HCM 500 CSU Health Equity and Disparities Question

HCM500: The U.S. Healthcare System HCM500: WEEK 8 Paper & Discussion Week 8 Portfolio Project: Health Equity Paper Health Equity Paper (325 points) In Week 4, you were asked to read the article below titled Healthy People 2020. You were also asked to create an annotated bibliography of six to eight scholarly sources addressing health equity in preparation for your final portfolio project. Use those scholarly references for your week 8 Portfolio Project: Read the following article titled Healthy People 2020. https://www.cdc.gov/nchs/healthy_people/hp2020.htm The final Portfolio Paper in week 8 is focused on United States Health Equity / Disparities, so the 6-8 scholarly sources should be US Health studies. Final Portfolio Paper in Week 8 should be 10 pages on the following topic: a. Health Equity / Disparities impacting Health Outcomes: Nutrition & Weight Status. i. Healthy People 2020: Nutrition and Weight Status: ii. https://wayback.archiveit.org/5774/20220413181722/https://www.healthypeople.gov/2020/topicsobjectives/topic/nutrition-and-weight-status This portfolio project will help you begin to understand how disparities can impact health outcomes and the overarching goals to eliminating these disparities. Healthy People 2020 came together to address health disparities. To gain an understanding of the differences in health conditions and behaviors across demographic groups, go to Healthy People Topics Objectives and select a topic area to explore the tabs of information related to that topic – objectives, evidence-based interventions and resources, and data (national snapshots). Once you have selected one, consider the following: • • • • • • • • • Your personal reaction to the information read. What were the objectives? How will understanding this information help reduce disparities? What are the emerging issues related to this topic? Provide specific examples from your research, and support these examples with the relevant literature. What are the interventions and resources recommended for this topic? Do you agree? What does the data tell you? Recommend three or more solutions to address this topic and enhance health equity across the nation. Discuss future considerations in monitoring this topic. What have you learned from this research? Page 1 HCM500: The U.S. Healthcare System Your paper should be well-written and meet the following requirements: • • • • • 8-10 pages in length (not including cover page & reference page). Robust Introduction: o Open with a robust one-paragraph introduction that provides a brief (3-5 sentences), formal overview of the specific purpose, approach and scope of the paper – provide precise thesis/problem statement. Preview the specific topics, issues, and recommendations that the paper explores. Include at least eight scholarly references from peer-reviewed articles beyond the text or other course materials. (Not more than 5 years old). Be sure to discuss and reference concepts taken from the assigned textbook reading and relevant research. o Utilize headings to organize the content in your work. Conclusion Week 8: Discussion Post ~ 400 – 500 words As we end our term, share your thoughts on your learning experience in this course. Using at least 3 of the 6 prompts below, provide your reflections and explain how you will use your new knowledge. Please also include interesting material, videos, or articles from the current module. • • • • • • I enjoyed …. This got me thinking about … I wish … I learned … I was surprised that … I can use this by (or to) … Page 2 HCM500: The U.S. Healthcare System References for Paper & Discussion: Chapter 14 in Delivering healthcare in America: A systems approach Daub, S., Rosenzweig, C., & Schilkie, M. C. (2020). Preparing for a value-driven future Links to an external site.. Families, Systems & Health: The Journal of Collaborative Family HealthCare, 38(1), 83–86. Kaiser Family Foundation. (2018). The facts on Medicare spending and financing. https://www.kff.org/medicare/issue-brief/the-facts-on-medicare-spending-and-financing/ Oberlander, J. (2019). Lessons from the long and winding road to Medicare for all Links to an external site.. American Journal of Public Health, 109(11), 1497–1500. Rodriguez, E., & Opel, D. (2020). Addressing the social determinants of health: “Vulnerable” populations and the presentation of healthy people 2020 Links to an external site.. Poroi: An Interdisciplinary Journal of Rhetorical Analysis & Invention, 15(1), 1–17. Schoen, C., Hayes, S. L., Collins, S. R., Lippa, J., & Radley, D. (2014, March 25). America’s underinsured: A state-by-state look at health insurance affordability prior to the new coverage expansions. http://www.commonwealthfund.org/publications/fund-reports/2014/mar/americasunderinsured Shi, L., & Singh, D. A. (2019). Delivering healthcare in America: A systems approach (7th ed.). Jones and Bartlett Publishers. **THIS IS OUR TEXTBOOK** Social Security and Medicare Boards of Trustees. (2018). 2018 annual report of the boards of trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-andReports/ReportsTrustFunds/Downloads/TR2018.pdf Page 3 HCM500: The U.S. Healthcare System ***Helpful Resources from this week’s readings for Paper***: The Future of Health Services Delivery In this module, we examine future trends and challenges in health insurance and service delivery. A close examination of the Medicare system will help us understand and appreciate these trends and challenges. We also explore the concept of population health and how consumer-driven interactions influence healthcare delivery. In this final unit, we examine complex issues, often debated by politicians, and gain a better understanding of the hard decisions that need to be made. Learning Outcomes 1. Discuss future trends and challenges in service delivery for healthcare organizations. 2. Describe consumer-driven interactions and their influence on healthcare delivery. 3. Describe the concepts of population health on healthcare delivery. 4. Identify strategic indicators used to plan for community healthcare needs. To be successful in this module, it is important to understand the concepts of insurance, cost shifting, and the financing of the largest healthcare insurance program in the United States: Medicare. As the baby boomers age, the tremendous cost of the Medicare program will continue to increase to the point of insolvency, unless significant policy changes are enacted. Having an understanding of the concepts of insurance, population health, and consumer demand can enhance your understanding of the issues and possible solutions. There should be little doubt that both Medicare and the Affordable Care Act will continue to evolve to address the challenges. 1. What is Insurance? Insurance is a mechanism for financing risk and costs spread across insured populations. We purchase insurance for many things, such as our home, automobile, and our health. The traditional role of insurance was to provide benefits when the rare catastrophic event occurred, such as a house fire, automobile accident, or significant injury. Over time, insurance products have evolved to meet the changing needs of society, especially in healthcare. We have moved away from the use of health insurance as a device to protect against significant financial losses in the event of catastrophe and toward policies and plans that offer comprehensive coverage, including preventative and primary care. Now, while the term health insurance is still used, most people are covered under a health plan. These plans offer defined benefits for a specified cost and often include deductibles and co-pays. The insurance companies act as agents for those paying for the insurance product; in the case of healthcare, this generally means the employer who offers health insurance as a benefit. The employer wants to pay low premiums, however, so in order to do this, limitations and restrictions are placed on the coverage. If the plan covered everything, the premiums would be so expensive that very few could afford the coverage. Both traditional insurance companies and managed care plans focus on reducing costs. This results in reduced premiums, which is something all businesses want when paying for insurance for their employees. Click the tabs to learn more about the plans. Page 4 HCM500: The U.S. Healthcare System Traditional Insurance Plans: Traditional plans (often called indemnity products) and managed care products usually require pre-authorization for services, excluding emergency care, and the determination for services is generally based on medical need. Managed Health Care Plans: Managed care plans generally require a referral from the primary care physician for most specialty services. Many health plans are customized to meet employers and employee needs for a particular organization. Services covered in one plan are not necessarily covered in another. Therefore, health plans vary in deductibles and premiums. Since each health plan can differ in complexity, many consumers often do not understand the services covered or the pre-authorization requirements. People often believe their plans are going to cover all of their healthcare needs. Thus, confusion and frustration arise when their insurance (or health plan) does not cover something, and they have to pay out-of-pocket. Furthermore, because there are so many different types of plans, including health maintenance organizations (HMO), exclusive provider organizations (EPO), preferred provider organizations (PPO), and point of service (POS), understanding benefits can be even more challenging. The distinction between the different types of plans can be viewed at Healthcare.gov 2. Who Pays for Healthcare? The short answer to the question, “Who pays for healthcare?” is that just about everyone pay, in some way. Most healthcare expenses are paid by insurance, which are either government-sponsored, commercial, or private plans. The Medicare and Medicaid programs are funded by taxpayers, primarily through payroll taxes. Special state-level initiatives, such as alcohol and tobacco taxes, also fund a relatively small portion of public health programs in some states (Shi & Singh, 2019). The major funding sources for the commercial plans are employers. As mentioned, employersponsored insurance is often provided as a benefit to attract and retain employees. This expense is then reflected in the price of the product or service that the company pays. Thus, in the end, it is the consumer who pays the cost. The question of fairness when paying for healthcare is a subject that comes up frequently. Those with higher incomes are generally subject to higher taxes and generally spend more on consumer goods. Should they, therefore, have access to higher quality healthcare? Should they fund those who cannot afford it? The topic is, obviously, politically sensitive and value-laden. Another contentious area is cost-shifting. The term is broadly used to refer to those situations where the price of one product is higher than it should be, in order to pay for losses on another product where the price is too low. In healthcare, while the same price is generally charged to all consumers, the reimbursement to the provider for the same service often varies, depending on the insurance plan. Traditionally, many insurance companies, including Medicare before 1983, paid a fixed portion of the bill, generally 80% of charges. Hospitals used various methods and systems to predict utilization, payer-mix, costs, and planned profit levels. From this, the various charges for services were established. Sophisticated systems could be used to maximize reimbursement by adjusting charges for services that were known to be used by those with better paying insurance programs. Page 5 HCM500: The U.S. Healthcare System This would allow the hospital to accept patients with no insurance or those with low-reimbursing plans, such as Medicaid. This is cost-shifting (Shi & Singh, 2019). However, beginning in 1983, Medicare changed to a model that reimbursed the hospital a fixed amount, regardless of the price charged by the hospital. In many states, Medicaid now pays a fixed case rate, per-diem, or a very small percentage of charges. Over time, many insurance companies and managed care plans have adopted similar negotiated case-rates or per-diem (a set amount for each day the patient is in the hospital) mechanisms. Thus, the opportunity to shift costs has been reduced and has caused financial distress for many hospitals, especially those with disproportionate shares of uninsured and underinsured patients. The Commonwealth Fund analyzed U.S. census data, and found that in 2012, there were 31.7 million underinsured people under the age of 65 and over 47 million uninsured individuals (Schoen et al., 2014). This number of uninsured and underinsured individuals in the U.S. was one of the primary drivers for creation of the Affordable Care Act. 3. Medicare Insolvency Without doubt, Medicare has improved access to care, especially for the elderly and disabled, who might not otherwise have access. Furthermore, Medicare was long viewed as an excellent payer by both hospitals and physicians, fully covering bills, and even providing a profit margin. However, due to rising healthcare costs and other drivers, such as the increase in proportion of the aging population, spending is anticipated to increase further for Medicare (Shi & Singh, 2019). Indeed, the program is extremely expensive. In 2017, Medicare benefit payments were about $702 billion, an increase of $277 billion from ten years prior (Kaiser Family Foundation, 2018). Concern over the solvency of the Medicare program has existed for years. In its annual report, the Trustees of the Social Security and Medicare trust funds noted the following: • • Neither Medicare nor Social Security can sustain the cost of current benefit levels without legislative changes (such as higher taxes). Costs for both programs will increase substantially above the GDP growth through the mid2030s. This is due, in part of, the rapid population aging caused by the retirement of baby- boomers. • • The annual cash-flow deficit will average $77 billion between 2014 and 2018 and will then rise rapidly. The Medicare Hospital Insurance Trust Fund is projected to be completely depleted by 2026 (Social Security and Medicare Boards of Trustees, 2018). The government has delayed insolvency via the implementation of prospective payment and by reducing the amount of payment to providers (or, effectively reducing payment by making insufficient inflation adjustments). This has caused the profit margin to decline, and, in many cases, the reimbursement no longer covers the costs for providers. As a result, some doctors no longer see Medicare patients; even more refuse Medicaid, which pays even less than Medicare. Page 6 HCM500: The U.S. Healthcare System 4. How Can Medicare be Saved? There are essentially two ways to ensure the solvency of the Medicare program: reduce the cost of the program or increase the trust fund reserves. Increase the eligibility age for Medicare: This can reduce costs; however, it is very unpopular with many powerful interest groups such as the American Association of Retired Persons, the American Medical Association, and the American Hospital Association, as well as with those individuals approaching the eligibility age. Reduce benefit levels: For example, a reduction in end-of-life benefits or the creation of a list of services that would no longer be covered. This is not popular to those who are retired and expect the same (or better) benefits than they had previously. Increase deductibles and Co-payments: For example, a reduction in end-of-life benefits or the creation of a list of services that would no longer be covered. This is not popular to those who are retired and expect the same (or better) benefits than they had previously. Increase the tax rate: Tax increases are unpopular with those who are working and do not want any additional money taken out of their payroll. Further reduce reimbursements to providers: Providers have already seen decreases in reimbursement, which often no longer cover their costs. Some have stopped accepting Medicare patients or do not take on new Medicare patients. Page 7

"Get 15% discount on your first 3 orders with us"
Use the following coupon

Order Now