Healthcare Finance

Healthcare Finance

Healthcare finance is a broad topic that covers various costs incurred in healthcare delivery, cost management strategies, and the relationship between healthcare quality and cost. This report covers the concepts of healthcare quality and cost by discussing managerial practices and strategies used to connect value to quality, the elements included in the COST framework and how they are used to provide high-value care to patients, how the COST framework is used to enhance organizational performance, the three phases involved in “Caring Wisely,” some of the cost-saving strategies used by payers, providers, and patients and how the cost-saving strategies enhance the quality of care, some of the barriers to providing valued health services and how they are overcome. Our assignment writing help is at affordable prices to students of all academic levels and academic disciplines.

Introduction

The cost of healthcare is one of the main determinants of access to healthcare. Most people are unable to access healthcare because they cannot afford to meet important costs such as purchasing medicine and paying healthcare providers. Therefore, it is important to understand various cost-reducing strategies that patients can use to enhance their access to quality healthcare services. Healthcare providers also need to reduce their operational costs to avoid charging high costs to meet operational costs. The implementation of cost reduction strategies also applies to payers who also apply cost education strategies to reduce operational costs.

Examples of managerial practices and strategies used to connect value to quality

The main managerial practices and strategies used to connect value to quality are continuous improvement, customer focus, and process approach. Continuous improvement is an ongoing process that focuses on improving processes, services, and products. It streamlines the flow of work, saving money and time and ensuring that products, services, and processes are continuously enhanced to meet clients’ needs. Customer focus prioritizes customers’ needs. Managers mainly use the customer-focus strategy to improve the quality of products, services, and processes while maintaining effective communication with customers to understand their current and future needs (Baxendale & Laws-Chapman, 2018). The process approach includes activities that use resources such as machines and people to convert inputs to outputs. The main emphasis is on following the right processes and using the right input to get the best output.

Elements included in the COST framework?

One of the elements in the COST framework is valuing resource stewardship and cost-consciousness as the practiced standards of medical professionalism at the team and individual levels. The second element is requiring accountability for decision-making that focuses on reducing costs at both organizational and peer levels. The third element is creating supportive systems to make cost-conscious decisions using decision-support tools, institutional policy, and evidence-based clinical guidelines. The fourth element is providing the tools, skills, and knowledge needed by clinicians to make cost-conscious decisions in their clinical settings.

Role of COST framework elements in providing high-value care to patients

Valuing resource stewardship and cost-consciousness as the practiced standards of medical professionalism at the team and individual level creates broad access to healthcare by increasing affordability (Institute of Medicine, 2010). Accountability contributes to high-value care for patients by ensuring that health workers observe professionalism. A supportive system, on the other hand, provides high-value care to patients by enabling healthcare providers to create a clear, shared vision with patients while providing the tools, knowledge, and skills needed by clinicians to make cost-conscious decisions in their clinical settings facilitate the development of payment models that reward the improvement of quality over volume.

Role of COST framework in enhancing organizational performance

The COST framework is used to enhance organizational performance by ensuring that a patient’s needs are accommodated through an ideal high-value care system, including the professionalism and leadership of healthcare workers, a collaboration between healthcare providers and patients, broad access to healthcare and payment models aimed at rewarding the improvement of healthcare quality.

Three phases involved in “Caring Wisely”?

One of the phases involved in “Caring Wisely” is the ideas contest. This phase includes an open call to all staff, faculty, and trainees to crowdsource the best ideas to identify waste areas. The second phase is the request for proposal, which includes proposing the idea that should be considered. The third phase is project implementation, which includes regular meetings to develop an implementation strategy for the proposed project. The first test to determine whether the proposed strategy is effective or not should occur within 3 to 6 months.

Examples of the cost-saving strategies used by payers, providers, and patients

One of the cost-saving strategies payers use is limiting the number and type of visits eligible for reimbursement (Goldberg & Fleming, 2010). In most cases, payers do not cover physical therapy and mental health. The second strategy is decreasing the amount that they pay for specific procedures. The third strategy is co-payments and deductibles that include sharing the cost of medical care with the patient, particularly for repeated medical procedures such as chemotherapy (Pritchard et al., 2014). One of the cost-saving strategies used by providers is optimizing scheduling and staffing. This strategy includes reducing the staff in the hospital by outsourcing specialists to reduce overhead costs. Another strategy that most providers use is telehealth to remotely monitor the health of their patients and reduce unnecessary doctor visits and readmissions (Zhao et al., 2014). One of the strategies used by patients to reduce costs is using benefits such as discounted and free healthcare services such as eye checkups and dental care. The second strategy is using an in-network healthcare provider because they charge less due to their contract with individual health plans.

Role of cost-saving Strategies in Enhancing the Quality of Care

Cost-saving strategies enhance the quality of care by enabling patients to access quality healthcare at a reduced price (Yanushevsky, 2020). Patients can also pay for healthcare services on time, allowing providers to continue running the healthcare facilities and improve the quality of service they offer. Cost-saving strategies also enhance the quality of care by improving collaboration between healthcare providers and patients, particularly in making payments for healthcare services through individual health insurance plans.

Examples of barriers to providing valued health services

Common barriers to providing valued health services are lack of resources, shifting regulations and policies, technology interoperability, and difficulty collecting and reporting patient information (Shah et al., 2015). Lack of resources includes insufficient healthcare software and insufficient funds to purchase equipment, medicine, and pay staff. Technology interoperability includes difficulty in adopting electronic health record systems to manage healthcare data effectively. Changes in policies and regulations have shifted from a free-of-service strategy as healthcare providers struggle to navigate the changes in value-based incentive programs (Shah et al., 2015). Difficulty in collecting and reporting patient information affects the transition to a value-based care strategy because this type of care requires the coordination of healthcare providers and easy access to patient information.

Strategies to overcome these barriers

Technology interoperability can be overcome by training patients and healthcare providers to use electronic health records to monitor health records effectively. Lack of resources is overcome by outsourcing resources such as medical equipment and seeking government grants to meet operational costs. The difficulty of collecting and reporting patient records is overcome by collaborating with patients to facilitate the sharing of information required to structure healthcare plans. Shifting policies and regulations is overcome by continuous research and development to learn about new policies and the best strategies to adjust.

Conclusion

Understanding healthcare finance is important for patients, payers, and healthcare providers because it equips them with knowledge of effective cost-reduction strategies. Healthcare providers also need to understand the barriers that could hinder delivering quality care and strategies to overcome them.

References

Baxendale, B., & Laws-Chapman, C. (2018). Highlighting quality: Strategies, standards, and practices. Editorial. Highlighting quality: strategies, standards and practices. https://doi.org/10.1136/bmjstel-2018-aspihconf.editorial

Goldberg, A. J., & Fleming, W. P. (2010). Cost-containment and cost-management strategies. Journal of Healthcare Management, 55(5), 308-311. https://doi.org/10.1097/00115514-201009000-00004

Institute of Medicine. (2010). Value in health care: Accounting for cost, quality, safety, outcomes, and innovation: Workshop summary. National Academies Press.

Pritchard, D., Petrilla, A., Hallinan, S., Taylor Jr, D., Schabert, V., & Dubois, R. (2014). Health care spending patterns in high-resource patients. Value in Health, 17(3), A148. https://doi.org/10.1016/j.jval.2014.03.859

Shah, N., Arora, V., & Moriates, C. (2015). Understanding value-based healthcare. McGraw-Hill Education / Medical.

Yanushevsky, R. (2020). How to decrease the cost of healthcare? Journal of Medicine and HealthCare, 1-5. https://doi.org/10.47363/jmhc/2021(3)165

Zhao, Z., Zhu, Y., Fang, Y., & McCollam, P. (2014). Health care costs and resource utilization in elderly patients with high-risk vascular disease. Value in Health, 17(3), A111. https://doi.org/10.1016/j.jval.2014.03.647

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Assignment Details

Effective managerial strategies are the key to connecting value to quality, cost savings, and overcoming barriers to valued health services.
Write a three-page analysis that includes the following:
What are some of the managerial practices and strategies used to connect value to quality?

Healthcare Finance

What are the elements included in the COST framework?
How are they used to provide high-value care to patients?
How is the COST framework used to enhance organizational performance?
What are the three phases involved in “Caring Wisely”?
What are some of the cost-saving strategies used by payers, providers, and patients?
How do these cost-saving strategies enhance the quality of care?
What are some of the barriers to providing valued health services?
How are these barriers overcome?

You are required to cite at least 5 references in APA format.

Submitting your assignment in APA format means, at a minimum, you will need the following:

Title page: The title should be in all capitals.
Length: 3 pages minimum (Make sure to include an introduction and a conclusion)
Abstract: This is a summary of your paper, not an introduction. Begin writing in the third person.
Body: This begins on the page following the title page and abstract page and must be double-spaced (be careful not to triple- or quadruple-space between paragraphs). The typeface should be 12-pt. Times Roman or 12-pt. Courier in regular black type. Do not use color, bold type, or italics except as required for APA-level headings and references. The deliverable length of the body of your paper for this assignment is 3 pages. In-body academic citations to support your decisions and analysis are required. A variety of academic sources is encouraged.
Reference page: References that align with your in-body academic sources are listed on the final page of your paper. The references must be in APA format using appropriate spacing, hanging indent, italics, and uppercase and lowercase usage as appropriate for the type of resource used. Remember, the Reference page is not a bibliography but a further listing of the abbreviated in-body citations used in the paper. Every referenced item must have a corresponding in-body citation.