Public and Private Healthcare
According to Institute of Medicine (IOM), healthcare costs and quality issues have risen in the last ten years (Linsley, & Morton, 2014). Healthcare is provided through both public and private health agencies. Public healthcare agencies are provided by the government such as Medicaid. Private healthcare agencies are non-government providers such as Blue Cross Blue Shield (BCBS). Both agencies have set rules of addressing cost and quality of care to the community. This paper will address these quality issues, initiatives to improve quality care, and the implications that will affect nurses.
Private versus Public Agencies Role in Healthcare Quality/Cost Issues Both public and private healthcare agencies debate their …show more content…
This includes preventive and primary care that helps people to stay healthy and avoid a higher costs. “BCBS has health care quality indicators that provide an important tool in measuring quality of care. Indicators are based on evidence of best practices in health care that have been proven to lead to improvements in health status and thus can be used to assess, track, and monitor provider performance” (BCBS, 2015). For example, patient care is coordinated with multi-disciplinary professionals to effectively manage acute and chronic conditions. This allows the focus to be more on preventive care for better outcomes. Medicaid has designed a “care delivery and payment structure that reward coordinated, high-quality care”—referred to as Integrated Care Models (Medicare, 2014). “Several of Medicaid initiatives align with recent state efforts, including the support of chronic care management programs, investment in health information technology, coordinated and integrated care, required transparency in cost and quality information, and promotion of patient safety” (Medicaid, 2014). For example, Medicaid has a pre-determined amount for each service provided. This means the doctor or specialist cannot charge a different amount and may lose money based on what that amount is. It also allows for better care at a lower …show more content…
Medicaid participants may have difficulty in receiving specialized care and have a higher rate of emergency room visits. BCBS has unintentionally caused consequences with their fee for service reimbursement system. Doctors and hospitals are rewarded for the quantity and complexity of services instead of the quality and outcomes. There may also be a risk in the interpretation of terms used that the consumer may not understand and can be reflected in their rating that service or care (Linsley, & Morton,
According to Institute of Medicine (IOM), healthcare costs and quality issues have risen in the last ten years (Linsley, & Morton, 2014). Healthcare is provided through both public and private health agencies. Public healthcare agencies are provided by the government such as Medicaid. Private healthcare agencies are non-government providers such as Blue Cross Blue Shield (BCBS). Both agencies have set rules of addressing cost and quality of care to the community. This paper will address these quality issues, initiatives to improve quality care, and the implications that will affect nurses.
Private versus Public Agencies Role in Healthcare Quality/Cost Issues Both public and private healthcare agencies debate their …show more content…
This includes preventive and primary care that helps people to stay healthy and avoid a higher costs. “BCBS has health care quality indicators that provide an important tool in measuring quality of care. Indicators are based on evidence of best practices in health care that have been proven to lead to improvements in health status and thus can be used to assess, track, and monitor provider performance” (BCBS, 2015). For example, patient care is coordinated with multi-disciplinary professionals to effectively manage acute and chronic conditions. This allows the focus to be more on preventive care for better outcomes. Medicaid has designed a “care delivery and payment structure that reward coordinated, high-quality care”—referred to as Integrated Care Models (Medicare, 2014). “Several of Medicaid initiatives align with recent state efforts, including the support of chronic care management programs, investment in health information technology, coordinated and integrated care, required transparency in cost and quality information, and promotion of patient safety” (Medicaid, 2014). For example, Medicaid has a pre-determined amount for each service provided. This means the doctor or specialist cannot charge a different amount and may lose money based on what that amount is. It also allows for better care at a lower …show more content…
Medicaid participants may have difficulty in receiving specialized care and have a higher rate of emergency room visits. BCBS has unintentionally caused consequences with their fee for service reimbursement system. Doctors and hospitals are rewarded for the quantity and complexity of services instead of the quality and outcomes. There may also be a risk in the interpretation of terms used that the consumer may not understand and can be reflected in their rating that service or care (Linsley, & Morton,