Top Five Elements of the Healthcare System

1) Write a paper of 1,000–1,200 words that lists the top five elements of the health care system that most need reform, in your opinion. Justify your choices through a logical analysis of the elements' impact on the current system.
2) Refer to the assigned readings to incorporate specific examples and details into your paper.
3) Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
Read "Reforming America's Health Care Delivery System," by Hackbarth, presented before the State Finance Committee Roundtable on Reforming America's Health Care Delivery System (2009).
URL:
http://www(dot)finance(dot)senate(dot)gov/imo/media/doc/042109ghtest1.pdf
Read "Successful Strategic Planning for a Reformed Delivery System," by Zuckerman, from Journal of Healthcare Management (2014).
URL:
https://lopes(dot)idm(dot)oclc(dot)org/login?url=http://search(dot)ebscohost(dot)com/login.aspx?direct=true&db=ccm&AN=107853130&site=ehost-live&scope=site
Read "An Innovative Approach to Health Care Delivery for Patients with Chronic Conditions," by Clarke, Bourne, Skoufalos, Beck, and Castillo, from Population Health Management (2017).
URL:
https://lopes(dot)idm(dot)oclc(dot)org/login?url=http://search(dot)ebscohost(dot)com/login.aspx?direct=true&db=ccm&AN=120926876&site=ehost-live&scope=site
Read "Telemedicine and its Transformation of Emergency Care: A Case Study of One of the Largest US Integrated Healthcare Delivery Systems," by Sharma, Fleischut, and Barchi, from International Journal of Emergency Medicine (2017).
URL:
https://lopes(dot)idm(dot)oclc(dot)org/login?url=http://search(dot)ebscohost(dot)com/login.aspx?direct=true&db=ccm&AN=123992208&site=ehost-live&scope=site
POPULATION HEALTH MANAGEMENT Volume 20, Number 1, 2017
Mary Ann Liebert, Inc.
DOI: 10.1089/pop.2016.0076
Abstract
An Innovative Approach to Health Care Delivery for Patients with Chronic Conditions
Janice L. Clarke, RN,1 Scott Bourn, PhD, RN, EMT-P,2 Alexis Skoufalos, EdD,1 Eric H. Beck, DO, MPH, NREMT-P,2 and Daniel J. Castillo, MD, MBA2
Although the health care reform movement has brought about positive changes, lingering inefficiencies and communication gaps continue to hamper system-wide progress toward achieving the overarching goal—higher quality health care and improved population health outcomes at a lower cost. The multiple interrelated barriers to improvement are most evident in care for the population of patients with multiple chronic conditions. During transitions of care, the lack of integration among various silos and inadequate communication among providers cause delays in delivering appropriate health care services to these vulnerable patients and their caregivers, diminishing positive health outcomes and driving costs ever higher. Long-entrenched acute care-focused treatment and reimbursement paradigms hamper more effective deployment of existing resources to improve the ongoing care of these patients. New models for care coordination during transitions, longitudinal high-risk care management, and unplanned acute episodic care have been conceived and piloted with promising results. Utilizing existing resources, Mobile Integrated Healthcare is an emerging model focused on closing these care gaps by means of a round-the-clock, technologically sophisticated, physician-led interprofessional team to manage care transitions and chronic care services on-site in patients’ homes or workplaces.
Introduction
Since its implementation in 2010, the Patient Protection and Affordable Care Act (ACA) has succeeded in pro- viding more people with access to care and improving value on a number of fronts (eg, banning preexisting conditions as a reason to deny health insurance coverage, instituting ex- changes that enable consumers to comparison shop for health insurance plans, allowing adult children up to age 26 cover- age under their parents’ health insurance). However, the complexity of the large, fragmented, and uncoordinated US health care system continues to prove challenging, despite ongoing efforts to address escalating health care costs and suboptimal quality outcomes.
The problem
Persistent inefficiencies, resistance to change, and multi- ple interrelated issues across the system prevent critical
information and resources from reaching providers and pa- tients in a timely manner. Strategic vision, coupled with the ability to mobilize and deliver appropriate resources to pa- tients in the community, is needed so that health care pro- fessionals can provide accessible, safe, well-coordinated, cost-effective, high-quality care.
Access to healthcare services. Continued barriers to access range from lack of availability to high prices to lack of insurance coverage. In the nation’s 4 largest states, 12%– 30% of residents lacked health insurance coverage or ex- perienced problems getting needed care in 2014.1 In many rural areas, an inadequate supply of health care profes- sionals restricts access to needed services, challenging the health care system to utilize and deploy clinical and material resources in different ways.2 A major weakness in typical outpatient and inpatient care delivery systems is that pri- mary care professionals, paramedics, emergency physicians, and hospitalists function in unintegrated silos that impede
1Jefferson College of Population Health, Philadelphia, Pennsylvania. 2Evolution Health, Dallas, Texas.
a Clarke et al. 2016; Published by Mary Ann Liebert, Inc. This Open Access article is distributed under the terms of the Creative Commons Attribution Noncommercial License (http://creativecommons(dot)org/licenses/by-nc/4.0/) which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.
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care coordination, inhibit communication, compromise quality, and raise costs. These and other modifiable barriers to access lead invariably to unmet health needs, delays in receiving appropriate care, and preventable hospitalizations.
Cost of care issues. Although the rate of escalation has diminished recently, health care costs remain high. In a recent Gallup survey, 42% of Americans named either the cost of health care or access to health care as the top US health issues.3 According to one recent projection, the rate of increase in the cost of employer-sponsored health care benefits in 2015 will equal about 4.1%.4 Equally troubling are estimates that up to one third of the more than $2.8 trillion spent on health in the United States each year may be classified as waste—waste that is related largely to failures of care delivery, care coordination, and overuse.
Health care quality and safety issues. Serious gaps in care guidelines and processes continue to have an adverse impact on the quality and safety of care, particularly in outpatient settings.5 Specifically, poor care coordination processes lead to failures in transmitting critical patient in- formation, adverse drug interactions, conflicting treatment plans, and/or lapses in necessary treatment. Failures in pa- tient communication and patient education were among the root causes of 197 sentinel events (eg, suicide, falls, wrong- side surgery) compiled by The Joint Commission from January 2014 to October 2015.6
Health information technology (HIT) issues. Although health care communities across the country have made some strides in adopting, implementing, and using HIT to share relevant patient information, the lack of widespread adoption of a reliable system that can share and integrate communi- cation across institutional and organizational boundaries is a significant hindrance to efforts to improve care coordination.7
Chief among these issues that hamper progress are per- sistent inefficiencies and wasted resources that compromise access, health outcomes, and value. These interrelated problems occur with alarming regularity: