Interrelationship between cost access quality in the delivery of health services
Essentials of the U.S. Health Care System, Fifth EditionLeiyu Shi and Douglas SinghCase StudyCopyright © 2019 by Jones & Bartlett Learning, LLC, an Ascend Learning Company2Case ReportDuring the summer of 2018, Blue Cross and Blue Shield, the Texas-based health insurance behemoth, entered an ACO relationship with Baylor Scott & White Health, the largest nonprofit health system in Texas. Under the agreement, in year one Baylor Scott & White would provide high-quality care to upwards of 140,000 Blue Cross and Blue Shield members, establishing it as the most substantial value-based care agreement with a commercial insurance company in the United States (Rege, 2018). Improvements in health outcomes for those with chronic diseases such as diabetes, hypertension, and obesity can build patients’ confidence in the ACO model resulting from increased quality of life, leading to higher levels of customer satisfaction in the health system. DiscussionThe shift from healthcare delivery based on patient demand to a more proactive approach will require a complete commitment from all healthcare stakeholders. Due to its ACO alignment, Baylor Scott & White Health had over 1 million lives under value-based care arrangements, and stakeholders believe that their patients will receive high-value, coordinated, and quality care (Rege, 2018). Designing, implementing, coordinating, and managing the delivery of health services can increase care and oversight across the entire continuum of patient care (Wexler et al., 2014). These tighter controls at the point of service will lower costs across the entire system. Increasing emphasis on disease prevention will directly affect the rate of chronic conditions and traditional high-cost illnesses. Moreover, financial risk pools will create economies of scale as younger and healthier patients begin to purchase insurance plan resulting from the ACA mandates. Health policies and reforms such as the ACA demonstrate the government’s meaningful efforts to reduce costs and increase access to and quality of care. These types of Essentials of the U.S. Health Care System, Fifth EditionLeiyu Shi and Douglas SinghCase StudyCopyright © 2019 by Jones & Bartlett Learning, LLC, an Ascend Learning Company3national standards are enforceable by government agencies with far-reaching authority. The lower cost of medical procedures coupled with reduced reimbursement rates from Medicare and Medicaid will fundamentally alter health care delivery in the United States.
Questions
1. Discuss the interrelationship between cost, access, and quality in the delivery of health services. Briefly describe the impact of each measure
on positive patient health outcomes.
2. Under the ACA, describe a scenario of how medical providers and healthcare professionals work together to enhance the quality of health
initiatives, interventions, or outcomes.
3. In your opinion, what role will ACOs play in the future environment of value-based health services delivery? Explain your answer by
integrating an example of how an ACO can either reduce costs, increase patient satisfaction, or improve health outcomes
