Oct 14, 2020
folder_opencategory: Medicine

Abstract

Health care is a major contributing factor towards the attainment of a stable economy of any country. A quality health care translates into a healthy nation and thus, more production and countrys growth. Through the years, the US health care system has witnessed numerous changes due to the sophistication of the global market caused by the advancement in technology. Medicare and Medicaid have been a significant boost to the country's health care system that has seen the numbers of Americans without the insurance cover reduced. Despite all this, the greatest dilemma that remains is to find that level in which the quality of the health care will be attained all over the country. There is a need to fill the gap of quality in the health care system to give the appropriate services and outcomes to the consumers who have contributed a greater part of their incomes to the health care through premiums. The researcher aims to discuss the emerging trends in the health care, the emerging model that can be convenient in ensuring quality in the health care as well as pointing out the traits of a high-performance organization while giving an example of a high-performance team.

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Nursing Management

Despite the fact that the United States spends more money on every individual citizen as compared to the rest of the world, the health care system in the country faces challenges that need urgent reforms to meet the current trends in the sector. Critical attention ought to be focused on almost 46 million Americans without the insurance cover, and the many insured citizens facing rapid out of pocket expenses and the premiums (Engelberg Center for Health Reform at the Brookings Institution & Avalere Health, LLC, 2009). As the Obama Administration seeks to reduce the number of people without the insurance cover, the efficiency and the quality of health care is of paramount importance. For the achievement of quality services, health system calls for new models that will meet the needs of the current situation. This essay seeks to discuss the emerging trends and an emerging model in the health care industry as well as point out an organization that has attained high performance.

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Current Emerging Trends in the Health Care

Shift in Employer-Based Commercial Insurance

Whether it is the role of the employer or general exchange, the companies would be required to have new ways of interaction with the employees in the matters of health insurance coverage (Rivard & Rebay, 2012). The workers will face deductions towards the payment of the premiums, and this would mean that a model that helps in the tracking of the payments would be necessary. With this development, the employees will know how much they contribute towards their health care and whether they receive the services they deserve.

Change of Transaction among the Commercial Payers

The commercial payers have to alter the manner, in which they transact their business. They will be compelled to be more cooperative in the changing world of health care and will pay less in the process (Rivard & Rebay, 2012). With the government currently being the primary sponsor of the health care through its affirmative programs of Medicare and Medicaid, the employers will benefit by mainstreaming their health care insurance regarding the already established government programs. Thus, the health care would be the work of collaboration of all the stakeholders.

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Increased Consumer Control of their Health Care Money

The increased deduction of the individuals will force them to be more active in monitoring whether the appropriate services are available to them. This development will mean that the consumers will be a critical part of the decision-making process; hence, they would be needed to include them in the formulation and the implementation of the legislations dedicated to health care (Rivard & Rebay, 2012). The service providers will have to get used to the increased demand from the consumers, as they will seek evidence-based performance in transparency and service delivery.

Financially Challenges on Providers

The improved health care sought after would mean that there would be better health and thus, a healthy nation. This achievement will lead to lower cost of health care in the long-run. It would mean that the model would cater for the financial needs of the providers so that they were motivated to carry out their mandate without constraints (Rivard & Rebay, 2012). This issue would call for more incentives from the government to supplement the scarce resources that would be experienced by the health care sector.

Bundled Payment Model

Among the numerous emerging payment models that are intended to improve the quality of health care, one can single out the Bundled Payment Model (AHA, 2016). The shift of the health care to the quality-based care has necessitated the redesign of the reimbursement models among the private and the public payers to stress the quality attention and cost accountability. This payment model is designed to bring various coordinating providers towards paying for an individual episode of service. It will enable value-based health care without putting the health providers at financial risk (Belliveau, 2016) unlike in the past, where the player would pay individual services offered to a patient. For example, if a patient undergoes surgery, he would have to pay the bills for the services of the hospital as well as anesthesiologist and surgeon separately. With the bundled payment, all these bills would be paid collectively, using a historical set cost.

One example of the successful Bundled Payment Model is Medicare Bundled Payment for Care Improvement (BPCI). In this model, providers have participated in four tracks. In the first track, the hospital receives payments for the inpatients, while the second and third ones have a base on a retrospective bundled payment program (Belliveau, 2016). The fourth, on the other hand, makes one payment to the hospital. The challenges that the model may experience include the activities that may be out of the providers control such as patients behavior that may worsen their condition or the medication adherence (Belliveau, 2016). There may also arise the challenge of determining the cost since, in most cases, it is not the provider who determines that cost but other factors that depend on the general market conditions of the supply and demand.

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Traits of a High-Performance Organization

For any health organization to be able to achieve a high performance, it needs to be in a position to harness all the available resources available. First, the value and quality of the care offered ought to be satisfactory (De Waal, 2007). This issue calls for the efficient and effective treatment of patients. Patient-based information and attention are crucial, and they will enable the organization to center its activities on the patients who are the target for the health industry. Integration of the modern information technology is essential since it helps in keeping pace with the emerging complexities of the health care (Gauthier, Davis, & Schoenbaum, 2006). The payment incentives should be aligned to reward performance, which would encourage the high standard service delivery to the customers. Lastly, there is a need to enhance the collaboration among all the stakeholders in the health care industry, as this will help in the sharing of a common vision of achieving high performance.

Conclusion

Conclusively, health care in the United States has seen the greater transformation in a variety of ways. These include a shift in employer-based commercial insurance, the change of transaction among the commercial payers, the increased consumer control of their health care money, financially challenges on providers, and the bundled payment model. The trend in the health care is an actual manifestation of the need for a better design that will meet the modern health needs while offering quality. In this case, the Bundled Payment Model is outstanding since it has cut across all the requirements that are necessary for the present and the future. For the high performance of an organization, excellent traits such as good leadership are important. My organization is a great performer because there is the connection of the vision, goals, and the aspirations of the organization in all its duties and actions. Secondly, measurement and performance are critical in its performance, so the company does not leave anything to chances.

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