Characteristics Of An Organization Health Care Provider

It is often recommended for (HCO)’s to have a corporate compliance plan to be more efficient, reduce errors, and not have small errors turn into large errors. As (OIG) it’s a necessary and fundamental need to incorporate a corporate compliance plan to have for staff and management to stay organized and lessen the chance of fraud, waste, and abuse in the company. Stated by, (Cleverly, Song, & Cleverly, 2011), it is effective only if it includes management support, effective communication, continuous monitoring, and individual accountability. All these aspects are a continual monitoring requirement as long the corporate compliance is in place for the duration.

H.R. 6261promotes the utilization of not only primary care services provided by Accountable Care Organizations (ACO’s) physicians, but also those provided by other ACO such as nurse practitioners, to increase patient access to quality care while reducing costs in underserved areas.

When establishing a health agency, there are specific requirements established by the government and professional agencies that we have to adhere to. In addition to state or county rules, there are federal rules and non-government standards that apply throughout the field, regardless of location. These regulations affect both your organization’s revenue and license to provide services.

The Accountable Care Organization (ACO) are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high-quality care to their Medicare patients (McCarty, B., 2016). For example, Medicare Shared Savings Program was created by The Center for Medicare & Medicaid Services to monitor and establish that all ACO’s are meeting the quality performance benchmarks and reduce Medicare spending by certain percentages (H., 2017). The growth of ACO’s from 2011 to 2016 is astonishing, in 2011 there was 64 ACO’s and by 2016 they have risen to 838 in the U.S. (H., 2017).

Hospitals should be encouraged to participate because improving hospital care is likely to be essential to success (McClellan et al, 2010). Accountable care organizations can be implemented through different payment models. These could include opportunities to share in demonstrated savings within a fee-for-service environment, in which providers took on no new financial risk. They could also include limited or substantial capitation arrangements, in which payments were unrelated to the volume of services provided, to the intensity of service use, or to the frequency of face-to-face meetings, and in which providers took on some financial risk for poor-quality results or failure to control costs (McClellan et al,

In the past few years the American health care system has changed in many ways. First there was the passage of the Affordable Care Act, which is a law that is giving Americans the opportunity to obtain health care. Under this new law, in 2011, the Department of Health and Human Services decided to create Accountable Care Organizations (ACO) to help doctors, hospitals and other providers better coordinate care (AthenaHealth.com). The first idea of an Accountable Care Organization was brought up in 2006 by Elliot Fisher, MD, and now there are over 400 in the United States (Healthcatalyst.com). An ACO’s primary job is to improve health care delivery, performance, and payment. This is done through physicians and

​Kaiser Health News recently published an article on a new trend in healthcare. This trend introduces the Accountable Care Organization (ACO). The Centers for Medicare and Medicaid services defines it as “groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients” (“Accountable Care Organization,” 2015). According to the Affordable Care Act (ACA), the goal of the ACO is to be able to share health cost-savings with providers who are able to save money by eliminating unnecessary procedures and reduce health costs while increasing quality of care. ACOs make health professionals become more accountable in maintaining good-quality, coordinated healthcare for a patient through a value-based system that is evaluated through a number of criteria and benchmarks (Ronai, 2011).

A healthcare organization such has a private hospital are classified as non-profit or for-profit institutions. According to Alliance for advancing non-profit healthcare; “ About 60 percent of community

Organization such as “Accountable Care Organizations”4 is one of the ways to ensure the quality of care for Medicare patients. The organizations combination of doctor, hospitals, and other health care providers who came together to ensure the quality of care for Medicare patients. This will help with effective communication with patients and clinicians, and help avoid medical

Nonprofit health care organizations are primary responsible and accountable to the communities and populations they serve. They are legally and ethically bound to do good for the benefit of their communities. Their governing bodies are comprised of leaders from the communities they serve. The earnings and reserves of nonprofit health care organizations are reinvested to benefit the community.(1).

The National Committee on Quality Assurance set the “gold” standard on health plans and their quality ratings. There was no other regulatory agency to oversee the health plan upon its initiation. Now we have other organizations; however NCQA provides the most stringent, ridged regulatory guidelines of the managed care organizations. In order for a health plan to do business with CMS, or state agencies, and to the public; they must show they meet NCQA guidelines. Health insurance has become a hot button topic with ACA and CMS. The Organization was established to set the tone of quality in the health/managed care environment. There are other governing bodies such as HHHAC for ambulatory centers and dome care URAC another nonprofit organization, who reviews health plan, clinical integration, health care, healthcare accreditation. Also AAAHC accreditation means that a health care organization meets or exceeds nationally-recognized Standards for quality of care and patient safety

The American health care system has been victim to an escalation in the prices of health care services juxtaposed with inefficiency in delivery of care services. There has even been cases where State spending on the actual health care increased dramatically in the United States and one of the key components of curbing this problem which has been prevalent over the mass media and has been a major discussion among physicians is the advent of Accountable Care Organizations. Accountable Care Organizations (ACOs) is structured with the goal of trying to improve health care delivery and aid in the reduction of the overall cost of services (Weissert & Weissert, 2012). If there is insufficient coordination of high quality care delivery in the health care industry, this will have a negative impact on patient safety and diminish affordable care for patients. Hence, the development of ACOs is envisioned to be the savior of medical practices and can improve the overall fabric of the American society (Bresnick, 2013). ACOs serves as one of the answers for curbing the problem of high costs, low quality care and possible segmented delivery and as much as it serve as the major determinant for improvement in patient satisfaction, there are minor

1. Describe the qualities, skills, talents, and experiences of a good health care practitioner. How do you exhibit them?

Healthcare professionals are faced with making multi-faceted decisions on a daily basis. These decisions are not just limited to clinical matters, but they include the total patient care experience. Because of emerging healthcare trends and complex health law and ethics, it is imperative that healthcare administrators have a professional organization that they can belong to. “The

This paper seeks to look into organizational behavior in health care management and most importantly its impact on health care management and delivery. Organization behavior is crucial in guiding the regulatory activities, the staff activities and the overall culture that directs an organization. Organizational behavior in health care setting is paramount to ensuring patient safety, ethical behavior among the medical practitioners, patient-centered care and effecting change in the facilities which is bound to improve healthcare delivery and patients’ satisfaction. The strategic management of any health