Taming the Cost of Medicare Program
Healthcare administration across United States faces diverse challenges emphasizing urgent reforms are needed. According to Niall, Nicole, Lawrence, Aaron, Marisa, Nadia, Mark, and Reginald, approximately forty six million citizens in the country are not insured. Conversely, insured Americans have to deal with rapid increases in premiums which are often classified under out-of-the pocket costs. President Barrack Obama and the Congress have had to consider ways of investing in healthcare while reducing number of citizens suffering due to lack of insurance coverage. The president has always stated that, addressing shortfalls with regard to healthcare quality and efficiency ought to be undertaken simultaneously. This will ensure healthcare costs are also addressed and poor healthcare outcomes resolved. As a result, feasibility and sustainability of quality and efficient healthcare ought to ensure systems and facilities are reformed and reorganized (Niall, Nicole, Lawrence, Aaron, Marisa, Nadia, Mark, & Reginald, 2009).
The Patient Protection and Affordable Care Act was developed to achieve the primary goal of providing Americans and legal residents across United States with universal quality healthcare services. It was therefore fully implemented to ensure citizens access universal healthcare insurance including the uninsured and underinsured. Universal public healthcare systems aim at ensuring the reforms are undertaken for healthcare insurances to increase and costs to reduce to enhance affordability rates among Americans and legal residents in the country. For example, more than two trillion dollars were spent by Americans which was more than seventeen percent of the country’s Gross Domestic Product in 2009 on healthcare (Susan, 2012).
The amount has been rising with predictions affirming the trend will be observed for several decades if serious interventions and reforms are not undertaken. This led the healthcare administration to target thirty two million citizens by 2014 that ought to have healthcare insurance. Although it was a tipping point within the fiscally overblown healthcare system, the reform has increased number of people able to access and afford healthcare services. The changes however slow, have been promising. For example, spending on federal healthcare programs including Medicaid and Medicare as well as Children’s Health Insurance Program (CHIP) has enabled a larger number of citizens to be reached and assisted in accessing healthcare services. The growing and unsustainable federal debt should therefore be addressed to guarantee more people will qualify for healthcare insurance in the future. Consequently, they will be enabled to access and afford quality and efficient healthcare services across diverse healthcare systems in the country (Susan, 2012).
Current Issues Affecting Healthcare Administration, Systems, and Industry
Population Health Issues
According to Shannon, Molly, Heather, Emily, Ellie, and Tamara, there are at least ten challenges affecting healthcare systems and administration in the country. The population health has always been considered as the major idea to be applied in maintaining or gaining momentum in the nation’s healthcare administration. Population refers to the multidisciplinary concept shared among social institution, policymakers, and public healthcare agencies. As a result, hospitals are required to play the role of providing expertise healthcare services to the population. This role however has been overwhelming as population health is ranked among the hardest skills set to find across the broader healthcare field (Shannon, Molly, Heather, Emily, Ellie, & Tamara, 2014).
In 2014, American Hospital Associated conducted a survey during which more than fifty percent of the executives identified that, management of community and population health suffers from a talent gap. The survey therefore provided proof that the talent gap across healthcare systems are often filled through creation of new positions such as executive and chief population health managers. This further challenges the process of quantifying the population health as healthcare leaders need to creatively think and develop methods improving health qualities and efficiencies across geographic populations. The leaders are also required to maintain healthy senses of skepticism with regards to populations’ efforts towards achieving and sustaining quality healthcare systems. Thus, the act of oversimplifying issues while overinvesting solutions for positive healthcare outcomes is not sustainable in improving healthcare administration (Shannon, Molly, Heather, Emily, Ellie, & Tamara, 2014).
Challenges Experienced when Shifting from Volume-based to Value-based Reimbursements
The second issue witnessed in healthcare administration involves shifts from volume-based to value-based reimbursements. This issue is described as inevitable as it depends on how quickly healthcare providers are able to make it successfully. For example, some medical facilities move too fast in providing healthcare services. They however also increase the risk of losing revenues and putting into practice strategies that are neither practical nor supported by the market. Conversely, some healthcare facilities move too slowly in providing healthcare services. This enhances the risk of either building or loosing opportunistic partnerships comprising of experienced and qualified healthcare providers. More so, a lot of time is utilized providing the healthcare services rather than modifying and transforming medical services and practices. A national study was conducted in 2014 by McKesson. The findings revealed that, at least ninety percent of healthcare payers and providers have transitioned to value-based reimbursement. As a result, healthcare providers including accountable-care organizations are very reluctant to embrace value-based healthcare initiatives, systems, and programs. Thus, at least sixty percent of healthcare payers and thirty five percent of healthcare providers have developed and embraced the behavior of believing in value-based reimbursement as it has a positive financial effect (Steven, & Peter, 2010).
Ineffective Hospital Infection Control and Prevention Programs
The third issue refers to hospital infection control and prevention programs. In 2014 in light of Ebola, the programs discovered new fame as healthcare facilities across United States received more attention from people and organizations afraid of contracting the disease. United States borders have been steering the citizens towards healthcare providers in order to be treated for infections. The providers are also required to develop and implement control measures to reduce the rate at which Ebola as well as other medical conditions are spread in the country. These efforts however, led to a larger number of healthcare providers being infected with Ebola as more than one million healthcare-associated infections were reported in United States by the Centers for Disease Control and Prevention. These revelations are neither positive nor promising as they affirm the country’s infection, control, and prevention not strong or properly managed. Ebola infections have therefore acted as a way of enlightening the healthcare administration. They have raised awareness on the need to prevent infections. The healthcare administration ought to acknowledge, hospital infection control and prevention programs were developed to protect citizens from various diseases. More so, the programs reduce the number of Americans and legal residents likely to suffer from an infection or disease healthcare systems were required to prevent from spreading. Consequently, the amount of healthcare costs incurred the healthcare administration is reduced drastically as citizens are protected (Thomas, & Hoangmai, 2016).
Jumbled Healthcare Information Technology: Data Storage
Healthcare systems have often been described as jumbled collections of facilities operating under diverse cultures, strategies, campaigns, and reimbursement rates. Healthcare executives have been realizing the systems have not been successfully posting healthcare transactions. For example, a research conducted by Strategy and Booz Company affirmed healthcare transactions are not always successful. More so, a study was conducted among hospitals between 1998 and 2008. The findings affirmed that, only forty one percent were able to outperform peers with regards to operating income and margins. Thus, various healthcare facilities had failed to identify synergies required to make wise, practical, and manageable decisions. They therefore develop alliances and power bases making it hard to make difficult decisions within healthcare strategies (Fisher, Goodman, &Skinner, 2009).
The healthcare sector generates huge amounts of data on a daily basis. More so, the sector generates big buzzwords as the healthcare information technology supports innovation. It is also developed to operate under diverse healthcare disruptions while accessing big data and supporting bigger ideas that are either consumer or clinically driven. For example, the IBM supercomputer Watson was developed and tailored to suit treatment plans according to peoples’ genetics. The Telehealth is therefore applied in providing world class healthcare services to people located in the most remote areas across the country. In 2015, Apple, Samsung, and Microsoft among others participated in the launching of platforms dedicated in providing quality healthcare services to enhance wellness across the country. These organizations participated to ensure the process tracks the patient’s progress as they provided wearable consumer technology to the receivers. The advances witnessed across the healthcare information technology however have increased the rate at which data has been piling up as they have improved the speed. As a result, healthcare managers working in a healthcare system’s data warehouse have to work closely with other teams and stakeholders in delivering patient care under meaningful insights. This requires backdated systems to track without system-wide infrastructures to leverage the process. This issue has been a great challenge as making sense of data based on how it is stored and brought together for health managers to gain comprehensive understanding has been exigent (Shannon, Molly, Heather, Emily, Ellie, & Tamara, 2014).
This has encouraged healthcare managers to rely on descriptive and predictive analytics when analyzing big data. This helps them in understanding why patient return seeking further treatment. It also assists in predicting when a patient is likely to return. Consequently, healthcare givers have to understand the causes of a patient returning by being proactive with each patient in order to provide better healthcare attention. The experts within healthcare organizations therefore strive being proactive in provide medical care at reduced costs for improved outcomes. The data developed through this process however has to be integrated which has been challenging. Healthcare organizations relying on data warehousing have had either to move or leave some data (Shannon, Molly, Heather, Emily, Ellie, & Tamara, 2014).
Resolving the population health issue has to involve healthcare leaders. The leaders ought to reduce reliance levels on traditional programs. Conversely, the leaders should focus on establishing new partnerships with communities as well as private, public, and non-profit making organizations. More so, healthcare systems ignoring wealth associated with expertise and sufficient resource allocation in order to act autonomously will be reformed. Consequently, issues involving domestic violence, cases of sexual and elderly abuses and public healthcare crises will be identified and resolved by health managers and leaders with sufficient resources and qualified expertise. Accountability will also increase among healthcare organizations prompting them to develop and implement unique programs responding to issues affecting population health (Shannon, Molly, Heather, Emily, Ellie, & Tamara, 2014).
Consequently, resolving the issue associated with shift from volume-based to value-based reimbursement of healthcare services, a new model ought to be developed. The model ought to ensure healthcare payers and providers agree to replace the traditional program paying more attention on the amount of fees paid for a service. The new model should therefore focus on providing healthcare seekers and payers with quality and efficient services. For example, a mixed model that does not rely on the fee-for-service should be developed in order for the traditional program to be completely replaced by 2020. The pay-for-performance model has also been introduced in the market. Healthcare payers are required to make necessary transitions as worthwhile and efficient as possible for providers. Conversely, the healthcare providers ought to adjust their thinking from short-term to long-term. Healthcare leaders and executives should therefore build strategic plans detailing how healthcare organizations ought to develop in a period of at least five years. The plan however, ought to be detailed, flexible, and consistent with environmental changes (Bruce, Kosuke, Sara, & Kate, 2010).
Conversely, resolving the issue allied to infection control and prevention programs across various hospitals in the country sorely involves the healthcare industry undergoing reforms. Foremost, the government should invest in the programs in terms of human capital and medical resources. The government should therefore ensure qualified personnel with adequate skills and experience are tasked with the role of preventing citizens from various infections and diseases. Consequently, healthcare personnel should focus on performing day to day tasks crucial in controlling and preventing infections and diseases. They should undergo retaining to acknowledge the importance of donning and doffing personal protection gears properly. This will effectively and efficiently deal with infections and diseases while the prevention team collectively provides the much needed healthcare averting. Lastly, raising public awareness on the need to perform proper hygiene is vital as it will control and prevent other diverse infections. The culture of infection prevention should therefore be encouraged and supported as it can emphasize the need to develop and embrace programs among citizens, patients, and organizations as well as private and public sectors (Thomas, & Hoangmai, 2016).
In order to resolve the issue allied to integration of efficient healthcare systems, traditional integration approaches ought to acknowledge the need to merge assets. The process of merging and acquisition of healthcare systems and assets is bound to maximize synergy opportunities. As a result, a focus on footprint, operations, head counts, and cost reductions should be paid in order to enhance capabilities among healthcare systems in the country. Achieving true integration of healthcare systems however requires reevaluation and development of integration strategies. This will ensure stalled integrated healthcare systems with reserved mutually reinforcing capacities continue to achieve the benefits. Consequently, they can be gradually improved during integration process based on the strategy and objective roadmap. More importantly, the integrated healthcare systems should be utilized in setting and creation of milestones and temporary transformations. This will ensure difficult decisions and policies guaranteeing positive changes and efficient quality outcomes are formulated and implemented. This however requires a transformation office to be established to act as an unbiased third party driving the process of integrating healthcare systems. Lastly, healthcare facilities should recruit and train staffs with specific skills required in operating integrated systems (Brenda, & Jeanette, 2011).
The issue involving jumbled healthcare information technology with regards to data is closely associated with lack of interoperation in the sector and industry. Healthcare information technology lacking interoperation in the sector and industry should therefore be addressed as the incapability has been crippling the healthcare’s analytical capabilities. Although identifying easy solutions to this issue can also be challenging, advancing healthcare information technology should embrace population health based preventive analytics. They can be effective and impressive as healthcare experts can utilize them in identifying factors crippling particular patients’ healthcare strengths. Consequently, they can develop treatment measures to undertake in order to control and prevent healthcare risks in the future. Thus, the population health-based preventive analysis should be embraced as it will leverage health data while managing population health and pursuing value-based care (Shannon, Molly, Heather, Emily, Ellie, & Tamara, 2014).
In 2010, the government had to spend over eight thousand dollars per citizen on healthcare costs. The amount is more than twice the amount of medical care costs incurred by other advanced and developed nations such as Japan, Germany, and Canada. This revelation however, should not be applied in claiming or judging United States healthcare sector as either bad or ineffective. Instead, it should be applied in justifying that the healthcare administration within the country is expensive. The government is required to take responsibilities involved in payment of healthcare costs through Medicare and Medicaid which has been a burden especially for the poor. Addressing the issues affecting the healthcare sector in the country will therefore ensure future generations do not experience the current challenges (Thomas, & Hoangmai, 2016).
As a result, the first recommendation involves ensuring medical costs are reduced. They have been rising due to reasons beyond demographics of the aging nation. This has encouraged people as well as healthcare seekers and providers to opt for greater volume of healthcare services leaning towards volume-based reimbursement. This explains why Americans have been purchasing improved healthcare services as income levels increase. This however, does not guarantee improved healthcare outcomes even without making wasteful decisions. All levels of healthcare ranging between consumers’ co-payment to government spending has incurred eighteen percent of the nation’s Gross Domestic Product. This translates to the government incurring one dollar for every five dollars an individual is required to pay for medical care. The medical costs should therefore be cut down by at least thirty percent to resolve fiscal crises in the country. To achieve this objective, the following steps should be undertaken (Mark, 2013).
Foremost, traditional healthcare practices including Medicare payments indirectly in support of medical education should be declared obsolete. This will encourage and enable the government to invest in doctor training a process that can save the nation more than five billion on yearly basis. Several people that are Medicare beneficiaries often sped a lifetime contributing payroll taxes during their working years. They also continue to pay premiums after retiring. These hurdles however, do not guarantee that the beneficiaries will utilize the medical cover maximally. Thus, the entitlement bomb that is likely to increase by 2037 among beneficiaries ranging between fifty and eighty million is adversely affecting the federal budget. Consequently, social security claiming the nation’s financial resources for almost a decade will rise. The president and Congress should therefore make legislations reforming the entitlement claims among citizens. Fiscal crises will decrease prompting the national debt to decrease accordingly. Consequently, the government can focus on allocating funds, resources, and staffs in implementing the viable solutions discussed above to resolve the issues affecting United States healthcare sector (Fisher, Goodman, &Skinner, 2009).
Brenda, N., & Jeanette, E. (2011). The Nursing Shortage: Solutions for the Short and Long Term. The Online Journal of Issues in Nursing.
Bruce, P., Kosuke, I., Sara, G., & Kate, F. (2010). High Value for Hospital Care: High Value for All? Client Report for National Business Group on Health.
Fisher, E., Goodman, D., & Skinner, J. (2009). Health Care Spending, Quality, and Outcomes: More isn’t Always Better. Milliman Medical Index Measures.
Mark, T. (2013). Taming Medicare Costs: What are the Options? The Christian Science Monitor.
Niall, B., Nicole, C., Lawrence, K., Aaron, M., Marisa, M., Nadia, N., Mark, S., & Reginald, D. (2009). Improving Quality and Value in the U.S. Health Care System. The Brookings Institution.
Shannon, B., Molly, G., Heather, P., Emily, R., Ellie, R., & Tamara, R. (2014). 10 Challenges and Opportunities for Hospitals in 2015. Hospital Review.
Steven, D. P., & Peter, B. B. (2010). How Medicare Could Use Comparative Effectiveness Research in Deciding on New Coverage and Reimbursement. The People to People Health Foundation.
Susan, A. C. (2012).Taming the Beast of Health Care Costs: Why Medicare Reform Alone is Not Enough. Annals Health Law, 21(1).
Thomas, B., & Hoangmai, P. (2016). Primary Care: Current Problems and Proposed Solutions. Health Affairs and Policies Review.