Week 9: Trends & Issues in Executive Management for Health ✓ Solved

The implementation of the Patient Protection and Affordable Care Act (PPACA, or ACA) was signed into law in 2010 to provide affordable health care insurance to Americans and rules for insurance companies regarding how they provide insurance. As a health care executive, you will be intimately involved with many of the provisions of the ACA, necessitating an understanding of how they are executed within your particular state. Each state was given the opportunity to choose whether or not to enact Medicaid expansion and how they would offer enrollment in ACA health insurance. The ACA is also intertwined with the new payment methodologies that you examined in Weeks 4 and 5, which are reflective of supporting population health.

Previously, hospitals were responsible for caring for patients in the hospital bed; however, with changes from the Center for Medicare and Medicaid (CMS) focusing on penalties for re-hospitalizations, hospitals now need to focus on patient care across the continuum. The ACA furthered this focus through encompassing population health, the outcomes of the health of the population, through expanded insurance coverage, improving quality of care and enhancing health promotion and prevention as well as the implementation of community-based activities.

This week you examine how the ACA has been enacted in your state, including how this may impact costs and benefits. You also compare the ACA with other states and study the connection between the ACA and population health.

Paper For Above Instructions

The Affordable Care Act (ACA) has been a significant legislative change in the United States healthcare system since its enactment in 2010. It promises to provide affordable health insurance to millions, but its implementation has revealed various challenges and disparities across different states. This paper will examine the ACA's enactment in a specific state, analyze the costs and benefits for healthcare organizations, and explore its impact on health care executives aiming to manage the evolving health landscape.

Understanding the Affordable Care Act

The ACA aims to reduce the number of uninsured Americans, lower the cost of healthcare, and improve healthcare quality. By expanding Medicaid and creating health insurance marketplaces, the ACA provides a platform for health insurance purchasing that is more affordable than traditional methods. Each state has approached the legislation with varying degrees of enthusiasm and implementation, leading to significant differences in the costs and benefits experienced by healthcare organizations.

State-Specific Analysis

For the purpose of this analysis, let’s consider the state of California. California chose to expand Medicaid under the ACA, which resulted in millions of additional residents gaining health insurance coverage. According to a report by the Kaiser Family Foundation (2021), California has seen a significant decline in its uninsured rate, dropping from 17% pre-ACA to just 7% post-implementation. This has allowed healthcare facilities to see an increase in patient volumes and a corresponding increase in revenue, though it has also introduced new financial challenges, including higher operational costs due to increased demand for services.

One example is a healthcare organization located in Los Angeles that has reported an increase in emergency room visits, not primarily due to increased injury rates, but rather due to better access to care. While this represents a success for the ACA in providing access, the organization faces challenges related to managing the costs associated with the increased service demand, such as staffing, equipment, and facility logistics.

Benefits of the ACA

The ACA’s implementation has brought several benefits to healthcare organizations, particularly in terms of improved access to care and enhanced preventive services. Financially, organizations can benefit from increased patient flow, particularly for preventive care services that may result in lower long-term costs for managing chronic conditions. For instance, hospitals that have implemented community outreach programs to educate residents about available services have observed increases in outpatient visits, which are generally more profitable than inpatient services.

Furthermore, the ACA incentivizes quality of care through value-based payment models. This shift encourages hospitals to improve their services and patient outcomes, as their reimbursement rates are linked to the quality metrics established by the ACA. As a result, the ACA is propelling healthcare executives to refocus their operational strategies toward population health management rather than traditional service delivery models.

Challenges for Healthcare Executives

While the ACA provides various benefits, it simultaneously places new burdens on healthcare executives. The legislation requires organizations to invest in systems and infrastructure that support continuous care and population health strategies. For example, executives must now consider how to improve care transitions to reduce readmission rates, as penalties for readmissions are a reality in the post-ACA landscape. The need for integrated care, that spans different settings, requires executives to bolster collaboration amongst healthcare providers, which can be complex and resource-intensive.

Moreover, the financial implications of these changes require healthcare executives to perform continuous cost-benefit analyses. The organization must balance short-term financial strains with long-term benefits that result from better health outcomes. As healthcare costs keep rising in California, managing operational efficiency and cost containment will be critical to remaining viable while meeting the needs of the patient population.

Conclusion

In conclusion, the Affordable Care Act represents a transformative shift in the American healthcare landscape. With its implementation varying widely by state, it is imperative for healthcare executives to remain informed about their specific state’s regulations and impacts. While challenges abound, the potential benefits of improved population health and the delivery of higher-quality care offer an ambitious pathway for health systems. As a future healthcare executive, understanding the nuances of the ACA will be essential for navigating the complexities of the modern healthcare environment.

References

  • Kaiser Family Foundation. (2021). Key Issues in Health Reform: The Affordable Care Act. Retrieved from https://www.kff.org.

  • DiMichele, T. (2016). Obamacare facts: Facts on the Affordable Care Act. Retrieved from https://www.obamacarefacts.com.

  • Hardcastle, L. E., Record, K. L., Jacobson, P. D., & Gostin, L. O. (2011). Improving the population's health: The Affordable Care Act and the importance of integration. Retrieved from https://www.healthaffairs.org.

  • Huelskoetter, T. (2015). 2014 census data confirm dramatic impact of the Affordable Care Act. Retrieved from https://www.census.gov.

  • Kliff, S. (2013). The cost of Obamacare varies wildly by state. Retrieved from https://www.vox.com.

  • Robert Wood Johnson Foundation. (2015). Reform by the numbers. Retrieved from https://www.rwjf.org.

  • Shaw, F. E., Asomugha, C. N., Conway, P. H., & Rein, A. S. (2014). The patient protection and Affordable Care Act: Opportunities for prevention and public health. The Lancet, 75-82.

  • Stoto, M. A. (2013). Population health in the Affordable Care Act era. Retrieved from https://www.publichealthreports.org.

  • Urban, J. (2013). How the Affordable Care Act (ACA) varies by state. Retrieved from https://www.statehealthfacts.org.

  • U.S. Department of Health and Human Services. (2015). The Affordable Care Act is working. Retrieved from https://www.hhs.gov.