The Purpose Of This Assignment Is To Evaluate The Framework ✓ Solved

The Purpose Of This Assignment Is To Evaluate The Framework And Variou

The purpose of this assignment is to evaluate the framework and various dimensions of access to care, including delivery, and quality among the health care models. Choose two models from the Topic 3 assignment that you feel are most effective in providing quality care. In a 1,250-1,500 word paper, answer the following questions: How is quality monitored? What are the qualifications for each of the plans? How do these plans reimburse health care providers? How much are prevention and wellness emphasized? What are the primary drivers of health care financing? Explain what component you feel requires the most reform in order to finance a health care system that covers all, or most, people. Justify your rationale. Support your writing with three to five scholarly peer-reviewed resources.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required. This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

Sample Paper For Above instruction

Introduction

In the complex landscape of healthcare, various models have been developed to improve access, quality, and cost-effectiveness. Among these, the Patient-Centered Medical Home (PCMH) and the Accountable Care Organization (ACO) are recognized as innovative frameworks that emphasize quality outcomes. This paper critically evaluates these two healthcare models, focusing on their quality monitoring mechanisms, provider qualifications, reimbursement strategies, emphasis on prevention and wellness, and their roles in healthcare financing. Additionally, it discusses which component necessitates the most reform for a more inclusive and sustainable healthcare system.

Overview of the Healthcare Models

The Patient-Centered Medical Home (PCMH) is a care delivery model that emphasizes comprehensive, patient-centered, coordinated, accessible, and quality-driven care (Nason et al., 2020). It aims to improve health outcomes through primary care transformation. In contrast, the Accountable Care Organization (ACO) is a group of healthcare providers (hospitals, physicians, and other clinicians) that voluntarily collaborate to deliver coordinated high-quality care to Medicare patients (McWilliams et al., 2016). Both models aim to enhance healthcare quality, but they differ in structure and focus.

Quality Monitoring

Quality in the PCMH model is monitored through a set of National Committee for Quality Assurance (NCQA) standards, which include patient access, care management, and patient engagement metrics (Nason et al., 2020). Regular audits, patient satisfaction surveys, and health outcome measures ensure compliance and continuous improvement. The ACO employs a different approach, utilizing performance metrics aligned with the Medicare Shared Savings Program (MSSP). These include preventive care measures, management of chronic diseases, and hospital readmission rates (McWilliams et al., 2016). Both models emphasize transparent reporting and accountability to ensure high-quality care delivery.

Provider Qualifications

In the PCMH model, healthcare providers are usually primary care physicians, nurse practitioners, and physician assistants committed to patient-centered, team-based care (Nason et al., 2020). Certification through NCQA distinguishes approved PCMH practices. For ACOs, participating providers are typically multispecialty physician groups, hospitals, and community health organizations that meet specific criteria for care coordination and quality standards (McWilliams et al., 2016). Both models require ongoing professional development and adherence to evidence-based practices.

Reimbursement Strategies

The PCMH model primarily employs value-based reimbursement, rewarding practices for achieving quality metrics and improved health outcomes rather than volume of services (Nason et al., 2020). It often involves care management fees and performance bonuses. ACOs operate under shared savings programs, where providers share in the cost savings generated through efficient care while maintaining quality (McWilliams et al., 2016). These reimbursement strategies incentivize high-quality, cost-effective care, shifting away from traditional fee-for-service models.

Prevention and Wellness

Both models place a significant emphasis on preventive care and wellness promotion. The PCMH incorporates comprehensive care plans focused on screening, immunizations, and lifestyle counseling (Nason et al., 2020). Similarly, ACOs prioritize preventive services and chronic disease management to reduce hospitalizations and emergency visits (McWilliams et al., 2016). Overall, these frameworks aim to proactively address health issues before they escalate, thus improving population health outcomes.

Drivers of Healthcare Financing

The primary drivers of healthcare financing in these models include patient populations’ needs, policy incentives, and reimbursement structures. Fee-for-service payments historically promoted volume over value; however, shifts toward capitation, shared savings, and bundled payments are redefining incentives. Administrative costs, technological investments, and provider supply also influence healthcare financing (Cleary & McNeil, 2019). Effective financing strategies must balance cost containment with quality enhancement.

Component Requiring the Most Reform

The most critical component requiring reform is the reimbursement system itself. The predominant fee-for-service model incentivizes volume over value, leading to unnecessary procedures and inflated costs (Verhoef et al., 2020). Transitioning toward a comprehensive, value-based payment system that rewards high-quality, efficient care is essential to covering more individuals affordably. Implementing global budgets and strengthening primary care payments can promote system sustainability and health equity (Reid et al., 2021).

Conclusion

In summary, the PCMH and ACO models represent innovative strategies to improve healthcare quality and access. Their emphasis on quality monitoring, provider qualifications, and reimbursement reform demonstrates promising pathways toward sustainable healthcare systems. However, reforming payment structures remains most vital to ensuring comprehensive coverage and high-value care for all populations.

References

• Cleary, P., & McNeil, B. (2019). Impact of value-based care on healthcare costs and quality. Journal of Healthcare Management, 64(2), 85–97.
• McWilliams, J. M., et al. (2016). Effect of accountable care organizations on cost and quality: A systematic review. Annals of Internal Medicine, 165(9), 620–629.
• Nason, E., et al. (2020). Transforming primary care: The patient-centered medical home model. Journal of General Internal Medicine, 35(12), 3710–3716.
• Reid, R. J., et al. (2021). Primary care: A critical review of the evidence on improving care. American Journal of Preventive Medicine, 60(4), 469–477.
• Verhoef, P., et al. (2020). Incentivizing value: Transitioning from volume to value in healthcare. Health Affairs, 39(4), 645–652.