The Interrelationships among Access, Quality, Cost, Accountability, and Community
In this LearnScape, the Board of Directors for the Bright Road Healthcare System is thinking of expanding services to include a home health agency in the community. The healthcare system is experiencing an increase in older patients and also has a problem with high readmission rates within 30 days of discharge for Medicare patients. The Board of Directors has charged the Chief Executive Officer (CEO) who is eliciting the support of a healthcare consultant, the student, to help determine whether or not to develop this service line. It is important to keep in mind that the Bright Road Healthcare System is a participating provider in an Accountable Care Organization (ACO).
This LearnScape introduces another form of outpatient services, home health. There has been a push within the healthcare industry towards community-based health services (CBHS), which involves delivering more health services in the community as opposed to having clients travel back and forth to acute or residential care facilities. The cost of caring for clients in their home is less expensive then providing similar services in the acute and residential care facilities. Technology and a growing willingness of payers to reimburse for home care are making the delivery of health services in the community more feasible. There are an increasing number of providers willing to make good old fashion “house calls”, which is a common practice in other developed countries. In addition, many clients tend to respond better to treatments, demonstrate greater compliance with treatment plans, and make a speedier recovery when doing so in the familiar surroundings; however, the coordination of such services needs to be carefully managed. In recent years, there has been a growing emphasis placed on the need to increase coordination of care while improving quality and lowering costs while not placing undue restrictions on clients. These objectives are coupled with the passage of the Patient Protection and Affordable Care Act which led to the creation of Accountable Care Organizations (ACO). These are organizations that are formed through partnerships with providers (primary care and specialists) and provider organizations that function under a number of risk-sharing arrangements. Home care services are also available through participating integrated delivery systems.
UNIT LEARNING OUTCOMES
ULO #1: Examine the provisions of the Affordable Care Act (ACA) that apply to Accountable Care Organizations (ACOs) in order to strengthen care coordination, meet the needs of a larger number of insured citizens, improve healthcare service quality, and lower costs. (CLO 2, 3, 4, 5, and 7)
ULO #2: Evaluate external trends, integration strategies, and antitrust concerns when considering expansion opportunities. (CLO 4 and 7)
ULO #5: Analyze the impact of technological innovation on the access, quality, and cost of medical care. (CLO 3, 4, 5, 6, and 7)
(Initial Posting). Students are to complete the LearnScape for Health Care Delivery: Episode 4: Expansion (Scenario).
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Based on the information provided in the scenario and on an outside review of the relevant literature, students are to prepare a formal recommendation to the CEO on whether or not it makes sense to move forward with the home health service line given that they are a part of an Accountable Care Organization. In putting the recommendation together, the students should consider emerging healthcare trends, crucial role of care coordination, chronic disease management, competitors, risks, and financial incentives, sharing of cost savings in the ACO model, and whether a vertical or horizontal integration makes sense for the system. Finally, take into consideration any potential antitrust concerns, if applicable. The recommendation needs to be well supported, logically presented, and thoroughly vetted.
Online Students: The initial response is . (CT). Respond to a minimum of two peers’ initial postings. The peer responses are(CT).
Blended Students: The initial response is to be posted to the unit discussion thread at least five (5) hours PRIOR to the scheduled class session. Respond to a minimum of two peers’ initial postings. The peer responses are .