Read Case 5: Middleboro Community Hospital in this week’s Learning Resources, an

Question

Read Case 5: Middleboro Community Hospital in this week’s Learning Resources, and consider the actions taken by this organization. Review data tables regarding their case mix (top DRGs), Patient Days, and CMS Core Measures. These metrics address both qualitative and quantitative measures in this organization. The Assignment: Write a brief, 2-page executive summary of the impact of the transition from volume-based to value-based health care. Specifically, address how this change in reimbursement methodology impacts operational requirements and how it can be implemented. Recommend at least two adjustments to operations which may position the organization for success under value-based health care.

Explanation / Answer

Changing the Healthcare organisation from volume based organisational structure to value based healthcare require intensive approach of different changes in capabilities as well as management systems inside the organisation. This type of approach is required to create a unique brand identity which provides extensive support to the overall brand image as well as improve the availability of providing Healthcare directly forecast on the patient rather than focusing on volume based revenue generation.
Implementation of the quality management programs such as Six Sigma as well as other total quality management programs including reduction of waste is essential for maintaining high quality standard in operation and provide quality Healthcare which is directly oriented towards value based service provision rather than focusing on volume. Specifying departments and having specialty in some specific department is definitely a better approach for changing operating structure of a Healthcare provider then providing General Health Care Services directly focusing on generating more and more revenue from the specific operational segment.

Reimbursement challenges that are faced by the Healthcare organisations as well as individual physicians in operating structure are as follows that should be focused while creating a value based operational structure and having a transition from volume based service provision to value based service provider.

Management of chronic care
Technologically patient-centered care

Management of chronic care

As most of the doctors are not fully prepared to care for the patient with extremely chronic diseases. Most of the people inside the United States of America suffer from the chronic diseases and this number is used as it reaches the 117 million. 86 percentage of total Health Care costs are used for the electronic health record as well as the disease control and prevention. By implementing new programs into the organisation is just a small initiative to reduce the overall Association with the chronic diseases.
Medicare chronic Care Management Service has began reimbursing the positions by $40.00 perman for every chronic Care Management Services related patient. This is a beneficial thing for the doctors but providing this is Pacific money to the doctors is very tough according to the structure.
By having a reimbursement to meet all the requirements of the specific solutions Medicare costs in the management directly reduces the overall given time and sometimes it's not even provided by a specific mean. Detail the patient specific health problems as well as treatment goals and prognosis. It also state the need for the social services for the patient. Capturing all of this information inside the electronic health record system can be very challenging for the present position as they have to maintain a balance between their working structure as well as feeding the data into the system.
These specific numbers are about $40 per month per member for a physician which is very less.
This specific problem is one of the biggest reimbursement challenges that should be being faced by the physicians in upcoming 3 years.

Technologically patient-centered care

As the world is turning to what the digital age the healthcare systems are also turning digital which is creating problems for the physician. Different technologically advanced gadgets such as a variable things are one of the most controversial things in the industry.
Implementation of this specific strategy into the Healthcare systems is mostly unrecognised by some old suggestions which are directly non relatable to the technological improvements. For them wearable technology is Aaye technology of aliens and I cannot manage to work with it.
This is specific Technology has its own benefit and reduces the overall communication time between the patient and the doctor. By reducing the overall communication time between the patient and doctor the Healthcare provision in the critical disease like heart diseases can be prevented.
Implementation of these specific technological tools are a real challenge in reimbursement for the physician in next 3 years as the implementation of these specific technologies are really tough for implementing into the past area of Healthcare network. This is weather get strategy is still struggling to make a meaningful changed in the Healthcare organisation and should be recognised by the payer as well.

By having understanding of above factors we can say that implementation of such a specific strategies would be very beneficial for implementation of strategies for changing volume based organisation to a value based organisation.

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