Medi-Cal Reimbursement Analysis

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The effect of ACA with reimbursement for service provided in primary care has had to come across changes on the way the payment is process for their services. In the past, the hospital has received waivers from federal to reimbursed expenses that were spent to the uninsured patients without criteria. However, with the new healthcare reform, ACA the reimbursement will be based on the patient outcome and quality of care. “The Medi-Cal 2020 waiver opens the door to innovative changes in the way Medi-Cal provides services to its members, all with the goals of improving efficiency, access and quality of care.”(Williams, 2015). This reimbursement also helps primary care physicians to increase its importance by providing 10% bonus. The ACA is main …show more content…
“An important first decision is to work to understand critical and actionable aspects of the problem. To improve health care and health, the hard and joyful choices necessary to reduce fragmentation await our thinking and acting differently.” (Stange, 2009, p. 101) With the implementation of ACA, the care coordination of the patient will be achieved using the Patient-Centered Medical Home model (PCMH). The ACA inquire the primary care to provide high quality care with PCMH model being implemented patient will be assigned to primary care provider to care for them, then if specialties is needed referrals will be utilized. This communication between primary and specialist provider will allow them to coordinate care more efficiently and faster service is provided can result to early intervention and better patient outcome. In addition, Coordinated Care Initiative (CCI) aids the government health care to organize a program that will help coordinate patient care at the same time will be cost efficient that resulted to Cal MediConnect. “Cal MediConnect Program -- aims to create a seamless service delivery experience for dual eligible beneficiaries, with the ultimate goals of improved care quality, better health and a more efficient delivery system.”("Dual Eligibles Coordinated Care …show more content…
Well functioning primary care management requires sufficient provider, the research predicted that shortage of provider in primary care would be inevitable. “Combined with an aging population, the influx of nearly 32 million newly insured people into the U.S. health care system by 2016 — a direct result of the Affordable care Act — will lead to an unavoidable consequence: a shortage of primary-care physicians”(Troxel, 2013) To withstand a proportion patient and physician ratio, one of the approach that needed is the team based care method. “The team-based approach provides roles for nurses for which they are uniquely prepared. The approach is highly collaborative and requires excellent communication skills on the part of all the team members,”(Masterson, 2014). Also, Team base model has shown improvement in patient satisfaction and able to maintain the care as patient centered. This model also provide individual with different entities to play the roles and take responsibility in patient care. For example, In primary clinic physicians may share the patient load to Physician Assistants (PA) and Nurse Practitioner (NP) and practice within their scope, then the reminding task that PA and NP is unable to perform due to their title will be provided by the physicians, with this model responsibilities and workload is shared and

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