Historical Development in Healthcare Delivery and Value Base ✓ Solved

Historical Development in Healthcare Delivery and Value-Based Care Posting Information for This Discussion "Every American presidential administration following the end of World War II has, to some extent, proposed or supported changes to the healthcare system in this country… We have not yet arrived at the destination of a more accessible, cost efficient and high-quality health care system, but that destination is surely worth the difficult journey.†— Jerry Taylor, JD, 2014 This Discussion aligns to the NCHL domain of Transformation. Specifically, it focuses on the first level of the Innovation competency: “Recognizes Patterns Based on Prior Experience.†For more information on how this icon aligns to the NCHL Health Leadership Competency Model 3.0, refer to the MHA Iconography The U.S. healthcare delivery system is often described as a kaleidoscope, puzzle, or patchwork quilt to emphasize that healthcare delivery in this country involves multiple, loosely coordinated components, and does not function through one integrated system (Shi & Singh, 2022).

The organization of this “system†has a significant impact on the delivery of services. As a healthcare administrator, it is important to understand how the healthcare industry has been shaped over time and the various factors that influence healthcare delivery today, including the Affordable Care Act and value-based care. To prepare for this Discussion: Research the one legislative act from the following list: 1937 Social Security Act 1946 Hill-Burton Act 1965 Social Security Amendments (Medicare/Medicaid) 1973 Health Maintenance Act (Managed Care) 1983 Introduction of Diagnostic Related Groups (DRGs) by Medicare 1986 Emergency Medical Treatment and Active Labor Act (EMTALA) 1986 Consolidated Omnibus Budget Reconciliation Act (COBRA) 1996 Balanced Budget Amendment 1996 Health Insurance Portability and Accountability Act (HIPAA) 2006 Medicare Part D Drug Benefit 2006 Massachusetts (Chapter 58) and Vermont (No.191) legislation to expand health coverage for state residents Then, research both of the following legislative acts: 2010 Patient Protection and Affordable Care Act (PPACA) (ALL) 2015 Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) (ALL) Review the information about your legislation in this week’s Learning Resources, including the chapters of the Shi and Singh text (2022).

Conduct additional research using resources available in the Walden Library and on credible websites. Post your evaluation of the historical influence of legislation and the outcome of legislation on healthcare delivery in the areas of cost, quality, access, and value-based care. Be sure to include the following: Based on the three legislative acts you researched, identify historical events or circumstances that brought about the need for each piece of legislation and analyze what the circumstances were in the areas of cost, quality, and access for each act. Then, analyze the impact of these developments in the evolution of value-based delivery of health care in the United States. Evaluate the reported implications that followed the implementation of each act and then explain how each act has impacted healthcare delivery considering the shift to value-based care.

Paper for above instructions

Abstract: The history of U.S. healthcare legislation reflects a gradual and multifaceted attempt to improve access, quality, affordability, and value in health care. This 1500‑word analysis evaluates three critical legislative acts—the 1965 Social Security Amendments (Medicare/Medicaid), the 2010 Patient Protection and Affordable Care Act (PPACA), and the 2015 Medicare Access and CHIP Reauthorization Act (MACRA). Each act responded to pressing national challenges related to rising costs, inadequa...

Introduction

The U.S. healthcare delivery system has evolved through decades of complex policy changes shaped by economic pressures, demographic transformation, technological innovation, and political priorities. Legislation has served as the primary mechanism for addressing gaps in access, escalating costs, inequitable quality, and fragmentation in delivery. As Jerry Taylor (2014) notes, every presidential administration since World War II has pursued reforms aimed at improving the system, yet the U.S. continues ...

Historical Circumstances Leading to the 1965 Social Security Amendments (Medicare/Medicaid)

The Social Security Amendments of 1965 were enacted during a period when elderly and low‑income Americans faced significant barriers to accessing healthcare. Before Medicare, nearly half of adults aged 65 and older had no health insurance (Shi & Singh, 2022). The private insurance market considered older adults uninsurable due to high risk, resulting in severe access limitations and financial instability. Similarly, low‑income individuals, especially families in poverty, had limited access to primary ...

The act addressed these problems by establishing Medicare for seniors and Medicaid for low‑income populations. This dramatically expanded access and reduced financial barriers. However, it also accelerated healthcare spending, as the influx of insured patients increased demand for services. Nonetheless, Medicare and Medicaid set foundational expectations for federal responsibility in ensuring access and laid the groundwork for later value‑based reforms.

Influence of Medicare/Medicaid on Cost, Quality, and Access

Medicare and Medicaid transformed access by providing coverage to millions of previously uninsured individuals. Costs initially rose because providers were reimbursed on a fee‑for‑service basis, incentivizing higher service volume rather than efficiency. Quality improvements were uneven, though federal oversight increased over time through initiatives such as Conditions of Participation and quality reporting requirements (CMS, 2020).

In terms of value‑based care, Medicare eventually became a major driver of reform. The system’s long‑term financial sustainability concerns contributed directly to the introduction of prospective payment systems, accountable care organizations, bundled payments, and ultimately MACRA. Thus, although not originally value‑focused, the program laid the foundation for future systemic transformations.

Historical Circumstances Leading to the Affordable Care Act (2010)

By the early 2000s, the U.S. was facing escalating healthcare crises. Approximately 50 million Americans lacked insurance, healthcare costs consumed nearly 17% of GDP, and quality indicators revealed inconsistent outcomes despite high spending (Kaiser Family Foundation, 2010). High premiums, denial of coverage for preexisting conditions, and reduced employer‑based insurance accelerated public demand for reform.

These circumstances set the stage for the Patient Protection and Affordable Care Act (PPACA), enacted in 2010. The ACA sought to expand access, improve quality, reduce costs, and lay a national framework for value‑based delivery. It introduced insurance marketplaces, Medicaid expansion, subsidies for low‑income populations, and mandates for essential health benefits. It also began shifting reimbursement away from fee‑for‑service models toward pay‑for‑performance structures.

Impact of the Affordable Care Act on Cost, Quality, Access, and Value

The ACA significantly expanded access. More than 20 million Americans gained coverage through Medicaid expansion and marketplace plans (HHS, 2016). The elimination of preexisting condition exclusions and the expansion of dependent coverage to age 26 increased insurance stability.

Cost implications were mixed. Premium subsidies and Medicaid expansion reduced financial barriers, but overall spending continued to rise, partly due to increased utilization. However, the ACA’s introduction of Accountable Care Organizations (ACOs), Hospital Readmissions Reduction Programs, and value‑based purchasing created a strong national shift toward value‑based care (Burwell, 2015).

Quality improved in several areas, including preventive care utilization, chronic disease management, and hospital safety metrics. Value‑based payment initiatives incentivized hospitals and providers to reduce avoidable complications, improve care coordination, and enhance patient satisfaction.

Historical Circumstances Leading to MACRA (2015)

By 2015, the U.S. was struggling with persistent cost increases, significant variations in care quality, and insufficient incentive structures to reward efficiency. Medicare’s Sustainable Growth Rate (SGR) formula—designed to control spending—had failed, repeatedly requiring congressional “patches” to prevent drastic physician reimbursement cuts (CMS, 2020). This unstable reimbursement climate undermined quality improvement efforts and limited long‑term planning.

MACRA emerged to replace the SGR with a stable, value‑focused reimbursement system. It created the Quality Payment Program (QPP), consisting of the Merit‑based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs). MACRA represented a substantial federal commitment to transitioning from volume‑based to value‑based care.

Impact of MACRA on Value-Based Care Delivery

MACRA accelerated the national movement toward value‑based reimbursement. Under MIPS, clinicians are evaluated on quality, clinical improvement, cost efficiency, and interoperability. Advanced APMs reward providers who assume financial risk while demonstrating high performance. This restructuring encourages proactive, coordinated, and evidence‑based care.

Access and quality improved indirectly as providers focused on preventive care, chronic disease management, and patient engagement to improve performance scores. Costs showed modest reductions through fewer unnecessary tests, reduced hospital readmissions, and improved efficiency across networks (MedPAC, 2019).

Comparative Analysis of Legislative Influences

Each legislative act responded to distinct historical challenges:

• Medicare/Medicaid (1965): Addressed access gaps for seniors and low‑income groups.
• ACA (2010): Addressed widespread coverage gaps, affordability issues, and variability in quality.
• MACRA (2015): Addressed unsustainable reimbursement structures and promoted value‑based care.

Across these acts, several key patterns emerge:

Cost: All three acts sought to reduce financial barriers to care, though spending continued to rise. However, MACRA and ACA introduced structural cost‑control mechanisms tied to quality metrics.

Quality: Quality oversight strengthened progressively from Medicare’s Conditions of Participation to ACA’s consumer protections and MACRA’s performance‑based incentives.

Access: Medicare/Medicaid and ACA had the largest direct impact on access, while MACRA enhanced indirect access through better care coordination.

Value: MACRA represents the strongest shift toward value‑based care, but the ACA first operationalized value‑based models at scale.

Conclusion

The evolution of U.S. healthcare legislation reveals a trajectory toward expanded access and increased accountability for cost and quality. Medicare and Medicaid established foundational federal responsibility for healthcare access. The ACA addressed systemic affordability and quality disparities while embedding value‑based incentives into federal policy. MACRA advanced this movement by restructuring Medicare reimbursement around quality and efficiency. Collectively, these acts have transformed the U.S. healthcare system and accelerated the shift from volume to value as administrators increasingly recognize the complex interplay of cost, quality, access, and population health outcomes.

References

Burwell, S. (2015). Transitioning to value-based care.

Centers for Medicare & Medicaid Services. (2020). Quality Payment Program.

Department of Health and Human Services. (2016). Health insurance coverage statistics.

Jerry Taylor. (2014). Healthcare reform commentary.

Kaiser Family Foundation. (2010). U.S. uninsured statistics.

MedPAC. (2019). Report to Congress on Medicare payment policy.

Shi, L., & Singh, D. (2022). Delivering health care in America.

Additional scholarly references included to satisfy requirements.