Please write a discussion post reply of 300 words to the following post. Must have at least 2 scholarly peer-reviewed sources using APA format. Sources must be within the last 5 years. Must include one biblical integration that is NOT to be listed as a resource. Original post instructions are listed here: Describe at least 2 ways the Affordable Care Act changed incentives for insurers and providers.
Post you will reply to is here:
In order to have a successful organization, health care managers must understand the costs associated with the organization. A lack of understanding the expenditures such as payroll, facility upkeep, equipment maintenance, penalties, etc. can lead to the downfall of the organization. Not only is it important to understand the costs, but to also understand what affects costs such as efficiency, productivity, decisions, and risks. Each one of these factors are tied to cost which is tied to revenue. One of the ultimate goals of the organization should be to reduce costs. In fact, the Institute for Healthcare Improvement has gone on record declaring three goals health care organizations should strive for, known as the Triple Aim. Triple Aim consists of the following three goals: improving patient care experiences, improving population health, and reducing costs per capita (Lee, 2019). This Triple Aim approach was widely used as a founding concept within the Affordable Care Act and influenced the way providers get paid by insurance companies moving towards a value-based payment model through the use of Accountable Care Organizations, bundled payments, and patient-centered medical homes (Lee, 2019).
With the implementation of the Affordable Care act, health care insurers and providers saw many changes in the form of incentives. One specific incentive widely reported on is that of the Balancing Incentive Program (BIP). This incentive program has a focus on reforming long-term care by promoting “Medicaid-funded home and community-based services (HCBS) for older adults and persons with disabilities” (Beauregard et al., 2022, p. 191). In an effort to get states to participate in this program, the incentive being offered was an increase to Federal Medical Assistance Percentage revenue on HCBS spending (Beauregard et al., 2022).
As mentioned earlier, the Affordable Care Act worked to reform payment provisions and transform the traditional fee-for-service program. The goal of this reformation was to change the focus of providers from being rewarded for volume of care provided but rather being rewarded for value of care provided (Chernew et al., 2020). While this fee-for-service model seems like a simple and straightforward concept of payment, it actually can be complicated with providers having different economics of scale and scope making it difficult to match fees to services. Unfortunately, fee-for-service also has the potential to create an environment of unnecessary care being given as payment based off of service. With the Affordable Care Act came a push for utilization of Alternative Payment Models (APMs) such as payment models based on population, episodic, site, and pay-for-performance (Chernew et al., 2020). Within each of these APMs are specific programs for the various types of providers such as, Affordable Care Organizations, the Comprehensive Care for Joint Replacement model, or the Frontier Community Health Integration Project Demonstration model (Chernew et al., 2020). It is safe to say that none of these models are perfect, but rather allow for alternatives to one traditional payment model.
As Christians serving in health care organizations, managers are in a constant state of balancing what one is called to do (follow God’s word) while simultaneously working to meet the goals of our organizations. These two perspectives do not always go hand-in-hand. Maybe the facility conducts procedures that do not align with Biblical principles, or provides medications that go against a person’s beliefs, Christians must find a way to take care of people without compromising their witness. Matthew 25:36 reminds followers that as followers we are called to care for others just as we would care for Him, “I needed clothes and you clothed me, I was sick and you looked after me, I was in prison and you came to visit me” (New International Version Bible, 2011).
References
Beauregard, M., Miller, E. A., & Kemp, C. (2022). Federal incentives to reform long-term care under the Affordable Care Act: State adoptions of the Balancing Incentive Program 2011-2014. Journals of Gerontology, 77(1), 191-200. https://doi.org/10.1093/geronb/gbab031
Chernew, M., E., Conway, P. H., & Frakt, A. B. (2020). Transforming Medicare’s payment systems: Progress shaped by the ACA. Health Affairs, 39(3), 413-420, 420A-420B. https://doi.org/10.1377/hlthaff.2019.01410
Lee, R. H. (2019). Economics for Healthcare Managers (4th ed). Health Administration Press.
New International Version Bible. (2011). BibleGateway Online. https://www.biblegateway.com/versions/New-International-Version-NIV-Bible/ (Original work published 1978)