Exploring New Healthcare Models

Even before the pandemic, healthcare is vital – one that is required for any community to work optimally. However, like any other aspect of human endeavor, there is still room for improvement in how health is provided to those who need it. 

While the model of healthcare delivery in place has led us into a moment when almost everyone has returned to their current state pre-pandemic, we cannot argue that much effort and sacrifices had to be made to get here. 

Today, healthcare providers are looking for new models of service that will provide a higher efficiency level without going through all the rough patches the current system has been. With a better model, they can create a “new normal” in healthcare delivery that can better address present and future health problems. 

This article will discuss the current healthcare delivery system model and alternative healthcare models that can improve you as a healthcare provider. In the end, you will find out that traversing a new path for healthcare delivery can be more rewarding than it is dreading. 

Healthcare organizations will notice more flaws within current care settings. 

The pandemic came with little warning. No matter how advanced your organization is, no one came out unscathed in the wake of this unforeseen event. As the dust settles and everyone gets back to their feet, it is evident today that COVID-19 has affected the healthcare system by showing flaws within the current healthcare model. 

Present Healthcare Model: Fee-for-Service 

Present in almost all organizations is the fee-for-service model. Within this model, physicians are given incentives following the number of tests given to patients and the number of interventions that patients undergo to achieve a better state of health. 

However, this concept contradicts the idea of providing optimal care as the main goal of every healthcare institution. It is because providers can dish out duplicate tests or unnecessary procedures to certain patients while other procedures and medications will be neglected – yet providers will be paid all the same. 

As Third Way, an organization focused on social reforms, stated:  

• Almost 14,000 patients who have undergone knee replacements experience unwanted adverse effects (heart problems, infections, and others) every year because of the procedure.  
• Unnecessary duplication of CT scans costs about $11.95 billion per year, which also burdens patients’ bodies with unneeded radiation exposure.   
• Underuse of blood pressure medication leads to hospital admissions costing $3 billion per year.  
• Lack of use of inhalers brings complications to otherwise controllable medical situations, costing hospitalizations up to $2.5 billion per year.   

These pieces of evidence show that within a fee-for-service model, patients experience financial burdens, all while receiving subpar medical aid. As these studies show, it is best if healthcare is paid based on the outcome patients exhibit instead of the input from providers themselves (tests, medications, and procedures, among others). 

More organizations will look for improvement models in healthcare. 

As more people find faults within established systems, healthcare leaders and providers continue to look for more effective methods to address health provision issues. This only proves that healthcare innovation is important, especially today, with all the changes in healthcare due to COVID-19. 

The following are rising care models that can help you respond to national healthcare trends that will inevitably come next. 

Alternative Healthcare Models  

Value-based Care Model  

This healthcare model proposes an approach where providers are incentivized whenever their patients receive better treatment. Value-based care uses data analytics to determine if patients had undergone hospital readmissions or had experienced better health quality from their last physician visit. 

This healthcare delivery model rewards health professionals and organizations for better patient outcomes. Insurance companies also increase profit as they will be partnered with more healthcare organizations to finance procedures while patients receive appropriate treatment. 

As observed by Aetna, a US health insurance company, a value-based care approach to healthcare delivery reduced inpatient admissions by 14 percent, increased consumption of generic drugs by four percent, and reduced visits to the radiologic laboratory by nine percent. 

Accountable Care Organizations  

This health care delivery model is a modification of the value-based care model, although it focuses on interrelationships between patients and healthcare providers. For example, with the patient’s help, their primary care physician can determine if their physical, mental, or emotional aspects need medical intervention. 

Once determined, their physician will get in touch with the patient’s care partner (nurse practitioner or social worker) and other medical homes that will facilitate the aid required for every patient. This connection will ensure patient needs are duly met, which in turn will incentivize providers for effective care. 

As American Hospital Association counts, 1,783 community hospitals within the US are currently practicing this healthcare model. Additionally, as Artemis Health proved, accountable care organizations encourage the prevention of diseases as the rate of patients who undergo breast cancer screening reached around 55 percent compared to non-ACO patients at only around 47 percent. 

Bundles  

A bundled healthcare delivery system focuses on cost-effectiveness and the increased financial risks on the part of healthcare providers. Through this model, surgeons, nurses, and other professionals within organizations will be reimbursed by government or private insurance companies per a fixed price mandated before an “episode of care,” the duration when medical aid of any kind is given to a patient. 

Healthcare professionals must ensure that they only perform what is necessary for the patients’ betterment. This is because if they exceed the given budget, their organization, and even they themselves, will have to shoulder the excess bills. Conversely, they can keep the remaining resources if they cut expenses without compromising quality care. This encourages healthcare providers to be precise with actions and frugal with the payer’s finances. 

As per American Hospital Association, there is a gradual shift to this healthcare model because, as of 2020, 954 community hospitals within the US are currently implementing it. According to Altarum Institute, hospitals that decided to shift to a bundled payment model did not compromise quality care yet reduced costs by $3,286, while hospitals that did not shift reduced costs only by $2,119, with the same quality of care. 

Capitation Model  

Within the capitation model, insurance companies pay healthcare providers in advance. The payment given differs according to patient demographics. The finances will then be used to either cure current medical problems or prevent future complications. If physicians and other health professionals maintain control over their patient’s health, the costs with which medical aid is reduced can be converted into incentives that these professionals can keep. 

The point of the capitation model is to ensure patients are well taken care of in such a way that they would not require hospitalization or more invasive procedures to reach a better state of health. However, if they did require a higher level of care, the same physicians and professionals who took care of them beforehand will shoulder every expense outside the formerly given finances by the insurance company. 

As per Health Affairs, the capitation model greatly affected Medicare hospital costs in Maryland, US, as it showed a reduction of $429 million in 2017. In addition, complications were also reduced by 48 percent, while hospital readmission rates decreased by 57 percent within the same model. 

Flexibility and Adaptability: From Providers, For Patients 

These healthcare models propose the elevation of care given to patients without dismissing the efforts of healthcare providers. While each has its advantages, the country continues to find and incorporate systems that will best benefit patients and providers. 

As your organization adapts to changing demands within the healthcare community, be reminded that there is no perfect system. Even with these healthcare models, nursing practice struggles and other problems will still arise. However, your resiliency can best be partnered with a workforce willing to go the extra mile in providing primary care practice for patients who need it most. 

Along with flaws in the system, numerous conditions continue to exist. Chronic illnesses and other novel diseases could be the next medical issue. But with your help, practices and professionals within your organization can combat any circumstance. 

FIND THE BEST HEALTHCARE PROFESSIONALS READY TO ADJUST TO CONSTANTLY CHANGING HEALTHCARE MODELS.  

Juggling organizational goals with the demands of reforming the healthcare system will be difficult. However, the balance between two contrasting ideas can be dealt with only by great leaders and an even greater workforce. This is where a staffing agency comes in handy. 

PRS Global provides not only these ideas but moreover the manpower to perform said tasks. We provide competent healthcare nurses compatible with every healthcare organization. Our candidate selection process is thorough, ensuring every nurse is equipped with the consistent urge for learning and growth. Most importantly, we deploy healthcare professionals with the highest calling for care. 

If you seek competitive nurses who are flexible to adjust to changing healthcare demands, look no further. Contact us today, and let us start creating a more robust workforce for you!