Sample Health Care Paper on Health Transformation

Health Transformation


Question 1

What is the value-based healthcare and how it differs from similar models of healthcare, such as pay-for service model and etc.

Value-based healthcare refers to a healthcare delivery model through which providers, comprising physicians and hospitals, are paid according to patient health outcomes (NEJM Catalyst, 2017). Under the agreements stated in value-based care, providers are rewarded for assisting patients in enhancing their health, lowering the impacts and incidence of chronic illness, and residing healthier lives in an evidence-founded manner. Value-based healthcare programs are significant to an excellent quality approach in reforming healthcare delivery and finance (NEJM Catalyst, 2017). It backs up the triple-target of offering better care for healthier health for populations at a reduced cost. When transitioning from any other model to value-based care, multiple reimbursement strategies are available to the healthcare providers.

Value-based care varies from a fee-for-service, also known as capitated strategy, through which providers are compensated according to the level of healthcare services they offer. The worth in value-founded healthcare emanates from measuring health results in contradiction to the expense of delivering the result. The traditional fee-for-service approach promotes healthcare physicians to visit many beds and do numerous procedures (NEJM Catalyst, 2017). That prospers in increasing healthcare costs though it doesn’t enhance patient results. On the other hand, value-based care places the outcome’s quality first, and tethering reimbursement to this metric incentivizes healthcare providers to prioritize patients, together with a group of healthcare administrators, who have to respond how they can conform to the new system while conforming to the budgetary limitations.

Fee-for-service models may not be entirely on their way out of the entire healthcare industry. However, the value-based care approaches are pushing their strategy in. With the government back up, backing VBC as an outcome of the ACA and Medicare (via the Centers for Medicare and Medicaid Services), patients tend to anticipate seeing the VBC approaches become more common as time moves on (NEJM Catalyst, 2017). Value-based care denotes the query that all meaningful healthcare reforms perform how one manages to finance it. With numerous debates surrounding the healthcare reform, the replies to that question are multiple though necessarily intricate.

Other models that differ from the value-based model include bundled payments and population-based payments (PBP). The two differ from the value-based model in that, under bundled payments, healthcare providers coordinate care much earlier and presume that some dangers cover costs that move past the price of a sole care episode. However, they share some savings upon keeping the costs down while sustaining quality standards (NEJM Catalyst, 2017). Under the PBO, healthcare providers are offered to meet population-extent targets. They are responsible for patient-centric care for a particular population over a specific population over a specific period over the entire range of care.

Question 2

Summary of Value-Based Healthcare Benefits

Most healthcare systems are switching to a value-based healthcare model since providers and patients benefit in various ways.

Patients Spend Less for Better Outcomes

Since value is at the healthcare system’s heart, patients will pay lower to obtain the necessary care. Care providers concentrate on preventive care that is less expensive than treating a chronic disorder such as obesity, hypertension, or diabetes in value-based healthcare systems (NEJM Catalyst, 2017). Still, providers and physicians concentrate on treatment approaches that assist patients in recovering from injuries and illnesses more professionally. A patient in a value-based healthcare classical will have more minor medical procedures, medical tests, and doctor’s visits. Furthermore, they spend less on medication as their health advances.

Patient Satisfaction Rates Increases in the Value-Based

In value-based healthcare, patients are the healthcare process’ focus. They obtain cooperation care from all of their workers. Dissimilar to the fee- for- facility model, doctors, concentrate just on treatments and tests that are excellent for patients instead of doing as much as conceivable to gather a lot of money. Not just does that save cash, but the period used during the follow-up or exam visit is most engaging and productive. Patients feel like they are amongst the team instead of an item on a list to be verified.

General Reduction in Medical Errors

Value-based care assists in reducing medical errors, which are the primary concern amongst the insurance sponsors, who have recognized that a lot of their expenditure goes to ineffective or harmful treatments. Therefore, many corporations are turning to value-based care to decrease medical errors. The healthcare provider’s company data is gathered and analyzed (NEJM Catalyst, 2017). Data analysis assists companies know health risks detailed to a system or provider. The association can then obtain steps to offer defensive care for those risks and make treatment most effective. Implementing alterations to advance preventive maintenance is a period saving for various providers. Still, the advantages on the other end far balance that expense when they spend lower time managing and treating chronic disorders.

General Society becomes Healthier.

With value-based care, society at a lower cost overall becomes healthier. Medical emergencies and hospitalization could reduce, and more insufficient money could spend on managing chronic disorders. As an outcome, general healthcare expenditure expenses are reduced. Concentrating on preventing diseases and offering efficient treatments translates to residents with fewer chronic conditions. The healthier the inhabitants are, and the less money all parties use on healthcare, the more beneficial.

Question 3

How can the New Model of Care contribute into having a value-based healthcare? 

The value-based healthcare proliferation has changed how hospitals and physicians provide care. New healthcare delivery models stress encourages a team-oriented approach to patient care and sharing data regarding parents to ensure the care is coordinated, and outcomes are measured easily. The new model of care contributes to having value-based healthcare through two primary value-based models: Medical Homes and Accountable Care Organizations (ACOs). Regarding the medical homes, the models in value-based healthcare ensure that medical care does not exist in silos. Instead, it integrates specialty, primary and acute care in a delivery model known as a patient-centered medical home (PCMH). The term Medical Homes does not refer to a physical location, but it refers to a coordinated approach to patient care with the primary physician directing the entire clinical care team of the parent (NEJM Catalyst, 2017). The model relies on sharing electronic medical records between every provider on the coordinated care team. The electronic medical records put crucial patient information at the fingertips of each provider, ensuring that individual providers can see procedures and results of tests performed by other physicians on the team. Sharing of data reduces redundant care and the associated costs.

Accountable Care Organizations (ACOs) are designed to provide high-quality medical care to Medicare patients. Hospitals, doctors, and other care providers work a networked team to achieve better-coordinated care at a lower cost within this model (NEJM Catalyst, 2017). The team members share the cost-share the reward and the cost with incentives to increase access to healthcare, health outcomes, and quality of the care with reduced costs. The strategy differs from fee for service healthcare whereby the individual providers are incentivized to order multiple procedures and tests and attend to several patients to get more paid irrespective of the patient outcomes. Like PCMHs, ACOs are patient-centered organizations where care providers and patients part when making decisions. The organizations also ensure data sharing and strong coordination between the team members to ensure they achieve goals for all patients. They also share claims and clinical data with payers to demonstrate advancements in outcomes.

Question 4


Question 5

Discuss how DRG is linked to ACOs?

Diagnosis-Related Groups were established as Medicare’s hospital reimbursement systems. The systems are patient classification schemes that offer means to relate the kind of patients that a hospital treats to the total costs incurred by the organization. The initial motivation to develop the DRG was to create a practical framework that monitors the quality of care and utilization of services within a hospital (Centers for Medicare & Medicaid Services, 2019). The DRGs and ACOs link in several ways: both the DRGs and ACOs can provide and manage with patients, the care continuum across various institutional settings that include inpatient and ambulatory hospital care, and the cost of acute care. Also, the two schemes have the capability to prospectively plan resources and budget needs and have a sufficient size to support valid, reliable, and comprehensive performance measurements.





Centers for Medicare & Medicaid Services. (2019). Design and development of the Diagnosis        Related Group (DRG).

NEJM Catalyst. (2017). What Is Value-Based Healthcare? Retrieved from             file:///C:/Users/user/Downloads/What%20Is%20Value-Based%20Healthcare_(1).pdf