You
are the associate vice president for education and training for
OtroRaza Health, the academic medical center and health system
associated with Enormous State School of Medicine (ESSM). The vice
president of medical affairs comes to you concerned about the viability
of the school’s residency programs. Several of ESSM’s residency site
stakeholders are seeking clarification regarding new reimbursement
models being used by the system. Prepare a white paper – for the VP of
Medical Affairs to share with the residency sites — outlining the
differences between the new reimbursement models and prior, traditional
models for stakeholders.
In your response, include the following:
- Description of each model, such as capitated payments,
fee-for-service, including new and emerging models being introduced to
the industry, such as value-based, MACRA, and others. - In your review, compare and contrast the traditional and new models
and explain the motivation / reasons for the emerging models. Finally,
based on this evidence, describe what impact (if any) you perceive there
would be on the cost, quality and access to patient care. Support your
research with peer-reviewed sources and/or market data. The use of
professional charts / graphs to reinforce written content is encouraged.
Ensure that your content and information is professional and can be
followed by an executive audience.
Several example white paper formats can be viewed at: https://venngage.com/templates/. A free downloadable sample white paper can be found at: https://www.microsoft.com/en-us/download/details.aspx?id=17731.
Note: your product does not need to be this robust, but should follow the same basic framework.
Expert Solution Preview
Introduction:
The reimbursement models for medical services have been an area of concern for medical practitioners and patients alike. With multiple models being introduced, it is important to understand them to provide proper medical care. This white paper aims to provide an overview of traditional and new reimbursement models in the healthcare industry.
Description of Reimbursement Models:
1. Capitated Payments: This model involves the payment of a fixed amount per patient per month to healthcare providers. This model provides incentives for healthcare providers to manage patients’ health proactively.
2. Fee-for-Service: This model involves payment to healthcare providers for each service rendered to a patient. This model incentivizes the provision of more services to increase revenue.
3. Value-based: This model involves payment to healthcare providers based on the value of care delivered to patients. This model encourages healthcare providers to provide quality care, ultimately reducing healthcare costs.
4. MACRA: This model involves the payment of incentives or penalties to healthcare providers based on the quality of care provided to patients.
Comparison between Traditional and New Models:
The traditional fee-for-service model incentivizes healthcare providers to provide more services, leading to increased costs and decreased quality of care. In contrast, new models like value-based and MACRA incentivize healthcare providers to provide quality care, ultimately decreasing healthcare costs and improving access to care.
Reasons for Emerging Models:
The traditional fee-for-service model has led to increased costs and decreased quality of care. The emerging models like value-based and MACRA aim to incentivize healthcare providers to provide quality care and reduce costs. The emerging models also focus on the transition from providing care only in hospitals to providing care in a more patient-centered approach, improving access to care.
Impact on Cost, Quality, and Access to Patient Care:
The new models like value-based and MACRA are expected to decrease healthcare costs and improve the quality of care. Improved quality of care leads to better health outcomes and reduced healthcare costs in the long run. However, these models might restrict access to care because they may create challenges for small medical practices.
Conclusion:
In conclusion, understanding the differences between traditional and emerging healthcare reimbursement models is crucial for healthcare providers to provide quality care and reduce healthcare costs. While the new models incentivize healthcare providers to provide quality care, they may also pose challenges for small medical practices. The focus should be on providing quality care to patients while maintaining access to medical services.
