Health Policy and Evaluation HCM-590-MBOL1#1
Service delivery in health care involves the offering of treatment and supplies entitled to the patients (CMS, 2019). The most commonly used and recent service delivery model is the Human service model, where the health care providers’ focus on the client and their environment when administering treatment.
Payment models refer to the use of payment methods to leverage and promote higher value for the payers, providers, purchasers, and patients. There are several commonly used value-based payment models used in healthcare (CMS, 2019). These include Pay for Performance (P4P), Medicare Quality Incentive Programs, Bundled payments, Payment for Coordination, and Patient-Centered Medical Home.
The newly developed healthcare plans and payment system are crucial in improving the efficiency of healthcare systems while curtailing spending in the facilities (CMS, 2019). Since the payment models suggested and developed by the Center for Medicare and Medical Innovation (CMS) focus on the value of service and treatment t given to the patient, this ensures that physicians and their teams provide the best possible care to their patients.
Payment models such as the bundled system are programmed to align the patients’ and health care providers’ interests. This is done by assigning a fixed payable amount for all the services given in a single session of care and treatment (Shrank, 2013). The CMS developed payment systems and service delivery models that aim at providing the highest quality of healthcare at the lowest and most affordable prices while holding the caregivers responsible and accountable for any tasks carried out in their practices.
The application of these models and systems has led to expanded access and better coverage of health care resources to the patients who need them most (Shrank, 2013). It has also led to the lowering of health care insurance rates making it more accessible to more people. Facilities that embrace these payment and service delivery models receive higher reimbursement amounts from the federal government, which aids in the running and successful operation of their patient-based practices.
Embracing the CMS developed models ensure improved coordination and quality in the provision of health care for all entities involved (Shrank, 2013). These programs are designed to keep the leadership and management of the facilities accountable while they provide excellent services and healthcare to their patients. Practices that have embraced these value-based models have had to undergo a complete restructuring in their leadership, which has led to better coordination and higher quality of health care services provided by their teams.
Patient-Centered Medical Home (PCMH), is a health service delivery model that coordinates the delivery of treatment through the patient’s primary health care doctor (Wagner et.al, 2012). This ensures that the patient receives the necessary treatment and care whenever and wherever they need it. The main objective of this delivery model is to facilitate partnerships between personal physicians, the patient’s family, and the patients themselves by providing a centralized setting. The treatment and health care services are determined by the use of information technology, health information exchange, and hospital registries.
Several changes need to be carried out for a medical practice to become a patient-centered medical home. First, the practice needs to go through an empanelment process (Wagner et.al, 2012). This is where the facility’s management makes a conscious effort to link the patients and their families with a specific physician. The creation of these panels allows health caregivers to monitor and reach out to their patients, who may require their services and attention.
Secondly, there is a need for engaged and strategic leadership to enable the transition of a health facility into a PCMH (Wagner et.al, 2012). The leadership’s role is crucial in establishing a culture and system that supports PCMH. It is also the leadership’s responsibility to ensure that the staff understands how the system works as well as its role in better health care for its patients. Helping them understand the benefits and changes occurring to the system will ensure that the staff train and successfully adjust to the new policy.
Thirdly there is the need for planned and evidence-based care. PCMH centers should provide high-quality health care (Wagner et.al, 2012). Hence the use of registries enables the facilities to identify any areas that need improvement even before they visit a patient. The practice teams then plan and organize the patient’s healthcare, ensuring that all the needs are met efficiently. The use of information tools and decision support systems aid in improving healthcare services, by helping the health care providers, make evidence-based decisions in their treatment processes.
The fourth change is patient-centered practices and interactions (Wagner et.al, 2012). The PCMH models strive to provide adequate health care based on the patient’s values, preferences, needs, and work. This ensures that patients are involved in care, self-management, and decision making when it comes to the issues of their health. It is also the best way to ensure that the patients understand all the options and their repercussions of different treatments to their health.
The fifth crucial change in turning a facility into a PCMH is to provide enhanced access to the patients (Wagner et.al, 2012). The patients should be in a position to contact their health care team whenever they need them, whether during or after office hours. It also ensures that the patients understand and attain health insurance to better care for themselves.
Lastly, health care providers need to practice team-based healing relationships. The involvement of practice staff is vital in ensuring a productive, lasting, and robust physician-patient relationship (Wagner et.al, 2012). Therefore taking care of the patients is viewed as a team effort and not just the physician’s responsibility. The team members define the roles, assign tasks, and ensure that the members are appropriately trained to perform their functions efficiently. The cross-training of staff members for vital roles enhances the team’s capacity to be dealing with staff turnover and absences.
Health facilities and practices that achieve PCMH status benefit in several ways. PCMH guidelines help in the streamlining of care management and coordination, improving the facility’s efficiency while lowering the costs of operation and service delivery (Nielsen et.al, 2012). Secondly, PCMH practices benefit from enhanced government reimbursement support, helping them to reduce their cost of service delivery to their patients and therefore making them more affordable to more patients (Nielsen et.al, 2012). Thirdly, the systems put in place help in streamlining the facility’s participation in other value-based care programs, such as the accountable care organization. Lastly, the practice also receives accreditation confirming their higher quality of patient care and service delivery.
PCMH not only focuses on the improvement of the facility but the lives of the patients as well, which makes this service delivery model beneficial to all the stakeholders involved.
CMS. (2019, October 15). Home – Centers for Medicare & Medicaid Services. Retrieved from https://www.cms.gov/
Nielsen, M., Langner, B., Zema, C., Hacker, T., & Grundy, P. (2012). Benefits of implementing the primary care patient-centered medical home. Washington: Patient-Centered Primary Care Collaborative.
Shrank, W. (2013). The Center For Medicare And Medicaid Innovation’s blueprint for rapid-cycle evaluation of new care and payment models. Health Affairs, 32(4), 807-812.
Wagner, E. H., Coleman, K., Reid, R. J., Phillips, K., Abrams, M. K., & Sugarman, J. R. (2012). The changes involved in patient-centered medical home transformation. Primary Care: Clinics in Office Practice, 39(2), 241-259.
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