Certification Affecting the Healthcare Innovation Initiative
One would argue that the most advanced country worldwide in providing healthcare service is the United States. The country spends about $8,000 per capita annually on healthcare, more than any other country in the world. This amount of spending is expected to increase to $11,000 by 2015. This is an increase from 16.4% to 18.8% of the GDP. U.S. hospitals are considered the most sophisticated, equipped for teaching and medical research activities. They also have the most recent medical technology in the world.
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However, despite all this spending in preparing the hospitals to provide quality healthcare, the U.S. ranked 33rd globally (Dickinson and Mannion, 2011). Factors that affect how the distribution of these funds is determined include disease treatment, which constitute the majority of the healthcare expenditure, socio-economic status, region, race and even diet. The U.S. is also ranked 1st as the most obese country. These issues were identified by studies conducted by policy makers and healthcare service providers at a macro level. The only shortcomings of the results were that their application failed to capture the impact on patients and that they do not inform decisions on when, which and how many payers should reimburse or offer treatment by health care providers (November, 2012). This paper will discuss the Healthcare Innovation Initiative and the role of health informatics.
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Certification Affecting the Healthcare Innovation Initiative
The Healthcare Innovation Initiative will see Tennessee move from a quantity based primary care payment and delivery system to one based on value and the people. The goal of this endeavor is covering 80% of lives with a value-based payment. This initiative, a multi-payer effort, will supplement the population-based models that are currently underway, which includes the existing patient-centered medical homes (PCMH) programs. The population–based models provide rewards to care givers who maintain or improve the health condition of their patients over time. These Primary Care Providers (PCPs) are also acknowledged for giving care to all their patients and proactively assisting patients who suffer from high-risk conditions. The main problem in the healthcare system us the certification process for any initiative are very long and very
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involving. The main reason for such long processes is due to the sensitive nature of the healthcare system as it involved the welfare of the health of people and hence the need to ensure that any initiative does not harm the patient but rather assists in ensuring efficient and effective service delivery. The legislation and policy guidelines for healthcare initiatives and requires approval not only from the facility but also from the relevant authorities in the healthcare sector such as the Center for Medicare and Medicaid innovation. This proved to be challenge as the initiative proposal had to gain the support in the health facility, which would then rally the relevant healthcare oversight authorities to approve it and hence avoid litigations in the future. From the experience, there is need to put in place system and mechanism, which will ensure that promising healthcare initiatives are certified within the shortest time period and allow the benefits to accrue to the patients. Further, there are many huddles in ensuring that the iniative receives the State Innovation Model (SIM) grant, where these requirements are not easy to meet and sometimes overly demanding.
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The Healthcare Innovation Initiative Influences Reimbursement
The payment system in Tennessee currently rewards numbers instead of quality and caregivers who manage to maintain the health of their patients over time. The fixed scheduling of appointments only allows for the maintenance of the patient’s health, which makes the system more inclined to treating disease rather than maintaining wellness. In addition, there is no reimbursement of efforts made by healthcare providers; apart from traditional office visits or follow-up visits by other service providers on a patient’s care team (Dickinson and Mannion, 2011). It is argued that if preventive activities were well coordinated, there would be a reduction in demand for healthcare services, which would negatively affect the income of care providers. Nonetheless, this would allow for the provision of coordinated quality healthcare. The healthcare Initiative will focus in the payment system and process and identify areas of leverage, which can ensure there is quality delivery of services as well as reimbursement processes.
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The Healthcare Innovation Initiative Influences Patient Access
When the incentives are not aligned to the current system, it is an indication that there has been a substandard investment into information technology, transformation process and personnel, which is essential for desired outcomes and the wellbeing of patients over time (Tn.gov, 2014). Primary care providers do not have any source of information in regards to patients who seek medical care from the fragmented healthcare system. Thus, they are not notified when their patients are hospitalized or discharged (Robson and Baek, 2009). In early 2013, the State conducted pilot projects before rolling out a Directed Exchange based model. To facilitate its adoption the state set up health information service providers for the state government departments, which provide medical care to over 1 million Tennesseans annually. The state also created a financial incentive program for service providers to encourage the adoption of new technology with over 3,000 licenses available.
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The State is undertaking an evaluation of the effectiveness of the ‘Directed Exchange’ and scaling up its potential of providing feedback from the participant providers. The planned healthcare innovation initiative is taunted to improve the patient access to healthcare services in the state. Access to healthcare is a basic right for every individual and hence the initiative will emphasize on measure that will ensure all people receive quality healthcare whenever they need without any favorism.
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Role of the Health Informatics Professional
Healthcare informatics refers to the method used in the optimization of health information of acquisition, storage, use, and retrieval. The tools used by health informatics include ICT systems and clinical guides. They are applied in various areas in the practice of medicine such as nursing, occupational therapy, and clinical care, among others. Clinical informatics can simply be defined as including health care information in the medical services by clinicians (Tn.gov, 2014). Their responsibilities include carrying out analyses, evaluating the design of the communication system and seeking ways of improving healthcare, while at the same time strengthening the relationship between the patient and the clinician. Other categories under healthcare informatics include community health, nursing and medical informatics.
The health informatics professional will play a major role in Tennessee if the initiative SIM testing grant for the healthcare initiative. To ensure that the initiative runs successfully during the testing period, Tennessee will launch a technical advisory group, which will provide advisory and guidance services to ensure the pilot program is a success and that it is rolled out the state. There are high hopes that the initiative will be rolled out in the whole state, where all mmajor players in the sector will synchronize their PCMH efforts, which will help in their transitions to the PCMH model. The effort will cover commercial, Medicare Advantage and TennCare payers covering over 200,000 patients.
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The main agenda for the state’s approach to health information technology is to identify areas where the demand for health information exchange exists and carry out an assessment on whether the available incentives are able to meet that demand. Health informatics push the stakeholders to plan solutions for the expansion and adoption of health information technology (Tn.gov. 2014). At the core of the State plan is utilizing information technology to serve two main purposes: improving the quality of health care services and lowering the cost to ensure accessibility. During a stakeholders meeting in the fall of 2013, healthcare providers noted that secure email messaging between healthcare providers would be useful in terms of implementing episode-based payment models, having no text character limitations and readily exchanging messages without tiresome interfaces. It can also facilitate the acceleration of the adoption of Health Information exchanges via episodes. For instance, reports on quality and payment metrics help in identifying ways of achieving a reduction of the costs of future episodes and using direct messaging to cooperate with other providers in the eventuality of an episode.
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In conclusion, the provision of good healthcare is not only important for the development of the state but of a country. Statistics show that the U.S. is the biggest spender and the most advanced country regarding the provision of healthcare services, and nonetheless, it is globally ranked 33rd, along with Cuba, when it comes to the provision of healthcare services. This shows that government spending is not enough to address health issues in the country since there are other underlying causes that are yet to be addressed. As a result, some states such as Tennessee have taken the
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liberty to start up initiatives that can address some of these problems. In this case, through the Healthcare Innovation Initiative, Tennessee has been able to make positive changes in the provision of medical services in their state. For instance, when implemented, the direct messaging tool between hospitals will help provide consistent medical care to patients, as health records would be readily accessible for their caregivers. Furthermore, there would be harmonization of the payment system. Through these types of incentives, the State is encouraging caregivers to adopt such technology.
