Health Care Finance Discussion Question

I’m working on a health & medical question and need an explanation and answer to help me learn.

Discuss the importance of an organization determining its operational alignment. How are performance measurement outcomes used to determine operational alignment? Discuss the similarities or differences between an organization maintaining operational alignment and you maintaining your worldview.

Essentials of Health Care Finance

Cleverley, W. O., & Cleverley, J. O. (2018). Essentials of health care finance (8th ed.). Burlington, MA: Jones & Bartlett Learning. ISBN-13: 9781284094633

In the past, numerous legislative, public policy, and insurance company-driven initiatives were aimed at fundamentally altering the manner in which U.S. health care is financed and delivered. Although those initiatives may have appeared to be dramatic changes at the time—think back to managed care—the results turned out to be more comparable to marginal modifications to a health care system that seemed to be nearly unmanageable in terms of stemming the rapid increase in costs and an inability to deliver a uniformly high level of quality. In fact, the U.S. health care system remains on an unsustainable financial trajectory. The rate of spending continues to outpace inflation. Meanwhile, despite the amount of money expended, patient health outcomes in the United States often lag behind those of other countries that spend far less.

Comprehensive health care reform was enacted in March of 2010 when the Patient Protection and Affordable Care Act (PPACA) was signed into law. Depending on one’s point of view, passage of the Affordable Care Act (ACA) placed the U.S. health care system on a markedly different path. One’s political views may well determine whether that trajectory is considered positive or not. Either way, we appear to be entering an era of health system reform that attempts to usher in a structural change to health care financing unlike anything we’ve seen before.

Request “Write My Nursing Essay” for a 100% custom writing tailored to your instructions: Health Care Finance Discussion Question

The way in which physician assistants (PAs), physicians, and other health professionals will be reimbursed for the professional services they deliver is in the midst of unprecedented change. As practices, hospitals, and health systems begin to reinvent themselves and establish new practice and payment models, PAs must understand how they will adapt to a “new normal” in health care.

One of the essential concepts in health care today is value: value-based reimbursement, value-based purchasing, and a shift from fee-for-service to fee for value. Value in health care can have many different meanings dependingon who and where you are in the health care system. In the reimbursement arena, value can be described as the health outcome achieved per the dollars allocated.1,2

What is the concept behind value-based reimbursement or value-based payments? It deals with the providing of preventive care and intervention earlier in the disease process, delivering that care in lower cost settings (e.g., in the office or in the patient’s home vs. in an acute or urgent care setting) and having health professionals focus on improving both individual and population health. All this has to occur while at the same time reducing the number of avoidable emergency department visits and hospitalizations and reducing hospital readmissions.

The transition toward more innovative health care delivery system concepts such as population health, value-based reimbursement, and bundled and episodic payments continues. The pace of that transformation, however, has been slower than many expected. In fact, despite the efforts of the Medicare program and numerous commercial insurers to move the needle forward, many health care professionals remain substantially entrenched in the world of fee-for-service reimbursement.