providers at one time. This would allow them to pick a healthcare provider with a lower cost of care and a good review from other patients. “Several experiments have shown that giving price information to patients can lead them to choose lower cost care, help employers and other insurance purchasers save money, and even lead providers to reduce their prices.” McCue, M. J., & Hall, M. A. (2015)

The United States faces 2 big problems the quality of care patients receives, and the amount of money paid for that care. The cost of healthcare is not decreasing as the promise when the PPACA went into effect, in fact it is increasing. The cost and quality of care is one of the most debated topics in the healthcare reform as of present day. The belief of Americans is that if the quality of care is getting better, then the cost should be decreasing because there are less re-admissions for the same illness, less repeated testing being done. So, why isn’t this happening? According to Michael J. McCue and Mark A. Hall, The Commonwealth Fund, January 2015, each market, represented an average overall rate increase of 13% over these insurers’ prior-year premiums. Overall, increased medical expenses accounted for more than three-quarters of these requested rate increases. The remainder was attributed to increased administrative expense. The medical expenses increasing are being blames on many different factors like, greater utilization of services, higher unit costs for these services, and adjusting for underpredicting medical costs in the previous year. Sixty nine percent of the insurers say that the increase is partly blamed of the federal government for the fees and taxes they started assessing in 2014. Reducing Costs and Improving the Quality of Healthcare (2014)

How the Patient Protection and Affordable Care Act (PPACA) attempts to reduce costs and improve quality?

Since being implemented the PPACA and healthcare reform has been a topic of much debate. In 2010 the President signed the ACA into law. This would ensure millions of young Americans would have healthcare. 27 million people would gain healthcare coverage when it was fully implemented. Under the ACA uninsured people could get insurance through their employer or through market places or exchanges. There are some signs the ACA doing what it was designed to do, reduce the cost of healthcare and improve the quality of healthcare. Taufen, A. (2014)

Healthcare spending has been on the rise for the last half a century, healthcare care spending was 17.9% of the Gross Domestic Product in the US in 2011 this is twice what is was in the 80’s. The ACA was to help reduce cost and improve quality of care by implementing programs like, pay-for-performance programs, Medicare payment reforms, Accountable Care Organizations, value-based programs these programs were supposed to be the foundation for improving care and cutting cost in healthcare spending. Taufen, A. (2014)

The PPACA is supposed to ensure that all Americans have access to quality and affordable healthcare. It is supposed to transform the healthcare coverage system in the US, Shared responsibility of the insurer and the provider will help cut cost and quality of care. Reforming insurance practices like pre-existing condition exclusions, “insurers will be prohibited from denying coverage or setting rates based on health status, medical condition, claims experience, genetic information, evidence of domestic violence, or other health-related factors. Premiums will vary only by family structure, geography, actuarial value, tobacco use, participation in a health promotion program, and age (by not more than three to one).” Taufen, A. (2014)

Medicare implemented value -based programs are to link quality performance on high costing care of treatment for cardiac care, surgeries and care for patients with pneumonia. Physicians treating patients who receive Medicare are encouraged to report to the Physicians Quality Reporting Initiative, physicians are supposed to receive feedback on how they are doing and suggestions on improvement. Long term care hospitals, hospice and rehab facilities are to participate in value-based purchase programs or receive penalties for noncompliance. Taufen, A. (2014)

I am presenting an argument that the PPACA has been somewhat effective since being implemented.

My argument for the PPACA is because 8 million people has healthcare coverage now, either they were on a plan that was not cost worthy or they had no coverage at all. The emergence of healthcare exchange markets will allow for a more educated patient population, this could in turn help to drive down cost on a national level. The exchange markets would have to focus on the individual and not the price, employers, insurance brokers and the exchange markets will have to find a balance in cost and what plans work best for all. Reducing Costs and Improving the Quality of Healthcare (2014)

Since President signed the ACA into effect in 2010 there have been some major changes in healthcare. More people are insured, hospitals, clinics, home health agencies, hospices and rehab facilities all have improved on their quality of care. I believe that the healthcare reform has played a major part in that. The different payment options have made the healthcare system take notice. That they are responsible along with the insurer and the individual to what’s best for the patient. Whether it is picking a coverage that offers a reasonable cost for coverage, to the telehealth portals that are available to assist patients with their care. The landscape of healthcare has changed, patients have more control over their care then thy did in the past. Readmissions for the same illness have decreased, repeat testing has decreased and cost is decreasing as well under the PPACA. Glied, S.A. (2017, May 8).

Since the PPACA young people between the ages of 21-23 now have healthcare coverage. There were 41 million uninsured Americans since PPACA there are 27 million uninsured Americans. Studies have shown since the enactment that people with health insurance whether it be Medicaid or private insurance, they all have access to services now. Access to care at a population level has improved, the number of Americans without a PCP has decreased under the PPACA. Regular source of care has increased, and the amount of unmet care has decreased with the new policies in place. Less health disparities in race and ethnic groups, people who would not have sought care before the ACA because they did not have insurance can now seek help for their illnesses because of the ACA. Glied, S.A. (2017, May 8).

Expanding the Medicaid coverage and the establishing of state marketplaces have decreased the number of people who are uninsured and increased access to services for those who enrolled in a healthcare plan. People will be less likely to report they did not receive medical care because of cost. While the road to healthcare reform has been rocky strides have been made to ensure that all Americans have access to healthcare coverage and medical services, people no longer have to say I did not go to the doctor because I couldn’t afford to go. Glied, S.A. (2017, May 8).

Healthcare is changing and hopefully for the better, we are not were we need to be as far as our healthcare system is concerned, but we are going in the right direction. Time will tell if the PPACA reduces cost and improves the quality of care. As for now many people have access to care and insurance because of the PPACA, that is a good thing. Hopefully as the reform continues, we can adopt a policy of universal healthcare coverage for all like other countries such as Canada have. Until we reach that point what is happening in the US with healthcare reform is a good thing. Cost may not be decreasing as fast as thought but it is getting better. Quality of care has improved under the ACA. Small steps are good if we keep moving forward.

References

Glied, S. A. (2017, May 8). Effect of the Affordable Care Act on Health Care Access: Commonwealth Fund. Retrieved October 10, 2019, from https://www.commonwealthfund.org/publications/issue-briefs/2017/may/effect-affordable-care-act-health-care-access.

McCue, M. J., & Hall, M. A. (2015). What’s Behind Health Insurance Rate Increases? Medical Benefits, 32(8), 5–6. Retrieved from http://search.ebscohost.com.proxy.cecybrary.com/login.aspx?direct=true&db=bth&AN=102244769&site=ehost-live&scope=site

Reducing Costs and Improving the Quality of Healthcare (2014); Retrieved on October 09, 2019, from www.whitehouse.gove/sites/default/files/docs/erp2013/ERP2014_chapter_5.pdf

Taufen, A. (2014). The PPCA effect. Benefits Selling, 12(7), 32–35. Retrieved from http://search.ebscohost.com.proxy.cecybrary.com/login.aspx?direct=true&db=bth&AN=97078205&site=ehost-live&scope=site

The Patient Protection Affordable Care Act: Detailed Summary (2016); Retrieved on October 09, 2019, from www.dpc.senate.gov/healthreformbill/healthbill04.pdf

VACCARO, K. (2014). Update on the Affordable Care Act. Public Management (00333611), 96(3), 19. Retrieved from http://search.ebscohost.com.proxy.cecybrary.com/login.aspx?direct=true&db=f5h&AN=95377202&site=ehost-live&scope=site