Discussion week 2
During its adoption, the Affordable Care Act (ACA) was a watershed moment in as far as undertaking effective healthcare reforms across the US is concerned. Nevertheless, as with many public policies; ACA has not been spared opposition especially from the Republicans especially on how to reduce the ever-rising healthcare costs and healthcare spending (Gusmano, 2017). The primary point of debate has been health coverage and more importantly-the Medicare program which is the biggest source of healthcare finance (Rudowitz, 2019). Various views have been raised on how best to re-design different aspects of the healthcare system including Medicare. For instance, according to KFF (2019) several proposals have been made on how Medicare should be designed. Some bills support the idea of Medicare-for-all which in some way resembles a universal health coverage program. Some proposals, on the other hand, feel that Medicare should be for all but at the same time, allow some options for those willing to pursue private health coverage. In another proposal, the conversation is around giving states the power to elect whether to modify Medicare in the best way that suits them under the ACA market place. It is apparent that each of these proposals is intended to minimize health spending and at the same increase access as well as enhance the quality of care provided. These arguments or mindsets have essentially originated from the political class but other players within the larger healthcare industry have different views. Adopting a Medicare-for-all program or universal coverage can significantly kill the private health insurance sector and at the same time- promote government monopoly which somehow beats the logic behind having a liberal healthcare market. In this regard, some players have considered other non-political options intended to reduce healthcare spending without necessarily forgetting the aspect of quality. As can be extrapolated from the ongoing debate, it is no doubt that the political class has been canvassing around the issue of cost which is not the only pillar of the US healthcare system. For instance, Rand Health Care (2019) provides various small ideas that at the end of the day can help ease the current healthcare cost burden and improve quality. This is essentially through modifying various care processes in a view to eliminating unnecessary spending. Among the ideas provided by Rand Health Care (2019) include the use of low-cost antibiotics, reducing the occurrence of hospital-acquired infections, eliminate co-payments and shift some emergency care services to retail healthcare facilities and clinics. These ideas largely support the re-configuration of care processes so as to do away with unnecessary spending. This is an idea that has been shared by Mitre Corporation (2017), whereby they feel that the problem is not with the health coverage model but the primary infrastructure of how care is provided at the grassroots level. According to the Mitre Corporation (2017), reforms should focus on providing incentives for quality and adopting a value-based model whereby reimbursement in pegged on quality. In turn, this will motivate healthcare providers to pursue the best evidence and best practices to ensure high-quality levels. This being the case, a sizeable amount of healthcare costs that go preventable medication errors can be eliminated. McConnell, Charlesworth, Meath, George & Kim (2018) also share the same idea in as far as reducing healthcare spending in the US is concerned. According to McConnell et al. (2018), the solution to the current healthcare spending in the US can be cured by the adoption of the ACO model whereby healthcare organizations are reimbursed based on their cost-savings, quality and essentially-the value of care provided. Different models have been proposed and some of them are currently in operation. However, according to Faster Cures et al. (2018) each of these models comes with unique drawbacks and the best approach is to allow some room for Alternative Payment Models (APMs). The adoption of APMs by Medicare can go a long way towards ensuring that patients get the right value and quality through cost-friendly approaches. For instance, Managed Care Organizations (MCO) provides a cost-reducing model since patients are grouped on the basis of their healthcare needs and contribute towards a common insurance pool. This enhances the use of patient-centered care approaches and brings on board the economies of scale. As Marshall (2018) underscores, the problem is not that the current Medicare program is ineffective but the biggest proportion of healthcare spending is essentially caused by minor and yet preventable issues in the care process. These include the occurrence of medication errors, pursuing unwarranted medical procedures and lack of a quality-oriented care model within public and private healthcare organizations (Meidani, Farzandipour, Farrokhian & Haghighat, 2016). A lot of money goes to unnecessary lab tests and surgical procedures and arguably as Marshall (2018) Marshall asserts- the solution to the US healthcare system is tethered on the existence of practical models intended to promote quality and efficiency. Having reviewed the opposing views about Medicare and ACA, it is apparent that those opposed to the current Medicare program miss the whole point. Of course, with Medicare and Medicaid (CMS) being the biggest healthcare financier-it is expected that it will be on the receiving end on many criticisms as people and especially politicians; debate around the issue of reducing healthcare spending. However, this is entirely not the issue since the biggest cause of increased healthcare spending is centered on the core minor issues which can be easily written off. The problem is entirely on the actual process of care since in its current state provides various pathways for unnecessary spending. Therefore, the ultimate solution to this debate is to re-design the care process by allowing APMs to thrive and at the same time- investing heavily towards quality and safety (Porter & Lee, 2016). This is through the integration of technology, the use of the evidence-based practice, investing in the healthcare workforce to enhance advanced practice skills as well as promoting a culture of value through incentives for quality. Such approaches will address the problem from its roots by the virtue of motivating healthcare providers to use evidence and strive to enhance quality improvements and cut unnecessary costs. References Faster Cures et al, (2018). A Closer Look at Alternative Payments Retrieved from https://www.fastercures.org/assets/Uploads/PDF/VC-Brief-AlternativePaymentModels.pdf Gusmano, M. K. (2017). Obamacare Wars: Federalism, State Politics, and the Affordable Care Act. Political Science Quarterly, 132(3), 551-554. KFF. (2019). Comparison of Medicare-for-all and Public Plan Proposals Retrieved from https://www.kff.org/interactive/compare-medicare-for-all-public-plan-proposals/ Marshall, A., (2018). Unnecessary Medical Care: More Common Than You Might Imagine Retrieved from https://www.npr.org/sections/health-shots/2018/02/01/582216198/unnecessary-medical-care-more-common-than-you-might-imagine McConnell, J., Charlesworth, C., Meath, T., George, R., and Kim, H., (2018). Overview of Research on ACO Performance Retrieved from https://www.naacos.com/overview-of-research-on-aco-performance Meidani, Z., Farzandipour, M., Farrokhian, A., & Haghighat, M. (2016). A review on laboratory tests’ utilization: A trigger for cutting costs and quality improvement in health care settings. Medical journal of the Islamic Republic of Iran, 30, 365. Mitre Corporation, (2017). Alternative Payment Model Framework Retrieved from http://hcp-lan.org/workproducts/apm-refresh-whitepaper-final.pdf Porter, M. E., & Lee, T. H. (2016). From volume to value in health care: the work begins. Jama, 316(10), 1047-1048. Rand Health Care (2019). Small Ideas for Saving Big Health Care Dollars Retrieved from https://www.rand.org/health-care/projects/small-ideas.html Rudowitz, P. (2019). Medicaid Financing: The Basics Retrieved from http://files.kff.org/attachment/Issue-Brief-Medicaid-Financing-The-Basics