Assume that you are a planner within a large healthcare system in a state that i
ID: 359019 • Letter: A
Question
Assume that you are a planner within a large healthcare system in a state that is participating in the Affordable Care Act's expansion of Medicaid coverage. You want to project the demand for healthcare services over the next ten years in the countries in which your healthcare system operates. What data will you need to model demand for healthcare services? Assume that the model you produce projects a significant increase in demand for ambulatory care visits over the next ten years. How should the healthcare system respond to these projections?
Explanation / Answer
In order to model the demand for healthcare services, we need to compare past data of the health of the individuals to the present health of the individuals and forecast the health of the individuals, of the future data . This tells us about the aging population, how fast is the population aging, their health issues and the number of deaths. Based on that, one can analyze the demand for healthcare as well as emergency and ambulatory services.
Next thing that is needed in the modelling of the demand for the ambulatory services is earning potential and healthcare costs. Since our nation’s healthcare system is predominately focused on acute care provided by physicians in healthcare facilities, it has resulted in higher than necessary healthcare costs and lower than optimal healthcare outcomes for our population. Reforming healthcare financing alone will not resolve these problems. We need innovative models to provide care earlier, more effectively, and at lower cost. These models should be developed and implemented through a collaborative problem-solving approach that uses the knowledge and resources of all stakeholders and is attentive to the varying conditions of the society.
Although the resulting healthcare models are varied, they share a number of common elements. The models employ teams of traditional and nontraditional providers; they stratify the population according to risk (medical, social, and environmental); and they use information technology to coordinate community, primary, and specialty care for some of our community’s most vulnerable populations.
Collaborating with the community to determine what services can be most effectively provided (where, when, how, and by whom) starts with analyzing the health needs and strengths of diverse communities. This should include small-area analyses of variations in disease burden and neighborhood-level clusters of illness and care patterns and the identification of institutional and community readiness for change. For effective and affordable health care, providers, payers, and patients have to be willing to use the right provider at the right time for the right level of care. The strategic and cost–benefit analyses should employ appropriate economic and health metrics and be iterative, as the needs and resources of communities change over time.