Provisional and Reimbursement of Health Care Services

Health Care Case
April 19, 2024
Health Evaluation Data
April 23, 2024
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Provisional and Reimbursement of Health Care Services

According to Protection & Act (2010), the Patient Protection and Affordable Care Act with the acronym of (ACA) and tagged as Obamacare is a federal statute of the United States which was enacted on the 111th State’s Congress and signed into law. This law works together with the Health Care and Education Reconciliation Act of 2010. This law came into force by 2014. A good population of people in the United States are covered under this act whereby by 2016, the number of uninsured members halved (Protection & Act 2010). The increased number of people covered under this act is higher due to the development of Medicaid suitability which caused the significant changes in the separate insurance. ACA was thought of being able to reduce the deficit and the act has ultimately reduced the inequality since it primarily taxes the 1% at the top in order to fund the families which range from the bottom, Protection & Act (2010). It has also endorsed the delivery system reforms which is majorly intended to improve the quality of the healthcare and to constrain the healthcare cost. The Patient Protection and Affordable Care Act is already showing the impacts in the organization as a large percentage of people have been proclaimed members. The impacts are majorly felt by healthcare workforce which is currently experiencing the augmented stress and instability. The patients will now be experiencing longer wait times and reduced access to the health providers.

The Bundled Payment Structure Versus Fee for Service Payment Structure is another trend which has been used as a middle ground for fee services whereby the providers are getting paid for each of the services that they give to patients. Colborn (2017). The bundled payment structure involves the payment of a lump sum amount of cash to the caregiver per patient, not considering the risk factors that is shared between the health provider and the payer. It has been proposed in some of the healthcare during the debate in the States that the act is used in the United States majorly during the Obama’s era of administration, as a strategy for reducing the costs of the health care centres. The payment for the fee on the other side includes payment of the health caregiver on the services order. It involved on a basis for the expected cost in the clinically- defined series of health. The other organizations being the commercial payers have also participated in the bundled payments with the interest of cutting costs of health care. The allied organizations are experiencing the impacts of this acts in times when the costs are too high, the providers tend to give unnecessary services whereas when the rates are too low, the care providers experience financial difficulties hence the miscalculation may be caused when the data is incomplete. The impact is due to the fluctuation of the cost which many a time have caused confusions and mixed up of data.

In line with Kashef & Nezamabadi-pour (2015), the Accountable Care Organization is defined as a trend which is an association of doctors, the hospitals and other health care facilities that come together in volunteering to give people the quality medication, with a common goal of ensuring patients is cared for rightfully at the right time as they avoid the unnecessary duplication of services and prevention of medical errors. Following the success of ACO in high-quality service delivery, wise spending and care, the savings achieved are shared for the purpose of the medical programs. ACOs, have got positive impacts in the organization as their ever-changing model of payment usually shifts the financial risks from the payers, for instance, the insurance companies and the employers and channelled to the provider. This makes the provider to be incentivized on how they deliver special care aiming at decreasing the rate of spending as they improve the quality measures and meet the patient’s satisfaction. They work to reverse the mode of payment for care in the States whereby the incentives are higher than the quality provided.

Technology and telemedicine is simply a broader perspective of finding solutions in a medical field that includes technology in storage, sharing and analysis of medical data (Kann, Marca & Mazzola 2016). In the past, telemedicine functioned in connecting patients in rural healthcare to the specialist in a populated urban area. Today telemedicine has got a wide variety of functions such as in electronic health records and the patient management technology utilizes the knowledge of Information Technology. This has enabled patients to be monitored from home as they receive follow up care on chorionic illnesses. This highly reduces the chances of the patients being exposed to potential patients with contagious diseases. Telemedicine can also of great importance to the care providers as it can be used in clinical services extension and health improvement through the follow-ups. Despite the positive impacts that telemedicine brings to the patients and providers, it also has negative impacts on the organization. In terms of data security, telemedicine is unreliable as the personal information can get malicious attack leading to data loss and personal data access. Compliance in telemedicine can also be a matter of discussion hence cannot be trusted with all types of information. Due to that, there is a great need for backing up useful data that may need a reference later.

The Medical Advantage Plan is also a current trend which is a way in which one gets covered with insurance offered by a private company, as researched by Jacobson, Damico, & Neuman et al., (2015). The plan usually offers and substitute way of getting the medical benefits through the medical-approved private companies which may offer additional benefits beyond what was expected. It is in conjunction with several organizations such as the Private Fee-For-Service plan which dictates the amount of money that is given to the health care provider to pay for the service and the amount the beneficiary is expected to solicit for to cover up the bill. The Preferred Provider Organizations is also part of the Medical Advantage Plan that is responsible for the recommendation of the allocation of health care facilities. This trend has got an impact on the organization on a certain distant organization by reduction of the risks to cost cutting hence economical to the provider and the beneficiary. It also provides the provider-patient relationship even after retirements through the issuance of the medical cover. The efficiency of the plan has been proved to be reducing the governmental expenditures hence reduces the organization’s costs.

The Population Health Management Strategies another current trend which is is a body in which its main aim is to advance the health of each person in a clinical set up stated (Hibbard, Greene & Sacks 2017). They work to satisfy the requirements of the patient liable to their care, and provision of proactive support to the patients in a population-based centre. Some of the impacts of this trend to the organizations are the ability to control the large population of patients giving them required care depending on their health conditions. This is an important aspect when dealing with patients of different health needs.

The identified trends have got a variety of impacts that range from risks, safety, improvement of quality and management. The organization benefits much from ACO’s impact on medication quality improvement. The policies are majorly impacted by the Medical Advantage Plan, which also assures safety and reduces risks. The other trends such as telemedicine have also shed some light on the management issues of the organization.








Colborn, D. P. T. (2017). What Bundled Payment Structure Should Physical Therapists Support for Patients After Total Hip and Knee Arthroplasty?.

Hibbard, J. H., Greene, J., Sacks, R. M., Overton, V., & Parrotta, C. (2017). Improving population health management strategies: identifying patients who are more likely to be users of avoidable costly care and those more likely to develop a new chronic disease. Health services research52(4), 1297-1309.

Jacobson, G., Damico, A., Neuman, T., & Gold, M. (2015). Medicare Advantage 2015 spotlight: enrollment market update. Kaiser Family Foundation website. kff. org/medicare/issue-brief-medicare-advantage-2015-spotlight-enrollment-market-update. Published June30.

Kahn, E. N., La Marca, F., & Mazzola, C. A. (2016). Neurosurgery and telemedicine in the United States: Assessment of the risks and opportunities. World neurosurgery89, 133-138.

Kashef, S., & Nezamabadi-pour, H. (2015). An advanced ACO algorithm for feature subset selection. Neurocomputing147, 271-279.0

Protection, P., & Act, A. C. (2010). Patient protection and affordable care act. Public law111(148), 1.