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Running Head: THE NEED FOR APPROACHES TO IMPROVE CASE ADMINISTRATION AND REPAYMENT IN THE HEALTHCARE SYSTEM

Title: The Need for Approaches to Improve Case Administration and Repayment in the Healthcare System

Abstract:
This paper is talking about the need for approaches to improve case administration and repayment in the healthcare system, because of the high costs and poor health outcomes.

The articles, McKethan, A., Morrison, M., Shepard, M., Nguyen, N., Brennan, N., Cafarella, N., Williams II, R. D, & Kocot, S. L. (2009). Improving quality and value in the U.S. health care system. Brookings Institution. Stone, P., Hughes, R., & Dailey, M. (2008). Creating a safe and high-quality health care environment. Agency for Healthcare Research and Quality (US). U.S. Department of Health & Human Services (2014). New HHS Data Shows Major Strides Made in Patient Safety, Leading to Improved Care and Savings, from. United Health Group (2014). Solutions for a Modernized Health Care System, from. Whelan, E. M., & Feder, J. M. (2009). Payment reform to improve health care: ways to move forward. Center for American Progress Action Fund, from.

The United State spends a large percentage of its GDP on healthcare. It spends over twice as much as other developing nations spend on each person. Despite the high expenditure, there are still numerous issues associated with the health care system including low life expectancy, poor outcomes, high infant mortality and low patient safety. Apart from that, most of the Americans are uninsured. Also, the small percentage that is insured still has to spend their income on treatment. The current health care reform mainly focuses on repayment and case administration. It has focused on administering the highest level of medical services and reducing the occurrence of errors and minimizing their harm if they occur. Consequently, health care providers have maximized their profits despite the low health care quality provided. The need for approaches to improve case administration and repayment in the healthcare system.

There are many ways of looking at my topic the need for approaches to improve case administration and repayment in the healthcare system, but I have focused my research to five articles that represent the many scholarly sources on this topic. McKethan, A., Morrison, M., Shepard, M., Nguyen, N., Brennan, N., Cafarella, N., Williams II, R. D, &Kocot, Improving Quality and Value in the U.S. Health Care System. Stone, P., Hughes, R., & Dailey, Creating a Safe and High-Quality Health Care Environment. U.S. Department of Health & Human Services, New HHS Data Shows Major Strides Made in Patient Safety, Leading to Improved Care and Savings. United Health Group, Solutions for a Modernized Health Care System.

Whelan, E. M., & Feder, J. M. (2009). Payment reform to improve health care: ways to move forward.

The article, written by Aaron McKethan and other authors, makes a review of the delivery system and payment reforms which can be designed to improve the quality as well as the value of the health care system in the US (McKethan et al., 2009). According to the article, health care faces tremendous challenges which need reform. The US has about 46 million uninsured citizens, while those who are insured are sometimes forced to incur out-of-pocket expenses and high premiums (McKethan et al., 2009). The state of the health care system is poor regardless of the fact that the US spends more finances on individual health expenses compared to any other nation. The system continues to experience underutilized preventive care as well as ineffective and unproven treatments for chronic diseases. The article notes that reform on the health care system is essential in addressing the poor insurance coverage, poor health quality and increasing health costs (McKethan et al., 2009).

According to McKethan et al. (2009) the strategies that can be used include Primary Care Coordination, Health Information Technology (HIT), Chronic Disease Management and Comparative Effectiveness Research (CER), narrower approaches targeted to certain patient populations, integrated health care delivery which ensures accountability from patients and health providers, transition of reimbursement from intensity and volume to value and quality and lastly, integrated implementation of health coverage and delivery expansions.

The article above is carefully composed and well presented, facts and information concerning the topic are free-flowing from its inception to its end. The data provided is also credible due to reliance on past studies. However, the article lacks specific statistical records that would better depict the situation. The only mention of statistical figures is observed when the number of uninsured individuals is indicated, to my opinion the paper would have been more informative and authoritative if more numerical figures were used. As an example; numerical figures would have been used to emphasize and display strategic and qualitative aspects of care provision. Nevertheless, one should not underestimate the information provided by this source.

The article, written by Stone, Hughes, and Dailey examines strategies that can be used to create a high quality and safe health care environment (Stone et al., 2008). According to the article, creating a safe health care environment shows the level of vigilance and compassion for the welfare of patients. Safety is improved by learning the causes of errors and then using the information to design strategies that make the errors less harmful (when they occur) and less common (Stone et al., 2008). The article utilizes previous studies to explore patient outcomes and organizational climate, turnover, job satisfaction and organizational climate and the implications of the evidence-based practice. The article links the work environment to motivations, attitudes, and behavior of clinicians. The orientations have the potential of affecting health quality outcomes and processes. Stone, Hughes, and Dailey (2008) affirm that clinicians are more satisfied and comfortable working in environments having an empowering and supportive organizational arrangement and leadership. Hence, improving the organizational environment improves the safety of patients and in turn decreases health care costs.

The article is well presented and written it also has a good flow of information. Moreover, the article is quite credible it has relied on some previous studies to explain each concept. For example, a critical analysis of previous research has been used to deduce the relationship between patient outcomes and organization climate as well as the relationship between turnover, job satisfaction, and organizational climate. The article has also made a good use of statistics by identifying the samples sizes used and the outcomes of each study. Furthermore, the article has made use of diagrammatical illustrations such as the organizational attribute and outcome model. These illustrations have enhanced the flow of information hence a good understanding of the article's content. All in all, the article is an authoritative, credible and rich source of information for the study.

Aaron’s book is mainly dealing with quality and value where he elaborates how the sector has grown in customer service and health safety issues. Stone and Hughes article is not that different, they aim to inform the reader about the health care risks. And in their capacity, they have tried to explain the importance of having prevention measures in place to safeguard the health of patients. Both articles relate; first the articles discuss the situation in the sector and secondly the synthesis of both papers will create a condition where an individual can increase quality and value through proper prevention measures.

The article, prepared by the United Health Group, highlights solutions for modernizing the health care system which aims at promoting the delivery of quality care and reforming payment models. According to the United Health Group (2014), the nation spends approximately $3.4trillion on the health care system, yet the quality and value of heath care are uneven. Many Americans experience medical errors that can be prevented, while others receive inadequate health benefits. The article notes that the nation has the potential of achieving higher value for health care spending and promoting better health outcomes for citizens. The nation should adopt solutions consistent with certain principles including optimizing public resources, modernizing public health care, building the employer-based coverage foundation, employing progressive strategies to realize the benefits of health care, modernizing health care delivery to enhance quality and affordability and applying technology as a facilitating force (United Health Group, 2014). The article also highlights the significance of using integrated technology and data to improve health care outcomes and quality. According to the United Health Group (2014), technology and data should be used as a way of informing treatment decisions as well as driving greater efficiencies and intelligence within the health care system. A good example given is encouraging the provision of technology and data analytics to identify the highest risk or need patients, along with populations targeted for interventions.

The delivery of content is unmatched; the author effectively administers information in immense portions. It is well founded, and mitigation factors are included to the problems stated on the paper. It recognizes the fact that the investment deposited on the US health sector as a key factor that has aided in its success. It states strategic moves that may be used to aid the health care system to achieve long-term visions. However, the minimal use of numerical data is a concern since the use of tools endowed upon the field would increase its applicability and credibility. Statistical tools would have been used to depict the importance and application of the solutions illustrated for modernization of the sector.

The United health group puts across factors, measures, and moves that can be used to modernize the American health care sector while incorporating issues discussed by Aaron and Stones. In their capacity, they have been able to document key strategic factors that are applicable. Quality, value and risk prevention are significant needs that should be satisfied before modernization takes root. Article C is an effective tool to join the three in a useful course; the papers may aid to health care system to improve on services rendered, reduce risks and form strategic actions to modernize the sector.

According to Whelan and Feder (2009) the US health care system is inefficient despite the fact that the nation spends over twice as much as what other nations spend on each. The article describes the US as having the poorest outcomes including high infant mortality and low life expectancy. Also, Whelan and Feder (2009) note that one in every three people are not insured while approximately 25 million people are underinsured and devote a large amount of their income on medical expenses. Moreover, the nation spends 17% of its GDP on health care, which could increase to 25% by 2025 (Whelan & Feder, 2009). The article recognizes that the situation of the nation’s health care system could get worse if no action is taken.

Whelan and Feder (2009) identify restructuring health care payment as the best solution for the problem. Currently, hospitals, doctors, and various health care professionals are reimbursed depending on the number of procedures and visits. “Consequently, the providers' profits and revenues increase if more services are delivered and as a result, the health care cost increases” (Whelan & Feder, 2009). However, more services don’t necessary mean improved health care. They often have the poorest outcomes. According to Whelan and Feder (2009), experts conclude that the initial step of reforming the health care is formulating a vision or the system. The vision, therefore, be used to guide specific reforms, which will also inform the payment reform. Whelan and Feder (2009) also highlight the most prominent and significant proposals or the payment reform. The first proposal is rewarding of primary care delivery using approaches like the “medical home” which reimburse the primary care practices with the aim of providing and coordinating care. The second proposal is accumulating payments into bundles that can be paid after a certain period instead of paying for single procedures and visits. The third proposal is transferring medical practices into health providing organizations and then developing compensation strategies that enhance global capitation, which aims at paying a single price or all patients’ health care services.

The information conveyed by the article is distinct in its description it has an excellent flow of ideas and facts. It is comprehensive and authoritative due to the statistical data provided on the paper. Numerical data is used to reinforce the qualitative aspect of the study; diagrams representations are also included which not only improves the quality but also makes it an interesting read. Overall it is one of the best articles on the subject of medical sector and issues concerning the practice.

Whelan and Feder compared to the rest of the writers have delivered a far much better paper its descriptive quantitative nature depicts scenarios not thought about in the other articles. They have encompassed the aspect of statistical tools that have described the situation on the ground reasonably better. The detailed statistical data provided can aid in the inception and initiation of better decisions, targets and management in the sector. Comparison exists where all individuals are concerned and by using this factor the other papers can be used to appeal and introduce an idea of better performance through stated recommendations custom made for the sector.

The article, prepared by the US Department of Health and Human Services, demonstrates how patient safety, care, and savings improved in 2012 compared to 2010. According to the HHS (2014) the nations has experienced a 9% decrease the 30-day readmissions the FFS Medicare service. The Department of Health and Human Services notes that a nationwide a decrease in unfavorable drug events, infections, falls and various forms of harm have decreased the number of deaths in hospitals by 15,000. It has also saved the nation $4.1 billion in health care costs while preventing approximately 560, 000 harms in both 2012 and 2011 (HHS, 2014).

According to the Department of Health and Human Services, these are historical improvements, which have been due to a high number of federal initiatives and programs, active patient and family engagement and strong as well as diverse private-public partnerships. The tools presented by the Affordable Care Act are highlighted as some of the federal initiatives. Finally, the Department of Health and Human Services emphasizes that despite the significant improvement, there is still a lot to do to enhance patient safety, including reducing readmissions and leverage the work already done. The HHS has plans to continue accelerating efforts towards formulating the health care system reform. “It also plans to work for hand in hand other health care partners in combination with tools availed by the Affordable Care Act to achieve a sustainable health care system while improving patient safety and reducing the cost of health care” (HHS, 2014).

The paper is well developed, and information conveyed by the paper is free flowing and well articulated. However, the author conveys a different message to the reader compared to the other writers. It recognizes the fact that the health care system has improved in the patient safety and health care savings while the rest of the papers major on the poor state of the health care system a result of uninsured and underinsured citizens. The paper has been prepared by a government office, therefore, giving an explanation for the content displayed.

The US Department of health and human services article is different from the rest. First it contradicts the information conveyed in all the other articles and secondly, it is heavily descriptive with quantitative and qualitative aspects explained in detail. Compared to the other papers it offers a new and distinct position which stand to show what the government thinks and what they have to offer. From the platform provided the other papers can compare objectives then align them to the recommendations provided. The paper should be examined, and the evidence and data conveyed evaluated and the best tactics provided by the other articles incorporated which will create a more stable decision and goal.

Conclusion

The health care system in the US is indeed in a poor state. The four articles acknowledge that; only one presents an opposing view. The main indicators of its poor state include a high number of uninsured and underinsured citizens, poor preventive treatment, ineffective treatment of chronic illnesses, little patient safety and poor payment structures. The situation of the US health care system needs to be saved; otherwise, it will get worse. The best solutions include the recommended tested solutions or restructuring payment and enhancing patient safety. The government should implement solutions. Future research should focus on how these solutions can best be implemented; investigate whether their impact is substantial and how the nation can minimize some of the negative consequences of these solutions.

References

McKethan, A., Morrison, M., Shepard, M., Nguyen, N., Brennan, N., Cafarella, N., Williams II, R. D, & Kocot, S. L. (2009). Improving quality and value in the U.S. health care system. Brookings Institution, from https://www.brookings.edu/research/improving-quality-and-value-in-the-u-s-health-care-system/

Stone, P., Hughes, R., & Dailey, M. (2008). Creating a safe and high-quality health care environment. Agency for Healthcare Research and Quality (US), https://www.ncbi.nlm.nih.gov/books/NBK2634/pdf/Bookshelf_NBK2634.pdf

U.S. Department of Health & Human Services (2014). New HHS Data Shows Major Strides Made in Patient Safety, Leading to Improved Care and Savings, from https://innovation.cms.gov/Files/reports/patient-safety-results.pdf

United Health Group (2014). Solutions for a Modernized Health Care System, from http://www.unitedhealthgroup.com/~/media/UHG/PDF/2016/UNH-Solutions-Quality-Care-Delivery-Payment-Models.ashx?la=en

Whelan, E. M., & Feder, J. M. (2009). Payment reform to improve health care: ways to move

forward. Center for American Progress Action Fund, from

https://www.americanprogress.org/wp-content/uploads/issues/2009/06/pdf/healthpaymentreform.pdf