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Case Study 1: U.S. Health Care Delivery 1. What are the requirements for Concerto to become an ACO? List two requirements that you deem the most important and recommend how Concerto can achieve them. 2. In your opinion, briefly describe one component of the Affordable Care Act (ACA) that supports Concerto's decision to become an ACO. 3. If Concerto can achieve its goal of becoming an ACO, how will access to medical care and satisfaction improve for patients? Case Study 2: Foundations of U.S. Health Care Delivery 1. In your own words, what is EBM? Is it a worthy goal for U.S. health care delivery? Why or why not? 2. How has MMCI/Allina Health mirrored how U.S. health care delivery has evolved into a modern EBM institution? Case Study 3: Financing and Reimbursement Methods 1. Explain why hospital readmissions are so costly for health systems or third-party payers. Explain your answer from the perspective of the three major stakeholders providers, patients, and payersand your analysis of the current reimbursement environment. 2. Identify and analyze one of the leading causes of hospital readmissions over the past 5 years. In your opinion, outline how each of the three major stakeholders can implement a process or procedure to reduce their contribution to the readmission cycle. 3. Describe how the transition for premodern reimbursements programs such as (P4P or DRGs) to current value-based compensation programs can potentially further reduce hospital readmission rates. Please provide a detailed example in your response. Case Study 1: Major Characteristics of U.S. Health Care Delivery Concerto Healthcare Incis medical management oration that specializes in dual-cligible Medicare and Medicaid patients approach is customized for each member. We prioritie cial and emotional com to medicale Concert Haltheare, pa 45 The company provides patients with support such as assistance with cal service, housing, and Gare Coordination. The Concertom floor approach to healthcare. It is about Iwwe wat in comet wittients, provides and heat place to Hellcare, 2015 Nr. 591. The organice ispalonctured and continued strives to prove afety indulity through innovative approaches and to develop best practices Model for a New Health Delivery System Cineet Healants goal is to enablish itself as an accountable care aranization (AC) with health serenes in multiple the company rectly started pinsationwide by building lines and hiring practities and plans to deliver primary careeder the new lealth care form legis AC code and deliver lealthcare services with the idea that the model will also make it easier to improve patient outcomes by using evidence used stands to care for special populations, such as the certy (Wexler, Hefnet, Wher & McAlamy, 2014 Analysis of the Problem Certo Healthcare isilnerable a medical, financial and legal risk de to a lack of evidenes el standard. The sence of region wide sandards for care delivery in medical legal ability standards and the primare improve health outcomes by lowering the risk of adverse event atal 2014). Concerto mest establish a set of AC policies, procedures and standards for based care detinery bete medical redakto kunch, Y. 2005) The company must conception of politycare delivery andards are Aalitantly, impartial at leane umbipaties tomcialaiee-hal utte NW ACO to choce the risk of adverse butcomes Steel et al. 2014) Desired Outcomes ACs are critical to overcoming performem limitatis, such as for preexisting condido megforme delivery models by wrance uwverage Designing, plementing cerdinating, and maging the delivery of health service can improve ware and only site continuatient care (Wexler. Her Wide Malay 2014 Coto's efforts to develop evidence-based standards for W AO include robust decuma bright clinical aware es from integrating research evidence and developing clinical guidelines, 2014)However, it is so important for Concertos clans to consider paties preferences in treatment and care le of the new Coto ACO wil ingenie wwful uption of evidence hued tandende to get high qulay health come Candles The establishment of practke stands and the collection of die mees can be posisie affect the time. A proper al neon is for delivering high quality pre Kule 2015 Control anphasis open forces polvere andre As Wealer et al. C014) on to a focused divery temat taldearers cred effort pagmulta purticipate in proving their overall health outcome. Access to relevant and meaningful information such as personal health records medicine and timdy medical treatment will empower points to Fonsibly. Contato e sheh delivery.um, it must to work to change patient behaves repuding liteyle choices and active participation in their werall healthcare Questions 1. What are the rements for Concerto to become an ACOL requirements that you deem the most important and recommend how Concerte cm achieve them 1. In your opinion, hriely describe one component of the Affordable Care Act (ACA) that supports Concerte's decision to become an ACO. 3. Concerten wie its poslof becoming an ACD, will access to mali care and satisfaction impree for patients Concerto Health Care. (2015). About Concerto. Retrieved from http://ocembeathcare.colou-concerto Kuh...BP.B.M. & Yockel T (2015) Clinical acument in the last century Executive summary of policy paper om die America College of Physics Awali af forwal New, 1621 301-305. p.de dol.cg/10.7326/M14-212X St. N. Abdelhamid A. Stokes, Edward H. Freerolt. R. Howe, A. & Quresht. N (2014) A review of clinical practice muidelines found that they were often bedenince of uncertain revanced primary care primar al Edmor, 6711), 1251-123.bttp: //10.1016) 2014.05.020 Wexler, R. Hefner 1. Welker. M., McAlcamey, A. (2014. Health care formalities and opportunities for primarul 1298-304 Rder Case Study 2: Few of U.N. I Care very The creditation of care with integrated devy systems is at the foundation of healthcare delivery in the United Stahes praty pod of government Official publieben powd and Beachwearing care coordination is a key perfume inte at det rettes with the news of the way & Stokopi, 2010 Northwestern Hospital first pedidows back 12 Minneapolis, Mums. By tepla were small one with fewer than 50 beds, and to entile compared to their deeper (Allneth Mwer, they mainly wned the powers of the commune parties who werewally ill en fingering Newestem Hapital was as early peer in the establishment of what would eventually become a evidence- baine Medford of the boots of uning in the United States Allah Introduction overy Newestem Hospital of Manableddlinan and storen to incorporate beste practices at the point of patient care in both their bland mbory nation. For example Norwen's geltonun quality delivery and overall prin care hund the formation of a new city, Minneapolis Medical Center Incorporated (MMCT). In 1966. Northwestern Hospital, along with other health care facilities in the Minneapolis ara, fomed the maches of an animation that would significantly master ce Coordinating and delivery in the many decades. Ukimately. Menvironment created standard of patient care that enabled MMI to advance care delivery and medical education and Lay the foundations of a membuat we delivery system. Case Report MMCT established a culture of continuous quality improvement (con Wenke Jongwha. Lilir, and Paz (2013) have linked colto better clinical quality and improved print satisfaction. The best practice in B methodology is to ensure the patient care is covedinated and of high quility through the use of objective clinical data from credible sources and references. By the 1980 a desire to add support services for the coordinated can of patients such as physical habilitation pedodolution from Northwestem H to MIMCI and the formation of Abbott Northwestern Hopal Since that time, the hospitals health services offering have grown to a primary health system, supporting cardiovascular cate, model buchen Conclusion MMCT recently went through a merger and is now part of a logo halt system called Alline Health the patients in location the Midwestlificantly expanded portfolio of TERM to include mental health services, repliecare and cancer Home Adly, de mestregut the newly formed health system must understand and made cache competent to maximize system efficiency and effectiveness Fa umple the diagnose of a medical condition is a fundamental activity that clinical professionals perform during a physical examination. It is crucial in medem health systems that com excute due diligence by ander the secury labowy tests, medical procedures adagnostic images arents who seek treatment from multiple health care anizations ogh to maiscared flag to clinicians to prudently exhat all evidence based options to be ympumah medical treatment Ouest In your own words, what he hit worthy goal for balth care delivery Why or why not? 2 Flow Fan MNC Altin Health mirrored how Us health care dellvery him evehed. into a modern ERMist? Heferences Allie Halt ind) www atlinbaltor Joon. Stekpil. (2010). Calam Guater Boston MA: Joe & Barles Publishers Wade, John C. Lahar M. & P. I 2013) Effects of integral del very system cil and quality Amerika. Man Cave, 5) 175-184 w/dourg/10.3471LTING Case Study 3 Financing and Reimbarment Muthods Introductie Hospital admissions representa considerable expense Innovative care delivery models such as Valoe-based reimbursement accountable care erant, and patient centered medical homes we designed to lower the cost of integrated came delivery and reduce hospital admission rates From a historical perspective, the primary organizational and economic structure of healthcare has been reimbursement on a forervice buss (lisecutive Office of the President's Council of Advisors Science and Technology. 2011. Guvern prince coverage, och as Medicate and Medicaid are distinguished from other types of this party payers due to the reimbursement model and contractul service level agreements. Fore.ample, the revenue generated by the party payers in health care organizations is known as the payer mi Baker & floker.2013) Many types of management reporting arranged by the payer mit (there source) and entifies the properties of revealed from each of the different types of payers Haker & Baker, 2013) Case Report Financing of the US and support, il prende a solid foundation for delivery of ingrated healthcare services. For example of patients with the same conditions or who have acquired a hospital-based infection or disease within 30 days of rees were among the highes for health plans and third-party payer Zimmerman, 2017) As mult, the Center for Medicine and Medical Service (CMS eliminued informasi ter than I calendar days after discharge. Since implementation of the plated resument model, the admittance rates for Medicare and Mediend parents fell from 21.3% in 2007 to 17.886 in 2015 Zimmerman, 2017). However Gerhard et al. (2013) peints out that doen we shower at hospitals participating a pay for performance programa para compra provide financially for performance based measures, sochas the number of medical procedures they perform or the member of diagnostic test onders. However, MP and other types of performance-based program luve been phased out in recent years in favor of physician compensation based on positive health somes for patients in the days following hospital or cardiacape(Rappley 2017 Conclusion Despite the best efforts of third-party payers such as CMS to reduce costs by lowering admittance, the policies and their implementation have been far from perfect, and in some cases fragmented or laphazarlos. Solomomi facea caling cause of higher admission rates in die total, which have a vital role in rating underserved and vulnerible population. CMS official must be contrate the intended effects of perity pero sentitom. Additionally, there tyst hospitals are often suhan wychologe alimwele hoopis te likely to be higher portion of patients of low comes Today, the focus for CMS on valming activities to minimize the value of the health system saling tinind sport the continent efforts och integrated Alivery ym. The remedies for the enti to remain fill olvent and critical to person in the makineries of value-based rimbursemen, 2013