Topic 5 DQ 1
Health care organizations continually face challenges from various regulatory and
government agencies while also being bound by Managed Care Organization (MCO)
standards. View the video located in the study materials entitled "College of Nursing and
Health Care Professions: Do We Know What Our Future Is?" for insight into the
challenges of health care reform. Based on the video, describe two key reform factors that
you believe will need to be addressed by future health care workers or leaders and explain
why. (Note: You can download slides from this video for ease of review in developing your
forum response). Additionally, what role does adherence to MCO standards play in your
future health care vision?
One of the factors I believe will need to be addressed by future health care workers is
readmission. Hospital readmissions rates are very costly to an organization and accounts for
approximately $17.4 billion dollars a year in the US (Warchol et. al., 2019). The current model is
fee-for-service resulting in providers overtreating patients and is not tied to the quality of
treatment the provider is offering (Warchol et. at., 2019). Hospital readmission rate programs
(HRRP) generates accountability for the organization and clinicians to provide better care and
education for patients after discharge because reimbursement is tied the quality of care provided
(Warchol et. al., 2019). It is important for the organization to keep them readmits low because
they can be penalized for high rates. HRRP is imperative because it gets the patient involved in
their care through education on their health issue once, they return home. It also fosters effective
collaboration among interdisciplinary caregivers and creates a better relationship with the
patient.
A second factor that comes to mind is value-based purchasing (VBP). VBP” encourages
hospitals to improve the quality efficiency, patient experience and safety of care” (Hospital
Value-Based Purchasing 2020) . This is an important program because it improves the quality of
care for the patients and patients have a better experience during their hospital stay. These scores
are tracked and made public by CMS. This is another measure that is ties in performance to
reimbursement.
Manage care assist in driving better patient outcomes and fights to balance quality of care with
the cost efficiency, and it continues to evolve to meet the needs of private and government plan
sponsors as well as patient members. MCO’s provides cost savings for patients while delivering
an integrated financing system that includes preventative care and coordinated are for patients
with chronic conditions.
References
Warchol, S. J., Monestime, J. P., Mayer, R. W., & Chien, W. W. (2019). Strategies to Reduce
Hospital Readmission Rates in a Non-Medicaid-Expansion State. Perspectives in health
information management,16(Summer), 1a.
Navarro, R. P., & Cahill, J. A. (2008). Role of Managed Care In the U.S. Healthcare System.
Jones and Bartlett Publishers, LLC.
Health care organizations continually face challenges from various regulatory and
government agencies while also being bound by Managed Care Organization (MCO)
standards. View the video located in the study materials entitled "College of Nursing and
Health Care Professions: Do We Know What Our Future Is?" for insight into the
challenges of health care reform. Based on the video, describe two key reform factors that
you believe will need to be addressed by future health care workers or leaders and explain
why. (Note: You can download slides from this video for ease of review in developing your
forum response). Additionally, what role does adherence to MCO standards play in your
future health care vision?
One of the factors I believe will need to be addressed by future health care workers is
readmission. Hospital readmissions rates are very costly to an organization and accounts for
approximately $17.4 billion dollars a year in the US (Warchol et. al., 2019). The current model is
fee-for-service resulting in providers overtreating patients and is not tied to the quality of
treatment the provider is offering (Warchol et. at., 2019). Hospital readmission rate programs
(HRRP) generates accountability for the organization and clinicians to provide better care and
education for patients after discharge because reimbursement is tied the quality of care provided
(Warchol et. al., 2019). It is important for the organization to keep them readmits low because
they can be penalized for high rates. HRRP is imperative because it gets the patient involved in
their care through education on their health issue once, they return home. It also fosters effective
collaboration among interdisciplinary caregivers and creates a better relationship with the
patient.
A second factor that comes to mind is value-based purchasing (VBP). VBP” encourages
hospitals to improve the quality efficiency, patient experience and safety of care” (Hospital
Value-Based Purchasing 2020) . This is an important program because it improves the quality of
care for the patients and patients have a better experience during their hospital stay. These scores
are tracked and made public by CMS. This is another measure that is ties in performance to
reimbursement.
Manage care assist in driving better patient outcomes and fights to balance quality of care with
the cost efficiency, and it continues to evolve to meet the needs of private and government plan
sponsors as well as patient members. MCO’s provides cost savings for patients while delivering
an integrated financing system that includes preventative care and coordinated are for patients
with chronic conditions.
References
Warchol, S. J., Monestime, J. P., Mayer, R. W., & Chien, W. W. (2019). Strategies to Reduce
Hospital Readmission Rates in a Non-Medicaid-Expansion State. Perspectives in health
information management,16(Summer), 1a.
Navarro, R. P., & Cahill, J. A. (2008). Role of Managed Care In the U.S. Healthcare System.
Jones and Bartlett Publishers, LLC.
