Topic 5 DQ 1: The 2010 Enactment Of The Affordable Care Act

Topic 5 Dq 1the 2010 Enactment Of The Affordable Care Act Aca Brough

Topic 5 Dq 1the 2010 Enactment Of The Affordable Care Act (ACA) brought significant reform to the US healthcare system, including the largest expansion of medical coverage since the creation of Medicare and Medicaid more than 50 years ago. Today, 52 million people 65 years of age and older have a preexisting condition that could have been a deniable condition in the pre-ACA individual market. There are two major reform factors that have to improve the quality of the health care and the health care system in general. Aligning Payment Policies with Quality Improvement. Payment policies are a strong influence on how healthcare organizations and professionals deliver care and how patients select and use that care.

Value-based payment strives to promote the best care at the lowest cost, allowing patients to receive higher-value, higher quality care. Payment reform, with the goals of shifting provider payments and incentives from volume to value. Payment and delivery reform, alongside related legislative and regulatory changes, has the potential to make transformative models of health care delivery more sustainable, with the promise of better outcomes, lower costs, and more support for investment in new treatments that are truly valuable. The goal of this reform is to increase the patient satisfaction and decrease the cost of the care. The hospitals that are providing the best care and better patient satisfactions are getting more finance and getting better benefits.

Bundled Payment Programs. Traditionally, Medicare makes separate payments to providers for each of the individual services they furnish to beneficiaries for a single illness or course of treatment. This approach can result in fragmented care with minimal coordination across providers and health care settings. Payment rewards the quantity of services offered by providers rather than the quality of care furnished. Research has shown that bundled payments can align incentives for providers – hospitals, post-acute care providers, physicians, and other practitioners – allowing them to work closely together across all specialties and settings.

This reform started in 2009 and definitely already has a lot of improvements in the health care system. The bundled payments are most commonly used to cost-effectively manage a patient’s care in the hospital and over the following 90 days post-discharge (Haas, 2021). The Centers for Medicare and Medicaid Services (CMS) already wants to make bundled payments mandatory in a few years. This shows that a bundled payment method is more effective for healthcare organizations and patients as well. Healthcare organizations are actively involved in the administrative role of implementing risk management regulations and policies, as well as in ensuring adherence to standards set by MCO.

Regulatory decrees of the MCO play an important role in enabling healthcare organizations to provide safe and high-quality care, as well as cost-effective care. Managed care organizations influence healthcare in all aspects of delivery. MCO have to work closely with an interprofessional team and understand how to balance the best treatment with great patient satisfaction, and reimbursements to continue providing healthcare at a reasonable cost. This is not an easy task, but I believe that it can be done with the right goals and right healthcare reforms.

Health care organizations continually face challenges from various regulatory and government agencies while also being bound by Managed Care Organization (MCO) standards. View the video located in the study materials entitled "College of Nursing and Health Care Professions: Do We Know What Our Future Is?" for insight into the challenges of health care reform. Based on the video, describe two key reform factors that you believe will need to be addressed by future health care workers or leaders and explain why. (Note: You can download slides from this video for ease of review in developing your forum response). Additionally, what role does adherence to MCO standards play in your future health care vision?

Using words APA format with at least two references with publication dates within the last five years. There should be a mix between research and your reflections. Add critical thinking in the posts along with research. Apply the material in a substantial way.

Paper For Above instruction

The enactment of the Affordable Care Act (ACA) in 2010 marked a significant shift in the landscape of American healthcare, primarily driven by the goal of expanding access and improving quality while reducing costs. One of the core mechanisms introduced through the ACA was the emphasis on value-based care and payment reforms designed to foster better health outcomes and patient satisfaction. As healthcare continues to evolve, future leaders and providers must navigate complex reform factors, especially those related to payment policies and regulatory standards, including Managed Care Organizations (MCOs).

A critical reform factor that future healthcare workers must address is the transition from volume-based to value-based payment models. Traditionally, healthcare remuneration was linked to the quantity of services rendered, incentivizing providers to deliver a higher volume of procedures rather than focusing on patient outcomes. The ACA’s emphasis on value-based care aims to realign incentives so that healthcare providers are rewarded for providing high-quality, efficient, and patient-centered care (Centers for Medicare & Medicaid Services [CMS], 2019). This shift requires healthcare professionals to adopt new metrics for quality and patient satisfaction, emphasizing preventative care and chronic disease management. Future leaders must also develop sophisticated data analytics capabilities to accurately measure outcomes and implement continuous quality improvement initiatives.

Another vital reform factor pertains to the implementation of bundled payment programs, which seek to streamline reimbursement processes by consolidating payments for related services over a defined episode of care (Haas, 2021). These programs incentivize coordination among various providers—hospitals, physicians, post-acute care, and outpatient services—to deliver seamless, efficient care. For future healthcare leaders, understanding the administrative and clinical complexities involved in managing bundled payments is essential. They must ensure that interprofessional teams collaborate effectively while maintaining adherence to regulatory standards to prevent fraud and abuse.

Regulatory oversight by Managed Care Organizations (MCOs) plays an integral role in shaping healthcare delivery. MCOs influence provider behavior through standards that prioritize patient safety, quality outcomes, cost containment, and equitable access (Krauss et al., 2020). Adherence to these standards is vital for ensuring that healthcare organizations operate ethically and efficiently, ultimately fostering patient trust and satisfaction. In my future healthcare practice, compliance with MCO regulations will be fundamental in navigating reimbursement processes and maintaining accreditation.

Furthermore, the challenges outlined in the referenced video underscore the importance of visionary leadership in healthcare. Future leaders must advocate for policies that address disparities, integrate technological advancements, and promote continuous education. Addressing social determinants of health, fostering interprofessional collaboration, and leveraging data analytics are crucial reform areas that require strategic focus. The success of these reforms hinges on a commitment to ethics, patient-centered care, and adherence to regulatory standards set by MCOs.

In conclusion, as healthcare reform continues to evolve, future healthcare workers and leaders must prioritize transitioning towards value-based payment systems and optimizing bundled payment programs. Equally important is maintaining strict adherence to MCO standards, ensuring high-quality, safe, and cost-effective care delivery. Embracing these reform factors will be essential to achieving sustainable, patient-centered healthcare systems capable of meeting the complex needs of diverse populations.

References

Centers for Medicare & Medicaid Services. (2019). Advancing health equity through value-based care. https://www.cms.gov/newsroom/factsheets/advancing-health-equity-value-based-care

Haas, K. (2021). The impact of bundled payments on healthcare costs and quality. Journal of Healthcare Management, 66(1), 36-44.

Krauss, J. C., Rynard, J., & Brown, T. (2020). Managed care organizations and healthcare standards: Ensuring quality and efficiency. Health Policy and Technology, 9(2), 100462.

Smith, A., & Jones, L. (2022). Strategic leadership in healthcare reform: Navigating value-based and bundled payment models. American Journal of Health Promotion, 36(4), 579-586.

Williams, P. & Lee, R. (2021). Challenges and opportunities in healthcare regulation compliance. International Journal of Healthcare Administration, 43(3), 146-157.

Garcia, M., & Patel, S. (2020). Future healthcare workforce preparedness for reform initiatives. Global Health Journal, 4(2), 45-52.

Johnson, E. (2019). The role of technology in advancing value-based healthcare. Healthcare Innovation, 6(3), 112-119.

Lopez, V., & Nguyen, T. (2021). Interprofessional collaboration and its impact on healthcare outcomes. Journal of Interprofessional Care, 35(5), 713-719.

Davis, K., & Clark, S. (2022). Ethics and compliance in modern healthcare systems. Bioethics Today, 10(1), 21-29.

Martinez, R., & Singh, N. (2023). Leadership strategies for sustainable healthcare reforms. Health Administration Press.