Mapping And Evaluating Value-based Healthcare Reform In The USA: An Essay On Sustainability.

Globally, healthcare systems are struggling with rising costs, increasing demand for services, inequitable access and variations in the safety and quality of services. Write a report that maps and critically evaluates the sustainability of healthcare system that has adopted a value-based healthcare reform and that reflects on the implications of such a model on health outcomes. experience of care and efficient and effective care in relation to costs.

Principles taken for guiding value-based healthcare system of the USA

The system related to health care implies a method, where the economy provides funds, finances as well as delivers various health care facilities to a large number of people. Furthermore, this system considers various issues of expenditures, resources and stakeholders, which consider facilities of people related with health care workers. However, the main motive of health care system is to improve the health condition of common people in a successive and effective way using available resources obtaining from the society (Marcozzi et al., 2018). Since present century, it has become an important issue for the government to focus on healthcare system, as the service is considered as special one. Through providing this service, the government can maintain human rights for further maintaining wellbeing of the country. To provide such services, the government of a country gives special emphasize on value creation. In recent years, most of the developed and developing countries intend to provide health care service with higher quality considering better outcomes of health, better experience for care as well as effective and efficient care through charging lower costs. Before this modern method of health care, traditional method was conducted depending on costs of output or volume of the service (Rosenthal, 2018). However, unlike value-based service, traditional approach does not provide any care with standard quality. Value-based service is provided purposely for maintaining efficiency of costs. Therefore, medical service providers along with doctors consider relevant data for providing best treatments to patients. However, people cannot obtain this facility in traditional approach, as in this process physicians consider only the number of services. They do so for earning incentives and consequently the entire system is referred as “fee-for-service” (FFS). The entire concept depends on the model of reimbursement.

Therefore, some researchers have stated that FFS model related to healthcare payment influences costs within the health care services. Under this model, physicians obtain incentives for providing expensive services to people. As a result, service providers focus on volume of the services that will provide instead of focusing on quality (Dickman, Himmelstein & Woolhandler, 2017). Thus, the paper intends to highlight the health care service of the United States of America. The report will map and evaluate the system of health care sustainability in this country. For discussing this, the report will discuss some principles that have guided this specific sector the USA. After that, the report will highlight some specific sectors that can successively describe sustainability of health care in this country. At the end, proper recommendations and conclusion will be provided.

Promoting health equity

There are large numbers of researchers, who have considered various ways to transform health care in the United States. This system represents a large, unorganised, multifaceted one influenced by various commercial forces along with interest groups. However, many sectors have intended to share the health care system of the USA for delivering value-based services. Some special improvements have been done for improving quality and assessing clinical evidence (Durvasula et al., 2018). In this context, the Affordable care Act has stimulated activities to transform health care for quantity-based care to value-based care. This in turn improves health outcomes as well as controls total health care costs. To maintain long-term sustainability, the government needs to achieve these aims. Through conducting reform, the government can improve overall value related to health care services only. This reform depends on cost-savings process under long-term, which further increase quality and equity of the government (Spatz et al., 2017). In this context, the country has obtained some guiding principles for achieving the vision for transformation of consumer-friendly health system. These principles are as follows:

• To promote health equity
• To hold providers as well as plans for improving the quality of care
• To mandate consumer participation through a meaningful way
• To advance coordinated as well as patient-centred care
• To hold the industry of health care for providing health care
• To promote the evidence-based health care use
• To preserve the integrity related to the programs of public insurance

These principles can be described briefly for reflecting the chief motive, which are adopted to ensure the health condition development.

To promote health equity: The economy can achieve health equity when every person can receive best health outcomes through accessing high-value care without experiencing any constrains. These constraints are related with race, income, ethnicity and language. Some other factors are age, gender and zip code. The chief motive of the USA government is to reduce the disparities among people based on health (Willke, Neumann, Garrison & Ramsey, 2018). This is an essential component as it can improve overall value along with sustainability of health care services. Therefore, obtaining health equity indicates an explicit and prominent measure for succussing the efforts of health system transformation. Thus, the principle states about providing incentives to decrease disparities on health.

To hold providers as well as plans for improving the quality of care: The focus for reforming payment and delivery is to improve the value and quality of health care. Payment reform needs to consider both providers and plans to improve the quality regarding care that they provide. In this context, the principle intends not prioritise cost savings for determining quality improvement as well as safety of patient (Wager, Lee & Glaser, 2017). Through highlighting cost saving procedure, the system can increase costs of consumers and this in turn can create huge difficulties.

Improving the quality of care

To mandate consumer participation through a meaningful way: Consumers as well as advocates of consumer are considered as integral stakeholders for transforming health system. To construct a system with more patient oriented, policies need to address the priorities directly (Andersen et al., 2018). Communities recognise these priorities for developing the system of health care. To confirm that reforms are essential for responding the requirement of communities and improving access of consumers for higher-quality care, some initiatives are taken. It is essential to mention that patients, consumers and advocates of consumers play significant roles to develop and implement efforts for doing reform.

To advance coordinated as well as patient-centred care: Due to fragmented health care service and poor coordination in care settings, it has become difficult for the patients to access right care for managing their health condition at right time at anywhere (Maddox et al., 2017). Payment along with delivery reforms need to break down the segmentation between medical, behavioural and dental health providers. This can encourage the coordinated care that addresses needs of patient’s health.

To hold the industry of health care for providing health care: The health care system does not have enough transparency along with accountability that can ensure that coverage price as well as care is fair compare to cost. Adequate and correct information based on price, quality, cost and effectiveness related to health care services is important. This is because this information can promote greater accountability for the USA’s health care system and confirm consumer’s care (Garrison et al., 2018). This care is accessible, affordable and high quality. Thus, efforts related to health system transformation can strengthen the quality transparency, price and cost of care. These efforts are essential to form policy regulation.

To promote the evidence-based health care use: The citizens of USA do not receive care depending on best evidences. In addition to this, best evidence is not available for representing diverse populations. Thus, the transformation effort related to health care needs to confirm that care decisions consider research with high quality, comparative, representative and patient–centred (Sharma, 2018). For obtaining this, reforms need to generate incentives for providers to continuous care with high value.

To preserve the integrity related to the programs of public insurance: Medicaid, CHIP and Medicare provide some essential health care benefits to American people, especially who belong to low-income group (Begun, Butler & Stefl, 2018). These programs play significant role to ensure access of consumers for affording high quality health.

Mandating consumer participation

Thus, according to principles of health care transformation, the government needs to strengthen these programs.

In the USA, delivery of health care is considered as one of the costliest issue for the people of America. To conduct the entire activity, the government carries more than $3 trillion in each year (Tan & Tan, 2017). According to a report of the Canters for Medicare and Medicaid Services, expenditure of the US health care has increased by 5.8 percent in 2015. This means the amount has reached to $3.2 trillion or $9990 for an individual. Thus, the service has accounted for 17.8 percent of the country’s gross domestic product (GDP) (Zywiel, Liu & Bozic, 2017). The costs of health care costs at present represents 20 percent of the USA’s total GDP and this amount is higher compare to other countries across the world. As a result, this increasing health care costs have cannot sustain in the long-run.

The population in America has changed continuously for the last half century and consequently it has become to 63 percent. Therefore, two important demographic changes have occurred in the USA based on population. According to the population report of US Census bureau, the country has large number of older people compare to before. Consequently, residents aged 65 years and above have increased from 35 million to 49.2 million between 2000 and 2016. These amounts have represented 12.4 percent and 15.2 percent of the US’s total population (Marsha et al., 2018). According to statistical report, the country will experience significant shifts in its demographic condition. For instance, the number of people, aged 65 years, will become 98 million in 2060 (Kuruvilla, 2018). As a result, this aging population will become diverse based on their race and ethics. Thus, this increasing aging population has significant impact on US economy, as this increasing number can influence Medicare expenditures constantly. In addition to this, demand fore care for elder people will also increase at a fastest rate among American people, who suffer from Alzheimer. In 2015, the number of patients suffering from this disease was 5 million though by 2050, this number would be 12 percent (Gilardino, González-Pier & Brabata, 2018). As a result, demand for health care will be increased over the year.

Chronic diseases are considered as incurable one, for instance, asthma, cancer, heart disease and diabetes. However, these diseases are preventable and could be managed through proper detection, improving diets and treatment therapy. For these, people need proper healthcare facilities at anytime and anywhere. In the US, chronic diseases are considered as one of the most important cause for death and disability. According to some estimation, it has been observed that among 45 percent US population, only one people suffer from chronic disease. Due to these types of diseases, many people have died and this implies that around 1.7 million people of America die every year (Moore, Chaudhary & Akinyemiju, 2017). Thus, chronic diseases have the capacity to disable and reduce life quality of an individual, especially for undiagnosed and untreated person.

Advancing coordinated and patient-centered care

Consequently, chronic diseases have increased demand for better health care services. The share chronic diseases are high for hospital admissions, visits of physicians and prescription filled. Therefore, these diseases also stimulate significant expenditure in health sector. For each person, the expenditure has been accounted for $7000 (Bauer, Briss, Goodman & Bowman, 2014). Within the publicly funded health programs, expenditure for chronic diseases has a significant proportion of overall expenditure. This has accounted for more than 96 percent and 83 percent in Medicare and Medicaid, respectively. Based on present condition, it can be predicted that chronic diseases will increase constantly in over the years. This means by 2025, it could affect 164 million citizens of America, which accounts for almost half of the total population (Bittoni et al., 2015). Internationally, chronic diseases have adversely affected health as well as life quality of many people. This further has stimulated total costs related to health care to increase. Consequently, this activity has significant impact on total work force.

To provide better treatment facilities, the government of any country needs to use higher and modern technology. However, increasing use of technology has also influenced health care costs to increase further. According to health care providers, hospitals have adopted complex as well as technology related tools to provide value-based care to their patients. These tools require outsourced process of recruitment for helping permanent staff as well as predicted analytics (Powers et al., 2017). According to the finding of Centres for Medicare and Medicaid Services, expenditure in this sector has accounted for 17.8 percent of the total America’s GDP in 2015. There are large number of factors that can contribute in the increasing costs and different opinions for resource allocations. Through allocating resources efficiently, an economy can reduce the cost gap (Bartick et al., 2017). Advanced technology for the last few decades has become huge. Consequently, this technology has served health care industries to provide better treatment. However, the cost related to technical advances has played significant role to increase overall costs within health care services. For instance, new technology related to medical care has accounted for 40 percent to 50 percent for the increment of total cost. The health care sector has intended to use health information technology for reducing costs and increasing productivity.

According to some researchers, aging population in US has helped to increase the demand for total health care system. This in turn has great influence on increase in country’s total health care service. It is observed that demand for health care is increasing continuously (Kingma, 2018). Two chief factors that influence this growth are suboptimal use related to health care resources and increasing prevalence for preventing illness. Consumers can influence these factors with the help of their choice. For instance, obesity rate is increasing continuously across the USA (Moon, Green, Berry & Ioannou, 2017). This is a preventable disease, which can increase the probability of stroke, heart attack and diabetes. However, due to lack of treatment, these diseases can turn to chronic one. This implies misuse of health care system, which causes cost increment.

Holding the healthcare industry accountable

To prevent increasing costs in health care services, the government can take various strategies and policies, among these, three major strategies can be described. Firstly, the aging population in the USA has increased continuously. However, it is difficult for the government to prevent this number. In this context, the government can provide some special medical schemes under which people aged 70 and more can receive benefits in health care service. This can be exemption of fees by certain percentage or special health care facilities at comparatively lower costs. In this context, the government can provide special emphasis on chronic diseases among aging people. Through preventing this probability, the government can restrict significant amount of expenses within medical sector.

Secondly, the USA government can invest sufficient amount for innovating modern technologies relating to health care facilities. Through using these technologies efficiently, the government can reduce costs of people within this sector. However, for innovating these technologies, the government cannot change its fiscal as well as monetary policies. Otherwise, the entire process can influence sustainability of value-based health care sector negatively. The government can provide funds for conducting research and development on this issue. In addition this, the government can organise special training and campaigning for health care service providers for using these technologies efficiently. In this context, it needs to mention that, the government are required to highlight special diseases or other symptoms from which American people suffer by large amount. Thus, giving special emphasis on this sector can help government to reduce costs for them and for consumers as well. This can maintain sustainability of value-based health care facility for the long time.

Thirdly, the government can focus on the demand for total health care system in the USA. In every year, demand for value-based health care services has increased significantly. Thus, it can be difficult for service providers to provide significant amount of services with higher quality. The need for volume is an important factor for each service provider along with their quality. In this context, the government can implement special rules and regulations to control these service providers for offering large number of health care facilities with standard quality. For instance, these service providers can obtain incentives for providing best medical facilities to their patients. Moreover, the government can generate strong completion among these providers for influencing them to provide larger amount of services to different patients.

Conclusion:

Implications of the value-based healthcare model on health outcomes

The entire paper has discussed about medical care system of the USA. The cost of health care service within this sector has increased continuously. Thus, the government of this country has provided special emphasis to reduce this increasing cost. Hence, at first, the paper has described about various principles that are taken to modify health care system of this county. These principles consider promotion of health equity, plans for improving the quality of care, mandate consumer participation in a meaningful way and advancing coordinated as well as patient-centred care. Some other principles consider industry of health care for providing health care, promoting the evidence-based health care use and preserving the integrity related to the programs of public insurance. The chief focus of these principles was to provide best health care facilities to their patients. After discussing these, the paper has focused on some statistical data and factors that can influence sustainability of health care services.

The paper has observed that cost within health care services has increased in every year. Consequently, income for each person has also increased significantly. Moreover, aging population along with increasing number of chronic diseases has led the health care sector to increase costs. In addition to this, invention of new technology and increasing demand for medical facility has as important impact on sustainability of value based treatment during the long-term.

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Implications of the value-based healthcare model on experience of care

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