Presentation of the United States Healthcare System

Presentation of the United States Healthcare System ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Presentation of the United States Healthcare System The U.S. Health Care Presentation: Part 1 Assignment Must be 15 to 20 slides in length (not including title and references slides) and formatted to APA. Presentation of the United States Healthcare System Must include a separate title slide with the following: Title of presentation Student’s name Course name and number Instructor’s name Date submitted Introduction: Create an overview slide that describes the required components to be covered within the presentation. Add bullet points for each of the topics being covered. Briefly describe each bullet point in the speaker’s notes. Content: The remaining slides will address the content of the presentation and the references. The content will address the following required components: Choose one revolutionary factor from each of the centuries (17th, 18th, 19th, 20th, and 21st) found in your textbook and time line. Describe each revolutionary factor. Discuss how the revolutionary factors changed the health care system. o Refer to the time line simulation Global Perspectives: Shifts in Science and Medicine That Changed Healthcare (Links to an external site.)Links to an external site. reviewed in Week 1. Chapter 2 in your textbook discusses the evolution of our health care system and is a good resource for this part of the presentation as well. Identify at least one major development from each of the following perspectives: financial, legal, ethical, regulatory, and social (e.g., consumer demand). Discuss how each development transformed the system into what it is For more perspective, you may want to review the time line simulation Global Perspectives: Shifts in Science and Medicine That Changed Healthcare (Links to an external site.)Links to an external site.. Choose three different stakeholders that have affected the health care system (e.g., health care professionals [physicians, nurses, etc.], clients [patients], health insurance plans [Blue Cross Blue Shield, managed care organizations (MCOs), etc.], federal or state governments, health care professional organizations [American Medical Association (AMA), American Nurses Association (ANA), etc.] and health care accreditation agencies [Centers for Medicare and Medicaid Services (CMS), The Joint Commission, National Committee for Quality Assurance (NCQA), etc.]). o Evaluate each stakeholder’s effect on the health care system by discussing their purpose and impact. Presentation of the United States Healthcare System o Include examples of both positive and negative impacts made by your chosen stakeholders (e.g., a negative contribution is when a patient uses the emergency room for non-urgent care). Part 2: The Cost of the U.S. Health Care System Describe three different reimbursement methods (e.g., capitation, fee-for-service [FFS], pay-for-performance [P4P], value-based, episode of care, prospective reimbursement, diagnosis related group [DRG], patient-centered medical home [PCMH]). o Explain why you think one of the reimbursement methods you discussed is more effective at reducing health care costs overall while still ensuring the delivery of quality care. Describe the use of two technological advancements (e.g., electronic medical record [EMRs], electronic health records [EHRs], medical research, improved equipment like magnetic resonance imaging [MRI], mammography, personalized medicine, mobile services like e-prescribing, disease registries, ). o Explain why you think these advancements have reduced costs overall while still ensuring the delivery of quality care. Part 3: The United States Versus Other Health Care Systems: An International Perspective Contrast the S. health care system with another country (e.g., Canada’s universal health care or South Africa compared with the U.S. health care system, etc.). You can use the same country discussed in the Week 4 Health Care Systems Around the World discussion. o Discuss how the other country’s health care system is funded. o Discuss disparities in health care from your chosen country. o Include at least one positive aspect from the other country’s health care system that you would like to see added to the S. health care system, explaining why you would like this addition. Part 4: Reforms and Improvements Describe two potential reforms and improvements currently being debated at either the local, state, or federal You may want to review the Laws and Regulations Affecting Health Care discussion prompt to help you with this component. Examples could include any of the following: o Federal modifications (e.g., antitrust reforms, CHIP, HSA or HRA, Medicare reform, Medicaid expansion, PPACA repeal, pharmaceutical regulations, development of a universal system, veterans’ health care, crossing borders for health care, clinical trial research, ) o State modifications (e.g., Medicaid reform, income tax credits, adoption of state level universal health care, etc.). Presentation of the United States Healthcare System o Increased consumer controls (e.g., patient-centered care, provider choice, complementary and alternative care choices, activism for changes at the state and federal level, etc.) o Reimbursement changes (Medicare, Medicaid, managed care plans, traditional insurance plans, etc.) Part 5: Conclusion: The Future of the U.S. Health Care System Examine what you believe the U.S. health care system will resemble in the next 10 years by recommending two changes and addressing access to care, quality of care, and cost of care, including an example of each in your vision of the future health care system. ADDITIONAL BREAKDOWN OF REQUIREMENTS BELOW: FOR PART 1 – You needed to include the revolutionary factors, the 3 different stakeholders and their roles, both positive and negative, and at least one major development from the financial, legal, ethical, regulatory and social. Plus all of the bullet items under each of the require components. Items often missed in the presentation: Financial: 1. How has reimbursement to physicians changed? Has it affected our health care system, if so how? 2. How have costs for insurance changed over the years? How has it effected employers and patients? Legal: 1. Have there been any legal challenges of our health care system over the years? 2. What are the laws that have affected our system? Did they affect it positively or negatively? Ethical: 1. Are there any ethical considerations regarding health care? Think about health care professionals and their ethics in delivering quality care. 2. What are the ethical considerations for insurance companies, pharmaceutical companies….etc? Think about the recent news about the Epipen… the pharmaceutical companies raised the prices sky high so people could not afford it… Regulatory: 1. Have there been any regulations from the government or health insurance plans that have affected our health care system? Good or bad? Presentation of the United States Healthcare System Social (Consumer Demand): 1. What are the demands made by the consumer for our health care system? 2. How has the increased need for access (more patients being insured) affected our health care system? 3. Has the consumer had a good or bad effect on our health care system? If so, good or bad? The Cost of the U.S. Healthcare System 1. Describe three different reimbursement methods. Make sure to explain why you think one of the reimbursement methods you discussed is more effective than the others (see directions for specifics). 2. Describe the use of two technological advancements. Make sure to include information on why you think these advancements in technology have reduced costs while delivering quality care. PART 3: The United States Versus Other Health Care Systems—an International Perspective 1. Contrast the U.S. health care system with at least one other (e.g., Canada’s universal health care vs. U.S. healthcare or South Africa vs. U.S. health care, etc.). Make sure to review the directions for specifics information you need to include. PART 4: Reforms and Improvements 1. Describe any potential healthcare reforms and/or improvements that are currently being discussed at either the local, state, or the federal level (review the directions for specifics). CONCLUSION: Future of the U.S. healthcare system 1. Explain what you believe the U.S. healthcare system will look like in the next 10 years. Give at least two recommendations for change. 2. Address access to care, quality of care, and cost of care including an example of each in your vision of our future healthcare system. APA FORMATTING & REFERENCE SLIDE: 1. You must have a title slide that includes your personal introduction. Make sure to introduce yourself. 2. You must have an overview slide, which gives a brief overview of what you will be covering in the presentation. 3. You must have citations for each reference used. The citations belong in the speaker notes with the detail that explains each of the bullet points on the slide. 4. You must have speaker notes for each slide. 5. You must have a reference slide that lists your references. They must be in APA format. history_of_medicine_timeline.pdf implementing_value_based_payment_reform.pdf organizing_the_us_health_care_delivery_system.pdf the_8_basic_payment_methods_in_health_care.pdf hca_205_chapter_2_history_of_healthcare.pdf Medicine Through Time Timeline 3000 BC Pre-History – understanding is based on spirits and gods. No real medical care. People die very young, normally by the age of 30-35 for men, but only 15-25 for women due to the dangers of childbirth. Most people suffered osteoarthritis (painful swelling of the joints). 2000 BC Egyptian Empire – development of papyrus, trade and a greater understanding of the body (based on irrigation channels from the River Nile). They believed the body had 42 blood channels and that illness was caused by undigested food blocking these channels. 1500 – 300 BC Greek Empire – Medicine still based on religion – Temple of Asclepius. Here, patients would get better, but mainly through the standard of rest, relaxation and exercise (like a Greek health spa) 400 BC Hippocrates – founder of the Four Humours theory. This theory stated that there were four main elements in the body – blood, yellow bile, black bile and phlegm. Illness was caused by having too much of one of these humours inside of you. He also wrote the Hippocratic Collection, more than 60 books detailing symptoms and treatments of many diseases. 400 BC – 500 AD Roman Empire – The Romans were renowned for excellent public health facilities. The Romans introduced aqueducts, public baths, sewers and drains, etc. In the citcy of Rome, water commissioners were appointed to ensure good supplies of clean water. 162 AD Galen – continues the four humours theory but extends it to have the humours in opposition to each other. This meant that an illness could be treated in one of two ways, either removing the “excess” humour or by adding more to its opposite. Galen also proves the brain is important in the body (operation on the pig). Galen’s books would become the foundation of medical treatment in Europe for the next 1500 years. Dark Ages Britain and Europe return almost back to pre-historic times under Saxons & Vikings 1066 Battle of Hastings – Normans invade Britain 1100s – 1200s 13471348 When Europeans went on crusades to the Holy Land in the 12th and 13th centuries, their doctors gained first-hand knowledge of Arab medicine, which was advanced by Western standards. Black Death – across Europe more than 25 million people die. Two main types of plague 1. Bubonic – 50-75% chance of death. Carried by fleas on rats. Death usually within 8 days 2. Pneumonic – airborne disease. 90-95% chance of death within only 2-3 days People had no idea how to stop the plague. People thought it was caused by various factors, i.e. the Jews, the Planets, the Gods, etc etc etc 1455 The Printing Press was invented by Johannes Gutenberg. This allowed for the massive reproduction of works without using the Church as a medium. 1517 Martin Luther posted his “Ninety-Five Theses” on the door of a Catholic Church in Germany. This began the Protestant Reformation. 1540s Andreus Vesalius – proved Galen wrong regarding the jawbone and that blood flows through the septum in the heart. He published “The Fabric of the Body” in 1543. His work encouraged other to question Galen’s theories. 1570s Ambroise Paré – developed ligatures to stop bleeding during and after surgery. This reduced the risk of infection. He also developed an ointment to use instead of cauterising wounds. 1620s William Harvey – proved that blood flows around the body, is carried away from the heart by the arteries and is returned through the veins. He proved that the heart acts as a pump recirculating the blood and that blood does not “burn up”. 1665 The Great Plague – little improvement since 1348 – still have no idea what is causing it and still no understanding of how to control or prevent it. In London, almost 69,000 people died that year. 1668 Antony van Leeuwenhoek creates a superior microscope that magnifies up to 200 times. This is a huge improvement on Robert Hooke’s original microscope. 1721 Inoculation first used in Europe, brought over from Turkey by Lady Montague. 1796 Edward Jenner – discovered vaccinations using cowpox to treat smallpox. Jenner published his findings in 1798. Presentation of the United States Healthcare System The impact was slow and sporadic. In 1805 Napoleon had all his soldiers vaccinated. However, vaccination was not made compulsory in Britain until 1852. 1799 Humphrey Davy discovers the pain-killing attributes of Nitrous Oxide (Laughing Gas). It would become the main anaesthetic used in Dentistry. Horace Wells would try and get the gas international recognition. He committed suicide the day before it got the recognition it deserved. 1830s Industrial Revolution. This had a dramatic effect on public health. As more and more families moved into town and cities, the standards of public health declined. Families often shared housing, and living and working conditions were poor. People worked 15 hour days and had very little money. 1831 Cholera Epidemic. People infected with cholera suffered muscle cramps, diarrhoea , dehydration and a fever. The patient would most likely be killed by dehydration. Cholera returned regularly throughout the century, with major outbreaks in 1848 and 1854. 1842 Edwin Chadwick reports on the state of health of the people in cities, towns and villages to the Poor Law Commission (forerunner to the Public Health Reforms). He highlights the differences in life-expectancy caused by living and working conditions. He proposes that simple changes could extend the lives of the working class by an average of 13 years. 1846 First successful use of Ether as an anaesthetic in surgery. The anaesthetic had some very severe drawbacks. In particular, it irritated the lungs and was highly inflammable. 1847 James Simpson discovers Chloroform during an after dinner sampling session with friends. He struggles to get the medical world to accept the drug above Ether. Doctors were wary of how much to give patients. Only 11 weeks after its first use by Simpson, a patient died under chloroform in Newcastle. The patient was only having an in-growing toenail removed (non-life threatening). It took the backing of Queen Victoria for chloroform and Simpson to gain worldwide publicity. 1847 Ignaz Semmelweiss orders his students to wash their hands before surgery (but only after they had been in the morgue). 1847 Elizabeth Blackwell becomes the first woman doctor in USA 1848 First Public Health Act in Britain – It allowed local authorities to make improvements if they wanted to & if ratepayers gave them their support. It enabled local authorities to borrow money to pay for the improvements. It was largely ineffective as it was not made compulsory for Councils to enforce it. This was an element of the “Laissez-Faire” style of government. 1854 Crimean War – Florence Nightingale and Mary Seacole contribute majorly to the improvements in Hospitals. 1854 John Snow proves the link between the cholera epidemic and the water pump in Broad Street, London. Unfortunately, he was unable to convince the government to make any substantial reforms. 1857 Queen Victoria publicly advocates use of Chloroform after birth of her eighth child.Presentation of the United States Healthcare System 1858 Doctors’ Qualifications had to be regulated through the General Medical Council. 1861 Germ Theory developed by Louis Pasteur whilst he was working on a method to keep beer and wine fresh – changed the whole understanding of how illnesses are caused. 1865 Elizabeth Garrett-Anderson – first female doctor in the UK 1867 Joseph Lister begins using Carbolic Spray during surgery to fight infection. It reduces the casualty rate of his operations from 45.7% of deaths to just 15.0 % dying. 1875 Second Public Health Act – now made compulsory. Major requirement is that sewers must be moved away from housing and that houses must be a certain distance apart. 1876 Public Health improvements – in the UK, the government introduced new laws against the pollution of rivers, the sale of poor quality food and new building regulations were enforced. 1881 Robert Koch discovers the bacteria that causes anthrax. He establishes a new method of staining bacteria. Using Koch’s methods, the causes of many diseases were identified quickly: 1880 – Typhus 1882 – Tuberculosis 1883 – Cholera 1884 – Tetanus 1886 – Pneumonia 1887 – Meningitis 1894 – Plague 1898 – Dysentery 1889 Isolation Hospitals were set up to treat patients with highly infectious diseases. 1895 William Röntgen discovers X-Rays. Though it is an important discovery, it is only WW1 and the treatment of soldiers that propels it into the medical spotlight. 1895 Marie Curie discovers radioactive elements radium and polonium 1901 Scientists discover that there are different blood groups- this leads to the first 100% successful blood transfusions. 1905 Paul Ehrlich discovers first “magic bullet” – Salvarsan 606 to treat Syphilis. The problem was it was based on arsenic and so could kill the patient too easily. 1911 National Health Insurance introduced in Britain 19141918 World War One – development of skin grafts to treat victims of shelling 1928 Alexander Fleming – discovers Penicillin. The mould had grown on a petri dish that was accidentally left out. Fleming writes articles about the properties of Penicillin, but was unable to properly develop the mould into a drug. 1932 Gerhardt Domagk discovers Prontosil (the second magic bullet). Slight problem is that it turns the patient red. 1937-45 Florey, Chain & Heatley work on producing penicillin as a drug. Their success will make the drug the second most finded project by the USA in WW2. They fund it to the tune of $800 million and every soldier landing on D-Day in 1944 has Penicillin as part of his medical kit. 1939 Emergency hospital scheme introduced – Funded and run by Government 1942 William Beveridge publishes the Beveridge Report. The report was the blueprint for the NHS 1946 National Health Service Act – provides for a free and comprehensive health service. Aneurin Bevan convinces 90% of the private doctors to enrol. 1948 First day of the NHS. Hospitals were nationalised, health centres were set up and doctors were more evenly distributed around the country. However, the popularity and costs of the NHS would rapidly spiral out of control. The £2 million put aside to pay for free spectacles over the first nine months of the NHS went in six weeks. The government had estimated that the NHS would cost £140 million a year by 1950. In fact, by 1950 the NHS was costing £358 million. 1950 William Bigelow (Canadian) performed the first open-heart surgery to repair a ‘hole’ in a baby’s heart, using hypothermia. 1952 First kidney transplant (America) 1952 Charges introduced in NHS – 1s for a prescription 1953 Description of the structure of DNA 1961 Contraceptive pill introduced 1967 Christiaan Barnard (South Africa) performed the first heart transplant – the patient lived for 18 days 1978 First test tube baby 1990s 1994 Increasing use of keyhole surgery, using endoscopes and ultrasound scanning, allowed minimally invasive surgery. National Organ Donor register created 615774 research-article2015Presentation of the United States Healthcare System MCRXXX10.1177/1077558715615774Medical Care Research and ReviewConrad et al. Empirical Research Implementing Value-Based Payment Reform: A Conceptual Framework and Case Examples Medical Care Research and Review 2016, Vol. 73(4) 437­–457 © The Author(s) 2015 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1077558715615774 mcr.sagepub.com Douglas A. Conrad1, Matthew Vaughn1, David Grembowski1, and Miriam Marcus-Smith1 Abstract This article develops a conceptual framework for implementation of value-based payment (VBP) reform and then draws on that framework to systematically examine six distinct multi-stakeholder coalition VBP initiatives in three different regions of the United States. The VBP initiatives deploy the following payment models: reference pricing, “shadow” primary care capitation, bundled payment, pay for performance, shared savings within accountable care organizations, and global payment. The conceptual framework synthesizes prior models of VBP implementation. It describes how context, project objectives, payment and care delivery strategies, and the barriers and facilitators to translating strategy into implementation affect VBP implementation and value for patients. We next apply the framework to six case examples of implementation, and conclude by discussing the implications of the case examples and the conceptual framework for future practice and research. Keywords value-based payment, implementation, conceptual framework This article, submitted to Medical Care Research and Review on April 9, 2015, was revised and accepted for publication on October 12, 2015. 1University of Washington, Seattle, WA, USA Corresponding Author: Douglas A. Conrad, Department of Health Services, University of Washington, Box 357660, Seattle, WA 98105-5660, USA. Email: dconrad@uw.edu 438 Medical Care Research and Review 73(4) Introduction Health care purchasers, plans, and providers in the United States are positioning themselves to move from the dominant payment model of fee-for-service (FFS) to payment based on value. This evolution is being driven by a combination of forces. Purchasers (e.g., Medicare and Medicaid, employers, and union trusts) are seeking increased value in health plan benefits and in health care for their employees and members. Insurance plans are searching for payment models and aligned benefit designs that will lead to improved health and health care quality and patient experience at least cost. Provider organizations and individual providers are trying to build efficient organizational and care delivery infrastructure and to escape the “hamster wheel” of volume-driven scheduling and patient care to generate revenue; they are adopting payment models that promote clinical practice to improve health. Value-based payment (VBP) reform seeks to change the behavior of individual providers and provider organizations by aligning payment with value. VBP models assume a variety of forms, but are operationally defined as financial incentives that aim to improve clinical quality and outcomes for patients, while simultaneously containing (or better yet) reducing health care costs. This article’s objectives are the following: 1. 2. 3. To present a conceptual framework for evaluating the implementation of multistakeholder VBP initiatives, drawing primarily on previous models of VBP implementation (Damschroder et al., 2009; McHugh & Joshi, 2010) and secondarily on models attempting to explain the impact of VBP on cost, quality, and outcomes (Conrad & Christianson, 2004; Damberg et al., 2014; Dudley et al., 2004; Hussey, Mulcahy, Schnyer, & Schneider, 2012). Presentation of the United States Healthcare System To apply the conceptual framework to VBP implementation in different environments. To articulate a set of insights for practice and research, based on particular projects and VBP methods, and where possible to present a set of more general, cross-cutting lessons for implementing VBP reform. The six VBP initiatives examined in this article were chosen from 11 pilots funded by the Robert Wood Johnson Foundation (RWJF) and evaluated by University of Washington researchers. We selected them purposefully to capture a broad array of VBP approaches: shared savings-based accountable care organizations (ACOs), bundled payment, pay-for-performance (P4P), reference pricing, “shadow primary care capitation,” and global payment. RWJF chose to fund multi-stakeholder coalitions that submitted “bold” and “innovative” payment reform proposals and that made a strong, credible case for development, spread, and sustainability of VBP innovation. As evaluators we studied the implementation of each initiative in detail and documented the context, objectives, payment and delivery reform strategy, logic model, barriers and facilitators, progress and results, and lessons learned for each project. We intentionally did not label different efforts as “successes” or “failures,” but sought to develop insights for practice and research from each project and (where possible) general lessons based on these multiple case studies. Conrad et al. 439 New Contribution This article’s original contribution is twofold: (1) offer a conceptual framework for the implementation of VBP through a multi-stakeholder approach, synthesizing prior implementation research (cf. Damberg et al., 2014; Damschroder et al., 2009; McHugh & Joshi, 2010) and insights from empirical work on the impact of VBP; and (2) apply that framework to six recent initiatives in implementing VBP through a multi-stakeholder approach, rather than through single payer–provider innovation. The analysis stresses implementation—not impact—in light of the early development stage of our six case examples, the paucity of research on implementing VBP, and realizing that implementation is a precondition for such reform to affect the Triple Aim. Conceptual Framework Implementation. The results of payment reform implementation are not affected only by the type of payment, but are heavily influenced by characteristics of the organization and environment. A separate field of study, implementation science, has arisen to better understand the factors which moderate the path from program implementation to observed results. Theoretical models seek to explain the effectiveness of any change effort—based on individual- or organizational-level characteristics alone (Ajzen, 1991; Prochaska & Velicer, 1997; Rosenstock, Strecher, & Becker, 1988; Weiner, 2009), or a combination of internal and external environmental factors (McLaren & Hawe, 2005; Stokols, 1996). To understand the full range of influences on effectiveness of change initiatives, recent meta-analyses and systematic reviews of constructs from empirical studies and conceptual models led to the development of the Consolidated Framework for Implementation Research (Damschroder et al., 2009; Durlak & DuPre, 2008). This framework identified several moderating factors that might influence observed results: structural, organizational, provider, and innovation attributes. Structural factors embody the larger social and political context of change initiatives, organizational factors relate to internal leadership and culture, and provider and innovation factors relate to interpersonal characteristics of individuals who carry out change. Presentation of the United States Healthcare System Application of these factors to explain the effects of health innovations seems to have been uneven. A recent systematic review of studies indicated that organization-, provider-, and individual-level measures are most often assessed, whereas structural and patient characteristics, which may have an equal if not greater influence on results, are less frequently examined (Chaudoir, Dugan, & Barr, 2013). Specific to payment reform efforts in health care delivery systems, implementation factors are not consistently assessed or well understood for different models. For example, in reference pricing, the importance of health care consumer characteristics and regulatory agencies has been identified, but the exact influence of these factors on the design and results of reforms remains unclear (Robinson & MacPherson, 2012). A systematic review of P4P studies reports that the incentive performance measures, type of provider groups involved, level of incentive (provider vs. team), and type of 440 Medical Care Research and Review 73(4) incentive all influenced reform effects. However, little evidence addressed the influence of patient characteristics, and structural factors were not examined in depth (Van Herck et al., 2010). A nationwide survey of patient-centered medical home demonstration projects illustrated many of the local contextual factors that shaped implementation; however, t … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10