Coordination versus Competition in Health Care - Literature review Example

Coordination versus Competition in Health Care Coordination versus Competition in Health Care Appropriate health care coordination is essential to ensure Accountability in improving the quality of care for every patient. According to Bodenheimer and Pham (2010), the rising challenges of providing care are due to the growing numbers of patients with both acute and chronic diseases, and the rise of healthcare charges. It is clear that most people can identify the problems brought about by lack of coordination care or poor coordination, but lack knowledge to implement the needed solutions (Baicker & Levy, 2013). There is a necessity for better health care coordination to enable efficient utilization of resources without having to increase costs (Bodenheimer & Pham, 2010). Although coordination can lead to improved quality, hospital mergers is highly monitored and discouraged in order to ensure affordable healthcare (Baicker & Levy, 2013, p.790). Baicker and Levy (2013, p. 790) note that when healthcare providers of similar services merge they can lead to increase in prices. If mergers happen among healthcare providers, then it must be for complementary services. According to Baicker and Levy (2013, p. 790), care coordination should aim at patient satisfaction without exaggerated charges on the patient. According to Burton, Anderson, and Kues (2004), adopting Electronic health record and a care management system gives the potential to organize and assimilate patient health information and ensure timely and error-free distribution among all authorized care providers. Baicker and Levy (2013, p. 790) note that, the Electronic health record (EHR) and well-implemented care management system are capable of improving coordination, dispatching the right information to the patient and avoiding unnecessary errors. The findings by Burton, Anderson, and Kues (2004) also supports this argument by Baicker and Levy (2013). According to Burton, Anderson, and Kues (2004), use of EHR can improve cordination and efficiency of service delivery. A number of studies indicate that only a small percentage of patients can account for their great spending on healthcare (Mello, et al., 2004; Fisher, et al., 2009; Bodenheimer & Pham, 2010). Fisher and his collegues (2009) point out, patients are unable to account for their spending due to poor coordination in the health care system. Poorly coordinated healthcare systems offer, poor communication, inadequate care and care providers do not spend adequate time with the patient. A competitive healthcare system have concentrated more on reducing cost and somewhat ignored the need for quality services (Porter & Teisberg, 2006). Coordination in healthcare with the proper use of technology (EHR) is critical in obtaining economical use of the limited resources (Burton, Anderson, & Kues, 2004). According to Burton, Anderson, and Kues (2004) efficient integrated care helps to minimize tension on services and leads to much more affordable healthcare. Baicker and Levy (2013) point out that care coordination plays a major role in the development of Accountable Care Organizations (ACOs) for the purpose of integrating incentives, quality measurement and accountability (p. 789). According to Mechanic (2012), the Affordable Care Act (ACA) presents Americans states with an opportunity to test new models of care delivery that improves the patients outcome and reduces on healthcare cost. CMS unveiled the final regulations in March 2012; these regulations defined the eligibility and policies necessary to achieve a system that covered individuals eligible for Medicaid and also for affordable insurance exchanges by 2014 (Mechanic, 2012). Eligibility covers the poor Americans though providing minimum Medicaid income eligibility level. The information technology system and data policy are important for promoting effective healthcare coordination (Baicker & Levy, 2013). The financing structure for information and technology provides states with tools required to invest in information and technology and promote courses such as the use of EHR in health cares (Burton, Anderson, & Kues, 2004). This model promotes the welfare of both the patient and care providers and reduces cost on both edges. Availability of improved technology by use of EHC also reduces cost by ensuring thats, tests are not repeated, and appropriate medication is administered, so the patient does not come back to the same problem. With a thoughtful design and implementation of the Affordable Care Act, healthcare coordination can enhance the patients experience, ensure the best outcome and eventually reduce unnecessary cost (Rosenthal, 2008). Rosenthal (2008) warns that, a health care system that ignores coordination is a high risk for the patients well being and in terms of cost. In a Medicare, fee for service situation, doctors are compensated for particular services; with patient visiting different doctors for a period, lack of coordination could cost a lot of money or a patients life (Cutler, 2005). According to Burton, Anderson, and Kues (2004), for improved quality and optimum result delivery, EHR needs to be incorporated in the coordination system as well as integrate primary care. Such coordination means fewer return trips to the doctor, better results, and reduced expenses (Cutler, 2005). The health sector needs to promote coordination and use of EHC or embrace technology in a great way (Baicker & Levy, 2013). The reality is that the financial system, funding streams, and competition may discourage integration. The healthcare sector should realize that as much as competition could be important, it could do little good without proper coordination. Competition can as well benefit the hospitals or the doctors while compromising on the patients experience if not well implemented (Woolf & Johnson, 2005). A culture that supports coordination and encourages innovation and economical services need to be promoted. (Woolf & Johnson, 2005) Integration does not only benefit the patient, but the health caregivers as well (Baicker & Levy, 2013). With appropriate coordination together with the use of electronic medical system referred to as EHR the healthcare provider can effectively work as a team (Hillestad, et al., 2005). Communication among caregivers in regards to dealing with the patients condition is made easier with EHR and a coordination system. The Accountability Care Organizations (ACO) provides incentives through the program of Medicare Shared Savings. The ACO clearly outlines the need for coordination for the Medicare patients. Patients who use services such as Medicare deserve to have a coordination care because different physicians often serve them. Without effective coordination care, it is possible to have a communication breakdown between patient and the physician that could cause harm to the patient (McPherson, Headrick, & Moss, 2001). Lack of a coordination system can also make the physicians work much more complicated since the physician could miss important patient details. Furthermore, without well-coordinated system and EHRs that a physician can use to refer, it can lead to a misdiagnosis that eventually adds to the patients cost (Cutler, 2005). Patients utilizing a Medicare model are guaranteed to receive improved treatment at a better cost. With coordination care and EHR, patients are going to have far more power over their health decisions and associate closely as partners with doctors come up with the best choice for their conditions (Hillestad, et al., 2005). Patients will be in a position to obtain doctors quality care standard record and have the ability to pick a doctor of their choice. Coordination, therefore, ensures improved patient and caregiver experience, patient safety, reduced cost and many other benefits. Spending on healthcare in the United States has witnessed a major rise; this rise could be largely attributed to chronic health conditions (Cutler, 2005; Bodenheimer & Pham, 2010). Baicker & Levy (2013) emphasize that poor coordination that leads to poor communication, inadequate care and missing information is the root cause of wasteful spending that can be avoided with improved coordination. From this argument by Baicker and Levy (2013), it is evident that health care coordination is adequate for attaining the best patient outcome and expenditure reduction. Cutler (2005) also note that cordination care gives room for performance evaluation; leaders can evaluate the quality of performance in different sectors in a health setting. Evaluation can also be done within regional, local and national levels to ensure there is a standard quality delivery. Designing and implementing the appropriate healthcare evaluation and quality coordination tools such as EHR will lead to enhanced patient care, controlled cost and efficient results (Baicker & Levy, 2013). Techniques aims at minimizing healthcare expenses through coordination care such as EHR continues to be developed to deal with the high-cost problem. EHR and health information exchange are made to make sure the physician can access the patients history including previous illnesses, medication, laboratory test and result and any other important information (Bodenheimer & Pham, 2010; Mechanic, 2012). An effective care coordination mode gives the patient a chance to participate in in their health plan shaping (Baicker & Levy, 2013). A perfect example is Wisconsin Supplemental Security Income Managed Care Program aimed at integrating medical care, social services, and coordinate care; the consumers were invited and advised to be a part of a set advisory committee (Simms, Dubowitz, & Szilagyi, 2000). These gave the consumer a chance to familiarize with the new design and make an informed decision. In a competitive healthcare system, the participation of the patient is often ignored giving more focus to the decision made by the physician or the caregiver. Employing coordination care and EHR enables individuals from various specialties in healthcare to contribute specialized knowledge and respond to a particular situation. Coordination care brings harmony among physicians and other caregivers in performing their roles (Fisher, et al., 2009). A suitable coordination between health professionals is possible when they can communicate effectively and access the necessary information regarding a situation (Baicker & Levy, 2013). Information and communication can only be made effective in the presence of tools that support the care coordination such as the EHR (Burton, Anderson, & Kues, 2004). EHR encourages collaborative problem-solving and high-quality care delivery that would not have been achievable for an individual. With efficient communication and flow of information, all elements of healthcare improve considerably. The advantage of coordination healthcare system does not only benefit the patients but extends to the health professionals, and all the aspects of the healthcare system (Baicker & Levy, 2013). Care coordination offers improved and total patient satisfaction, quality care, decreased medical cost, and increased the survival rate of the patient. Baicker and Levy (2013) note that health care system benefits in reduced IT infrastructure cost, proper utilization of resources, improved revenue, and more referral among others. Coordination care gives a healthcare system the ability to attend to the patient quickly, accurately, give timely information and create a reasonable payment schedule that in return improves patients satisfaction and gives better results (Porter & Teisberg, 2006). The EHRs have the capacity to improve on coordination in healthcare to provide safe and quality care for patients. Better management of patients cannot go void of Electronic Health Records. The patients need to be provided with updated information each time they visit the physician. EHR also ensure secure sharing of patients data with both the patient and other healthcare professionals attending to the patient. EHR has played a great role in permitting reliable prescriptions, guaranteeing the privacy and security of patients information, in addition to complete and accurate documentation. However, for coordination to be effective, it must be done in such a way that it does not hinder positive competition. References Baicker, K., & Levy, H. (2013). Coordination versus competition in health care reform. New England Journal of Medicine, 369 (9), 789-791. Bodenheimer, T., & Pham, H. H. (2010). Primary care: current problems and proposed solutions. Health Affairs, 29(5), 799-805. Burton, L. C., Anderson, G. F., & Kues, I. W. (2004). Using electronic health records to help coordinate care. Milbank Quarterly, 82(3), 457-481. Cutler, D. M. (2005). Your money or your life: strong medicine for Americas health care system. London: Oxford University Press. Fisher, E. S., McClellan, M. B., Bertko, J., Lieberman, S. M., Lee, J. J., Lewis, J. L., et al. (2009). Fostering accountable health care: moving forward in Medicare. Health Affairs, 28(2), w219-w231. Hillestad, R., Bigelow, J., Bower, A., Girosi, F., Meili, R., Scoville, R., et al. (2005). Can electronic medical record systems transform health care? Potential health benefits, savings, and costs. Health Affairs, 24(5), 1103-1117. McPherson, K., Headrick, L., & Moss, F. (2001). Working and learning together: good quality care depends on it, but how can we achieve it? Quality in Health Care, 10(suppl 2), ii46-ii53. Mechanic, D. (2012). Seizing opportunities under the Affordable Care Act for transforming the mental and behavioral health system. Health Affairs, 31(2), 376-382. Mello, M. M., Studdert, D. M., DesRoches, C. M., Peugh, J., Zapert, K., Brennan, T. A., et al. (2004). Caring for patients in a malpractice crisis: physician satisfaction and quality of care. Health Affairs, 23(4), 42-53. Porter, M. E., & Teisberg, E. O. (2006). Redefining health care: creating value-based competition on results. Boston, MA: Harvard Business Press. Rosenthal, T. C. (2008). The medical home: growing evidence to support a new approach to primary care. The Journal of the American Board of Family Medicine, 21(5), 427-440. Simms, M. D., Dubowitz, H., & Szilagyi, M. A. (2000). Health care needs of children in the foster care system. Pediatrics, 106(Supplement 3), 909-918. Woolf, S. H., & Johnson, R. E. (2005). The break-even point: when medical advances are less important than improving the fidelity with which they are delivered. The Annals of Family Medicine, 3(6), 545-552. Read More