The PPACA of 2010

The PPACA of 2010

Impact of Health Care Reform on Patients and Providers

The Patient Protection and Affordable Care Act (PPACA) of 2010 is a landmark reform that was targeted at enhancing access to care. This enactment expanded the Medicaid program to include more people, especially those with low income. This legislation also made healthcare more affordable by subsidizing healthcare costs through cost-sharing reductions and premium tax credits. Additionally, this reform provided rights and protections that have made health coverage to be fair and easily understandable. The Accountable Care Organizations (ACO) are a group of care providers and healthcare organization that comes together solely to provide quality care at the lowest possible cost. Patient-Centered Medical Homes (PCMHs) is a modern care provision model in which the patients are in a direct relationship with their preferred caregiver, who in turn provides coordinated care in concert with other care providers. ACOs and PCMHs are organizations formed under ACA to enhance the quality of care most cost-effectively. This paper seeks to discuss the impact of these organizations on the providers and the patients.

Since its establishment, the ACA has seen tremendous strides in healthcare provision. By expanding Medicaid eligibility, this legislation has enabled increased insurance coverage for many Americans and especially those with low income. The recent finding reveals that the number of uninsured Americans decreased significantly to historic lows of below 25 million. The consequential effect of these increased coverages has been seen in enhanced access to care for Americans that would have otherwise not gotten access to care. Growth in insurance coverages accustomed to the expansion of Medicaid eligibility has improved access to care and utility of specialty services. Through quality improvement programs defined under this legislation, several strategies have been undertaken to ensure quality care provision and enhance patient clinical outcomes.

Patient-Centered Medical Homes

Patient-Centered Medical Homes (PCMH) remain superior in care provision. Its utility in chronic care underpins its necessity. This care model engages the patients in their care provision process. In the model, the providers are in a direct relationship with their preferred provider. The provider, in turn, coordinates a multidisciplinary team who works collectively and collaboratively in comprehensive and integrated healthcare provision (Longworth, 2011). The provider also takes collective responsibility for the patients, and their healthcare outcomes, advocates for quality care provision, arrange appropriate care for their patients, and mobilize and coordinate community resources that are valuable in the care continuum and long-term care.

The practices defined in this care model are targeted at improving the efficiency, safety, and quality of care provision. In this regard, this model proposes the development of transdisciplinary care teams in care management and coordination. The PCMH has considerably impacted healthcare providers and patients. This model has been associated with better patient outcomes, lowered clinician output, improved quality of care, and reductions in healthcare utilization and cost. The PCMH model enhances patient satisfaction by taking into consideration patients’ health. This model also considers the patient’s preferences and tailors healthcare provision towards the patient desires. Subsequently, this optimizes care provision to the patients and engages them in their care provision process, thus enhancing care efficiency. The PCMH model also lowers healthcare utilization and the overall cost of healthcare (Sum et al., 2021). This model reduces the number of hospital readmissions and visits by ensuring optimal clinical outcomes. This reduces healthcare utilization, preserves the health of the patients, and overall reductions in the cost of healthcare.

Provider satisfaction is necessary for quality care provision. By aligning the hospital’s operations to the needs and desires of the patients, this model ensures that caregivers are satisfied with their work. This model also provides satisfaction by allowing caregivers to passionately take care of their patients as it focuses on patients’ specific needs. Care outcomes are enhanced through care coordination and multi-professional involvement in care provision. Additionally, the care process becomes seamless by defining roles, and health providers are not burdened by their tasks. This, in turn, reduces worker fatigue and ultimate burnout attributable to work burden. Work burden is also reduced when healthcare utilization accustomed to quality care provision is reduced. (Longworth, 2011). The overall effect is evident in enhanced quality of care provision and better clinical outcomes.

Accountable Care Organizations

Accountable Care Organizations (ACO) is another organization under PPACA that aims to enhance the quality of care provision for all Medicaid-registered healthcare facilities. The goal of this organization is to create a framework that links fund reimbursements to measures of quality that enable cost reductions and quality maintenance. The ACO achieves this by utilizing two cost-reduction models. The Medicaid Pioneer ACO and the Medicare Shared Savings Program enable ACO to generate savings if specific quality standards are met. This ensures that quality is enhanced as the cost reduces (Goroll & Schoenbaum, 2012). The ACO has significantly impacted healthcare providers, care organizations, and patients.

ACOs reduce the costs of healthcare without reducing the quality of care provision. Healthcare savings seen in ACO is attributable to reductions in outpatient expenses, especially in patients presenting with complex healthcare needs, and reduction in low-value services. (Goroll & Schoenbaum, 2012). ACO also ensures quality care provision by coordinating the care process in healthcare and by increasing the effective and meaningful use of healthcare technologies such as health information technology (Longworth, 2011). Overall effects of ACO are evident in quality care in the most cost-effective manner.

Challenges Facing Patients and Providers during ACOs and PCMHs Formation

Significant challenges affect ACO and PCMH during their formation. Specific challenges affecting ACO include the payment model, wrong-sized medical staff, incompatibility of technology platforms, and lack of physician leadership and management structure. While the prevailing model of payment rewards the volume of services, ACO champions reward the superiority of clinical outcomes. Shifting to the ACO-championed model sometimes presents a challenge to the healthcare system. Wrong-sized medical staff also presents a challenge to the ACOs. The challenge is keeping the required and necessary medical staff without compromising the quality of care delivery. Incompatibilities of technological platforms such as the electronic health record in healthcare provision also present a challenge. Incompatibility is often due to the differences in the health technologies used by the hospital and the ones used by individual physicians in their offices.

Similarly, several challenges also affect PCMH. These challenges include creating robust healthcare technology and its financial implications, achieving accreditation, and ensuring the educational and logistical challenges required for patient education. The financial implication of creating an effective healthcare technology such as electronic health records may sometimes present a challenge to the various healthcare organizations. Achieving accreditation from various accrediting bodies, such as the Joint Commission, may sometimes require dedication, teamwork, and resilience and may present a challenge to some healthcare organizations. Creating patient engagement is a key aspect of PCMH. However, getting patients to align with this provision remains a challenge. Patient educational programs may sometimes be required to ensure this. Logistical challenges may sometimes present for some healthcare organizations.

Opportunities Presented to Patients and Providers during ACOs and PCMHs Formation

Several opportunities may present during the formation of ACOs and PCMH. The opportunity to receive quality and effective health and spend less on healthcare are usually presented to the patients. ACOs and PCMH are patient-centered approaches that ensure quality care is provided to the patients at the least cost. The healthcare providers, they have the opportunity to provide passionate care that realizes better clinical outcomes. They also have the opportunity to collaborate with their fellow caregivers to attain safe and quality care. They also have a chance to learn further clinical skills necessary in care provision from their fellows during these clinical collaborations (Singer, 2011). The overall effect is evident in better patient and provider satisfaction.

In conclusion, PCMH and ACO remain crucial organizations under PPACA. Their roles in upholding the quality of care processes and healthcare cost reductions inform their utility. Since its establishment, the PPACA has been pivotal in reshaping the healthcare landscape of the country. This enactment expanded healthcare coverage to a great extent. These organizations it have brought positive changes to healthcare, with the benefits being realized for the patients and caregivers.

References

Goroll, A., & Schoenbaum, S. (2012). Payment Reform for Primary Care Within the Accountable Care Organization. JAMA, 308(6), 577. https://doi.org/10.1001/jama.2012.8696

Longworth, D. (2011). Accountable care organizations, the patient-centered medical home, and health care reform: What does it all mean?. Cleveland Clinic Journal Of Medicine, 78(9), 571-582. https://doi.org/10.3949/ccjm.78gr.11003

Singer, S. (2011). Implementing Accountable Care Organizations. JAMA, 306(7), 758. https://doi.org/10.1001/jama.2011.1180

Sum, G., Ho, S., Lim, Z., Chay, J., Ginting, M., Tsao, M., & Wong, C. (2021). Impact of a patient-centered medical home demonstration on quality of life and patient activation for older adults with complex needs in Singapore. BMC Geriatrics, 21(1). https://doi.org/10.1186/s12877-021-02371-y

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PPACA of 2010 brought many changes to the types of provider organizations available. ACOs and PCMHs are two new organizations formed under PPACA. Using the readings this week, discuss the origin, structure, and purpose of the new organizations formed under PPACA.

The PPACA of 2010

Using the South University Online Library (for example, CINAHL) or the Internet, search three articles from the list below and evaluate the challenges and opportunities facing payers and providers as ACOs and PCMHs are implemented:

Baird, M. A. (2011). The patient-centered medical home and managed care: Times have changed, but some components have not. The Journal of the American Board of Family Medicine, 24(6), 630–632. Retrieved from South University Library at: http://www.jabfm.org/content/24/6/630

Bolin, J. N., Gamm, L., Vest, J. R., Edwardson, N., & Miller, T. R. (2011). Patient-centered medical homes: Will health care reform provide new options for rural communities and providers? Family & Community Health, 34(2), 93–101.

Goldsmith, J. (2011). Accountable care organizations: The case for flexible partnerships between health plans and providers. Health Affairs, 30(1), 32-40. Retrieved from: https://search-proquest-com.southuniversity.libproxy.edmc.edu/docview/847269697?accountid=87314

Goroll, A. H., & Schoenbaum, S. C. (2012). Payment reform for primary care within the accountable care organization a critical issue for health system reform. JAMA: The Journal of the American Medical Association, 308(6), 577–578. Retrieved from: http://jamanetwork.com.southuniversity.libproxy.edmc.edu/journals/jama/fullarticle/1309182

Longworth, D. L. (2011). Accountable care organizations, the patient-centered medical home, and health care reform: What does it all mean? Cleveland Clinic Journal of Medicine, 78(9), 571–582. Retrieved from South University Library http://www.mdedge.com/ccjm

Singer, S., & Shortell, S. M. (2011). Implementing accountable care organizations: Ten potential mistakes and how to learn from them. JAMA: The Journal of the American Medical Association, 306(7), 758. Retrieved from South University Library http://jamanetwork.com.southuniversity.libproxy.edmc.edu/journals/jama/fullarticle/1104223

Based on your research, summarize your findings on the selected topics and compile your observations in a 5- to 6-page Microsoft Word document that includes an introduction and conclusion.

Support your responses with examples.

Cite any sources in APA format. Please review the rubric for further requirements for this assignment.