Innovation Model In Healthcare Organizations: History, Strategic Reasons, And Implementation Strategies

History

The report give a brief description about the innovation model that include a new service delivery payment models. The establishment of Innovative Center by section 115A for a Social Security Act has created by Congress. The purpose behind the Innovation Center is to test the innovative payment and service delivery models that could reduce the expenditures of the program which could enhance and preserve the quality of care for those who receive the benefits of Medicaid, Child Health Insurance Program or Medicare. The duration and scope of the model has been tested through rulemaking on the basis of nationwide. The model may either increase the spending in the quality of care or reduce the spending in the quality of care (Jain & Shrank, 2014). It integrates insights on care delivery redesigning progression, health information technology, performance-based incentives and practicing claims data sharing.  

The design of Center of Medicare & Medicaid Innovation model is to provide a four-year multi-player initiative that is needed for primary care. With the launch of CPC in the year October 2012 it has collaborated with the state health insurance and commercial plans. The Center of Medicare & Medicaid Innovation was the creation of Affordable Care Act that test the service delivery and innovative payment models. This model helps the Center to reduce the expenditures for enhancing and preserving the quality of care (Rajkumar, Conway & Tavenner, 2014). Those are for the beneficiaries of Medicaid, Medicare and Children Health Insurance Program. The individual payers have invested in primary care without any payers of having critical mass, having primary care investment which cannot provide fund. The new payment and service delivery models develops an Innovative Center when required a section 1115A Social Security Act. Designed the CPC that will address the collaboration of multi-payer for highest payment models that has sufficient funding have interest from national payers (Perla et al., 2018). Currently, the practice has been carried on in Colorado, Arkansas, Greater Kansas and Missouri, Hawaii, Michigan, Louisiana, Nebraska, Montana, North Dakota, New York, Ohio & Kentucky, Oregon, New Jersey, Oklahoma, Pennsylvania and Tennessee.  The highest market collectively penetrates their model of payment that have a practice of inviting for participating and delivering a health care services. The process having competitive application in the regions which uses health care information technology, with the ability to demonstrate primary care delivery to improve the transformation practice.

A critical role is played by the Innovation Center that can implement the Program of Quality Payment for Medicare Access and Reauthorization Act of the CHIP of 2015 (MACRA) that could replace the formula of Sustainable Growth Rate of Medicare for paying to the physicians and service provider (Scanlon et al., 2016). The new program has clinicians that provide incentives for payments with sufficient extent that have Advanced Alternative Payment Models (APMs). There are specific criteria for the Advance APMs clinicians that accept the risk for the outcome of the cost and quality of the patients. Clinicians’ consultation work with Innovation Center that could increase the models number and variety for rural areas and small practices.

Strategic Reasons for Healthcare Organization

The evaluation of innovation center that was conducted for each payment and service delivery model have stated the measure for evaluating each quality of care for analysis of the model (Davis et al., 2015). The evaluation is rigorous for each model that provide frequent feedback for quality improvement to learn and understand the essential health system for efficiency and improvements that are possible for new payment model. The actionable feedback get deliver based on the performance and providers get encourages when participating to use the performance that could continuously improve the outcomes.

The practice need to enter more than one tracks that will develop and receive the structure of payment. There are two tracks for practice that have advance care delivery and payment options that could meet the needs of practicing the primary care for the United States. The tracks are of two type, one is the financial support and the other is the comprehensive care as it dictate the capabilities of practicing the care delivery and receive the structures of payment (Reddy et al., 2017). The tracks that are involve in practices have changes in the care delivery. The key functions of Primary Care include, 1) Patient and Caregiver Engagement, 2) Access and Continuity, 3) Coordination and Comprehensiveness, 4) Population Health and Planned Care and 5) Care Management.

For comprehensive primary care delivery three elements of payment are included:

• Performance-Based Incentives Payment: The total cost for a care measures the utilization, clinical quality and patient experience are perform to practice well. There is a reconciles of performance-based incentive on annual basis along with CPC (Zivin et al., 2017).
• Fee Schedule Medicare Physician Payment: The bill need to continue and the payment need to be receive from the Medicare FFS for Track 1. For Track 2 bill continue as usual with practices, however reducing the FFS payment that could account to shift the CMS shifting for the payments of Medicare FFS in a lump sum amount (Dorr, Cohen & Adler-Milstein, 2018).
• Care Management Fee (CMF): The tracks have paid per-beneficiary-per month (PBPM) Medicare on a quarterly basis (Sharma & Grumbach, 2017). For every practice the amount of risk adjusted to account the intensity of giving the services for care management with specific population.

The test for every new payment model or new service delivery provide a platform to ensure those plans of action to learn the lesson and identified the best practices which spread the test widely with possible support and improve the health care system. The providers participate in sharing the evaluation results that promote for more rapid learning (Howell, Conway & Rajkumar, 2015). The models have created a learning collaborative that provide broad and rapid dissemination of evidence and have best practices to potentially deliver quality that are higher with low cost for beneficiaries of Medicaid, Medicare and CHIP. The service delivery and innovative payment models determines the appropriateness of the expansion that are associated with success receive the info about the policies.

The model got a learning collaborative for the model of Innovative Center for the stakeholders that designs the individual models, provides webinars and develop a model to facilitate the communication (Hirsch et al., 2016). The stakeholders are welcome by the Innovation Center to input the ideas and concepts that could direct the future. A new model design is approach for the innovation center and develop consistently with the existing initiatives. 

Payment Model chosen as a CMS practice

The potential assets and barriers for the CMS payment and delivery models are

1. The physicians, hospital and other clinicians participants that follow this model has a voluntary community-based organizations were the model design, scope and implementation are getting influenced with the need of the partners to engage with (Bishop & Casalino, 2015).
2. The design of the model foster multiplayer participation. The finances of CMS has a portion with delivery in the health care within the United States. The aims gets achieve by CMS to work with the payers and align the incentives.
3. The models of CMS will not get static as the intent of the design for CMS changes incrementally. The incentive and interventions structures is learned for the performance models. There are feedbacks and systems for learning that are embedded into the design to adapt and meet core objectives (Spencer, 2018).

The barrier could be overcome with the financial incentives by which it could reduce costs of the hospital, specialty care, readmissions and utilization that are excessive to make the challenges more for the providers and then maintain the compensation level for the traditional arrangements (Bazemore et al., 2018). The coordination in care provides a robust data analytics that could work effectively. There are more advanced integration in the health systems and there are capital available for better position that makes the investments necessary and increases the success within the framework that provide infrastructure with limited coordination.   

The recommended safety practices that are identified with the planned or unplanned EHR for the clinicians or other users of the EHR mostly cannot access the part of it. Due to failure in software and hardware infrastructure and also in the power outages and those of the man-made and natural disasters, there is an introduction of safety risks substantially unavailable for the organizations that have not prepared adequately. For the implementation of Recommendation Practice Worksheet that will print and enter information for self-assessment. It required the needs for some follow-up activities were the name of the person is enter. It provide information that help in evaluating the implementation level. It would contain a section list as examples for useful practices that contain scenarios with assessment and implementation having specific recommended practice.

Hardware are duplicated for the operation of the organization’s that runs the critical applications. There is an availability of electric generator with sufficient fuel that is needed to support the power outage of the EHR. The key functions of the EHR are available in the paper forms during the downtimes. The checklist contains the data of the patient and configurations of the software application that are critical for the operations of the organization. The policies and procedures of the patient identification are accurate at the time of preparing for or during or after the downtimes. There are trained and tested staff on downtime were it follow the procedures for recovery. The strategy for communication does not rely on the infrastructure of the computing that exits during the recovery periods and the downtime.

The EHR downtimes follows the written policies and procedures for the recovery processes that ensure the operations continuity that could safe the patient care and operations that are critical for the business. The EHR system that is live or production and is clearly differentiated to maintain the back up and read-only EHR system for the user interface. The strategies for prevention of ransom-ware are trained for the users that include the identification of malicious emails. The events of EHR downtime could be prevented and managed in place of monitoring strategy and comprehensive testing. It would address and identify the functional system downtimes proactively. The extended system that are unexpected are review for downtimes that is greater than 24 hours with the use of root-cause analysis with similar approaches. The appendix A provide the screenshot of the Recommended Practice Worksheet.

Internal Analysis

The Contingency plan implemented over here allow the electronic billers and provider to continue temporarily and send claims that are pre-HIPAA electronic format, requests for a claim status, and eligibility request of the beneficiary and send remittance advice temporarily, claiming for the responses of the status, eligibility responses of the beneficiary and transaction benefit coordination in the format of pre-HIPAA electronic (Sittig, Gonzalez & Singh, 2014). The claims that are made electronic are send to Medicare for durable medical equipment, fee-for-service carriers, or fiscal intermediaries and complying the implementation guides that are adopted as national standards and are rejected back with sender for standards of HIPAA. The electronic data interchange (EDI) contains a directory with a Medicare contractors. The announcements for claiming the inbound electronic are expected to be posted. There are more than one format of pre-HIPAA electronic that are encourage for transition of full usage with HIPAA standards and avoid the loss of electronic access in order to submit Medicare data or transaction data receipt from Medicare.

With HIPAA it could easily focus on the safety of the patient. The rule of HIPAA Security have standards and implementation specifications that ensure integrity, confidentiality and make available of health information that are protected electronically (Dolgin et al., 2016). Since the rule of the security differ, it will not equate the HIPAA compliance.

Conclusion

From the paper it is concluded that the evaluation of innovation center that was conducted for each payment and service delivery model is successful. The barrier has been overcome with certain recommendation. The rule of HIPAA Security create a contingency plan with a safety-oriented practices. There is a SAFER Guide for the self-assessment along with the contingency planning for HIPAA compliance for data protection and safety. 

References

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