Capella University Health & Medical Memorandum

Develop a two-page memo to help relevant stakeholders at Vila Health’s St. Anthony Medical Center better understand traditional and emerging reimbursement models.

Introduction

Note: This assessment uses the following media as the context for developing the reimbursement model memo. Review this media before you submit your assessment.

• Vila Health: Investigating a Readmission.

Basic understanding of the reimbursement system requires one to appreciate the size and scope of the system, the complexities associated with the system, and the various subsystems and payment rules associated with health care reimbursement and finance. As a dominant player in the health care sector, the U.S. federal government is the largest single payer for health care services. As a result of its size and dominance within the system, any changes made by the federal government regarding its reimbursement of health services profoundly affect those who are rendering the care, including providers, other payers, and the health system overall. In addition to government-sponsored health insurance, various other forms of health coverage, generally tied to employment as a benefit, were introduced in the United States to help offset the expenses associated with the treatment of illness and injury.

In an effort to address concerns within the U.S. health system regarding cost, access, and quality, Congress passed the Patient Protection and Affordable Care Act (PPACA or ACA) in 2010, with President Barack Obama signing it into law. Components of the PPACA included making health insurance coverage affordable, expanding Medicaid coverage, and improving quality while controlling costs. To this end, the ACA required the Centers for Medicare & Medicaid (CMS)to promote the concept of the accountable care organization (ACO) through a shared savings plan driven by a triple-aim approach. In addition to the ACO, the ACA required CMS to implement value-based purchasing programs that would reward hospitals for the quality of care they provided to enrollees.

As the recipient of the largest share of Medicare funds, the new value-based purchasing approach measures hospital performance using four domains:

1. Clinical care.
2. Safety.
3. Efficiency and cost reduction. 
4. Patient experience of care (Casto & Forrestal, 2019, p. 274).

Each measure scores the hospital performance achievement as well as their performance improvement.

As a health care sector employee, understanding the complex U.S. health care reimbursement system allows one to serve as a reference to internal and external stakeholders, family members, and organizational departments whose needs often require a working knowledge of how the system is financed. 

In this assessment, you demonstrate your understanding of traditional and emerging health care reimbursement models by composing a memo that outlines the characteristics and differences between reimbursement models. This memo targets relevant stakeholders from the Vila Health media simulation based in St. Anthony Medical Center.

Reference

Casto, A. B. (2019). Principles of healthcare reimbursement (6th ed.). AHIMA Press.