CRA500 Module 4 - SLP

MODULE 4 – SLP: Accountable Care Organization, Reimbursement Systems, and Affordable Care Act Name Course: CRA500 Module 4 – SLP- Health Care Delivery Systems Instructor Date Challenges in becoming an ACO Even as Kaiser Permanente seeks to deliver value as an ACO, there are barriers and challenges to achieving this. The current payment incentives do not necessarily cover all the required costs where there are concerns among payers on the market power of the ACOs. Kaiser Permanente has major operations in Northern California, and the organization provides fixed salaries without focusing on the clinical productivity indicated by the volume of service provided to determine compensation (Strandberg-Larsen, 2010). The goal of integrating more players in the ACO is to lower costs and improve the quality of care. For Kaiser Permanente, the physicians who are interested in research are likely to avoid the network if they do not get extra compensation for this. Kaiser Permanente has managed to improve operations and expand beyond California there are still challenges to retain the members, especially when transitioning (Bornstein, 2012). It is necessary to have a close connection between the members and physicians, but this is not always the case. Improving access to health information empowers members to make informed decisions. Patient satisfaction influences their choice to continue their membership, highlighting the need to improve the quality of care. When the members feel that the organization considers their interests they are also more likely to retain their membership. The challenge for Kaiser Permanente then is to attract and retain the voluntary members. The healthcare industry changes rapidly and it is necessary to adapt to changes, while health providers target different demographic groups to improve health population. ACOs are effective when they improve health outcomes without escalating the cost. Hence, there is a need for continuous innovation. Kaiser supports innovation and this requires collaboration with the stakeholders, including the associates who provide care (Bornstein, 2012). Continuous innovation also supports provision case since there is emphasis on easing access to care, but governance issues may affect care provision in the future since ACOs require networking. Kaiser’s response to the problems Kaiser Permanente increasingly relies on capitation to pay its affiliates, while seeking to improve the quality of care. Capitation is based on the idea of paying the health care providers, especially the physicians based on performance and patient risk. This option has allowed Kaiser Permanente to control costs. To ensure that capitation is a success, quality safeguards are identified making it easier to evaluate the value of health services provided. The case for capitation is that the payments are disbursed after assessing the quality and value of care. The affiliates and health providers within the Kaiser Permanente ACO then provide information on their performance including patient safety and reducing readmission rates. Kaiser has focused on improving access to membe...