Healthcare administration change in how care is delivered and paid for

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It is difficult to say whether job satisfaction will increase in the coming years, but continued technological advancements designed to streamline the healthcare process offer hope to those who may be frustrated with the complexity of their jobs.

Demands on healthcare change due to various reasons, including the needs of patients. Every year, new cures and treatments help manage common diseases. Each such development affects the entire healthcare system as much as it has a positive impact on patients.

As illnesses become more common, our healthcare system must adapt to treat them. Patient care needs will also evolve as the population ages and relies more heavily on resources such as Medicare and Medicaid. Patient empowerment is expected to increase with advances in technology. The bubonic plague is a good example of a disease that can drastically change the healthcare system by quickly shifting all resources to handle an epidemic.

In the Middle Ages, the Black Death spread so quickly across Europe that it is responsible for an estimated 75 million deaths. It may be surprising that the bubonic plague still circulates today. In fact, according to Center for Disease Control data, there were 11 cases and three deaths in the U. Although the bubonic plague is not near the threat it once was, other diseases and conditions of concern are on the rise.

The following seven conditions are on the rise and can be expected to have an impact on healthcare in the near future:. The healthcare industry has identified these previous conditions, preparing to handle further increases with supplies and resources. However, a new threat is always possible. If something similar to the Ebola virus spread across the country, this would have a drastic impact on patient care and healthcare facilities. The current baby boomer generation, which initially consisted of 76 million people born between and , will be coming to retirement age and will increase federal spending on Medicare and Medicaid by an average of 5.

Healthcare technology trends focus heavily on patient empowerment. The introduction of wearable biometric devices that provide patients with information about their own health and telemedicine apps allow patients to easily access care no matter where they live. With new technologies focused on monitoring, research, and healthcare availability, patients will be able to take a more active role in their care.

From policy to patients and everything in-between, the healthcare industry is constantly evolving. Aging populations, technological advancements, and illness trends all have an impact on where healthcare is headed. Since it is crucial to pay attention to shifts in society to understand where healthcare is headed, consider dedicating time each day to reading recommended industry literature that you will find in our list of 25 books for every healthcare professional.

The program provides traditional MBA core courses and specialized healthcare electives to help tailor the curriculum to your goals. Skip to main content. Historical Changes in Healthcare Healthcare reform has often been proposed but has rarely been accomplished. The Complexity of Healthcare The many layers of variance in all parts of healthcare is what makes this system so complex.

Health Insurance Market Choosing a healthcare plan illustrates the complexity of health insurance plans in the U. Healthcare Regulation Insurance is not the only complexity within the system. How Change Impacts Healthcare Resources and Facilities Changes in the healthcare industry usually occur at the legislative level, but once enacted these changes have a direct impact on facility operations and the use of resources.

Historical and Predicted Changes in Healthcare Facilities Cultural shifts, cost of care, and policy adjustments have contributed to a more patient-empowered shift in care over the last century.

The Future of Medicare and Medicaid As the baby boomer generation approaches retirement, thus qualifying for Medicare, healthcare spending by federal, state, and local governments is projected to increase.

A Shift in Healthcare Providers Along with policy and technological changes, the people who provide healthcare are also changing. Demographics In recent years, the demographics of the medical profession have shifted. Competence The prevalence of malpractice lawsuits is one way to evaluate the competence of healthcare providers.

Satisfaction Job satisfaction is one area that must improve. Evolving Needs of Patients Demands on healthcare change due to various reasons, including the needs of patients. Illness Trends The bubonic plague is a good example of a disease that can drastically change the healthcare system by quickly shifting all resources to handle an epidemic.

The following seven conditions are on the rise and can be expected to have an impact on healthcare in the near future: Sexually Transmitted Infections: Chlamydia and gonorrhea rates have increased, and syphilis rates rose by Obesity: Obesity continues to be an issue in the U.

Obesity rates have increased by 17 percent in the past five years. Autism: For every , people, 1, are diagnosed with autism. This number continues to rise annually. Recent increases may be due to awareness as doctors become more familiar with the symptoms of autism.

Coli: Within 10 years, cases of E. Many E. Liver Cancer: Incidences of liver cancer have increased by 47 percent in a recent year timeframe. Kidney Cancer: Healthcare practitioners have treated Whooping Cough: The year increase for whooping cough is nearly percent. This may be due in part to parents opting out of whooping cough vaccinations.

Population Shift The current baby boomer generation, which initially consisted of 76 million people born between and , will be coming to retirement age and will increase federal spending on Medicare and Medicaid by an average of 5. Advances in Technology Healthcare technology trends focus heavily on patient empowerment.

Conclusion From policy to patients and everything in-between, the healthcare industry is constantly evolving. Get Program Details. Apply Now. This will only take a moment. What is your highest level of education? Next Step We value your privacy.

Complete the form to download the brochure. We value your privacy. Industry experts expect significant changes to shake up the healthcare landscape in the next few years, which will affect both health insurers and providers. Many are the result of a shift toward value-based care, a move toward decreased care in hospital settings, technological advances, and other forces. Healthcare delivery will continue to move from inpatient to outpatient facilities.

This change is occurring as the result of clinical innovations, patient preferences, financial incentives, electronic health records, telemedicine, and an increased focus on improving quality of care and clinical outcomes. Payers and providers can prepare for this shift by analyzing and forecasting the cost and reimbursement implications of providing care in outpatient settings compared to inpatient settings.

They should continue to analyze changing patient demographics, consumer preferences, and satisfaction trends, Timoni says. Collecting and analyzing data regarding quality and clinical outcomes as the result of changes in delivery of care from inpatient to outpatient is also key. Healthcare providers should develop effective strategies to grow capacity and infrastructure for outpatient services and invest in innovative mobile technologies, diagnostic tools, and telemedicine systems.

More healthcare entities will continue to merge together. Increased consolidation will result in higher healthcare prices as larger sized institutions use their size to their advantage. Another impact will be narrowing the field of contracting options, which will result in greater dominance by fewer entities in a market.

This change is occurring because industry stakeholder believes that consolidation is the way to survive in a healthcare landscape still being shaped by the ACA. Another factor is that momentum for consolidations across the industry has continued to build and no player wants to be left behind.

Along these lines, Timoni says that consolidation has been motivated by the evolving and challenging commercial and government reimbursement models which include lower fee-for-service payment rates, value-based payment components, and incentives to move care from inpatient to outpatient settings.

Payers and providers can prepare for this change by evaluating their operations and determining whether consolidation with another entity is advantageous.

Timoni advises payers and providers to monitor the consolidation landscape and develop effective merger and acquisition strategies. These strategies should focus on optimizing economies of scale to reduce costs and finding the best partners to achieve improved quality of care and effectively manage population health.

Ongoing attention will be given to protecting the privacy of healthcare data. New laws, at both the federal and state levels, will be considered that could introduce new regulatory requirements, Fisher says.

While a federal law in an election year may be doubtful, individual states are proceeding. Other states are considering how to jump on the privacy legislation bandwagon, which means that regulatory requirements will increase. Meanwhile, debates around what is meant by privacy continue to evolve, Fisher continues. A backlash against the non-transparent sharing of healthcare data and arguable profiteering is creating anger among patients and other groups. Simultaneously, data breaches continue to be reported on a daily basis.

Add in that healthcare is a prime target, and all of the factors point to healthcare needing to do more to protect data. Payers and providers can embrace increased data privacy by focusing on existing compliance efforts, which will require taking time to better understanding HIPAA.

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Pay-for-value managed-care arrangements are used in Medicare Advantage, Medicaid managed care, and some commercial health insurance plans. In the Medicare program, around 30 percent of beneficiaries are enrolled in Medicare Advantage plans in which Medicare makes payments to private insurers that are responsible for delivering the Medicare benefit package, and payment arrangements between plans and providers are determined contractually and are thus difficult to describe because they are proprietary KFF, a.

In sharp contrast with Medicare, managed-care enrollment has greatly expanded during the past two decades, rising from just over one-half of all beneficiaries enrolled in managed care in to 77 percent in KFF, Medicaid-managed care plans cover a broad array of Medicaid benefits, including acute, primary, and specialty care and in some states, behavioral health and LTSS CMS, Although the fee-for-service model remains the most common payment form in the private health insurance market, private insurers have integrated aspects of the managed-care model into broader efforts to address the incentive problems created by the fee-for-service payment structure, such as utilization management and performance metrics for providers.

If managed care is defined by the use of capitated payments to providers that are responsible for the total cost of care, then very few people are covered by managed care KFF, b. If, however, anything other than unconstrained fee-for-service is defined as managed care, most people who are covered by private health insurance are enrolled in some form of managed care.

Managed care in any form usually involves restricting the set of providers from whom patients might obtain covered care to so-called in-network providers. Insurers can adjust network breadth to limit patient access to preferred hospitals and physicians. Figure illustrates that dramatic shift over time. In , 73 percent of employees enrolled in health plans had conventional fee-for-service coverage; by , fewer than 1 percent had unconstrained fee-for-service coverage.

The figure also shows the dramatic growth in HDHPs since Distribution of health plan enrollment of covered workers, by plan type, — A portion of the change in plan type enrollment for is likely attributable more The ACA included payment-reform provisions to incentivize the adoption of more effective care-delivery models Abrams et al. The new models involve some combination of shared risk among providers to enhance collaboration and coordination of care so as to reduce avoidable hospitalizations, ED visits, and other forms of expensive or unnecessary care.

To protect against stinting, quality metrics are often used to evaluate provider performance. Beyond payment models, the ACA encouraged perhaps unintentionally the narrowing of provider networks and reshaped the delivery of long-term services and supports, all of which have implications for the ways in which people who have disabilities receive care and for the documentation of that care in the medical record.

We discuss each in turn. The payment, contractually determined in advance, is intended to encourage better coordination among the various providers involved in a given patient's care. Some 7, post-acute care providers, hospitals, and physician organizations have signed up to participate in bundled-payment demonstrations Abrams et al. Early evidence suggests that bundled payments can reduce medical costs and improve patient satisfaction CMS, The ACA also incentivized the development of alternative delivery models, such as accountable care organizations.

Those involve collaboration among physicians, hospitals, and other health-care entities in a shared-risk arrangement. The alternative delivery models were intended to encourage provider organizations to address patient health needs better, to reduce the amount of hospital and ED care, and to meet quality goals. Their effectiveness and their effects on clinical practice, however, are still matters of considerable debate Schulman and Richman, ; Song and Fisher, The primary goal of the PCMH is to keep people ambulatory in the community, in addition to aligning provider financial incentives with the best interests of patients.

The PCMH is not a physical home but rather a care delivery system in which each patient's care is coordinated through his or her primary care physician PCP. The PCP manages and coordinates care with the goals of having each patient receive the necessary care when and where he or she needs it, and in a manner that the patient can understand and that is consistent with and respectful of the patient's preferences, needs, and values Blumenthal et al.

In patient-centered models, there is greater potential for providers to identify people who have comorbidities and to coordinate their care. Visits for both ambulatory care sensitive and non-ambulatory care sensitive conditions were reduced; this suggests that steps taken by practices to attain PCMH recognition might decrease some of the demand for outpatient ED care van Hasselt et al. NCQA also noted that PCMH recognition is associated with fewer inpatient hospitalizations and lower utilization of both specialist and emergency services Harbrecht and Latts, ; Raskas et al.

Money was offered to physician practices to meet compliance with health information technology or so-called meaningful use criteria or face penalties in Medicare reimbursement.

EMRs offer the promise of aggregating records from many providers into a single, legible medical record as long as all providers seen by a patient participate in the same EMR system; interoperability among systems is imperfect. The HITECH Act offers the promise of a more complete medical record that details the full history of care provided to a patient who applies for disability benefits.

The change in provider network size is another indicator of how the ACA has transformed the care that people get. So-called narrow networks existed before the implementation of the ACA, but they have grown more common as a result of it.

Many consumer protection measures, such as the prohibition of medical underwriting, have made it difficult for many insurers to rely on traditional strategies to keep costs low. Other elements of the law, such as the availability of the online marketplace where consumers can compare premiums, have made it possible for insurers to compete with each other. Plans that have narrow networks might benefit consumers by lowering premiums. Negotiations between insurers and providers on network participation might encourage more efficient delivery of care.

And the ability to contract selectively might allow insurers to attract a small group of providers that meet raised standards of quality and potentially would result in care of higher value Health Affairs, But narrow networks also pose risks to consumers. For example, if a network gets too narrow, it will jeopardize the ability of consumers to obtain needed care in a timely manner. That can also happen if the network contains an unsatisfactory mix or insufficient number of providers.

Network limitations can have the additional effect of turning away sicker patients who have more health needs and thus changing the risk pool. One study notes that consumer advocates argue that narrow networks adversely affect access to care, especially for patients who have chronic illnesses. They claim that insurers structure the networks strategically to discourage the higher-cost patients from enrolling.

Patients who have high needs will then have to go outside the network and possibly outside the EMR system and as a result tend to incur high expenses and receive surprise medical bills EBRI, Their medical documentation is also more likely to be missing elements. The ACA included several provisions aimed at improving deficiencies in the nation's long-term care system to ensure that people can receive LTSS in their home or the community KFF, a. In addition, in states that accepted the Medicaid expansion, funds were made available to pay for home- and community-based attendant services in connection with matching by the federal government KFF, a.

Nonetheless, Wiener has argued that despite the growing need for HCBS, not enough progress had been made in improving the financing of long-term care.

A comprehensive review of the literature on the effects of the ACA Medicaid expansion on health-care use KFF, c found that health insurance coverage has expanded overall, access to and use of care have increased, self-reported health status has improved, and flow of federal health-care resources into expansion states has risen.

One study by Barakat et al. It did not, however, detect a substantial change in top diagnoses or in the overall rate of ED visits and hospitalizations. The authors argued that there appeared to be a shift in reimbursement burden from patients and hospitals to the government without a dramatic shift in patterns of ED or hospital utilization.

In contrast, Sommers et al. Wherry and Miller observed an increase in office visits to physicians but also an increase in overnight hospital stays after the Medicaid expansion. Chen et al. There is consensus among studies on the effects of the ACA on utilization of preventive services.

Sommers et al. Similarly, Wherry and Miller found that Medicaid expansion under the ACA led to higher rates of preventive services, which resulted in more diagnoses of diabetes and high cholesterol. Several studies have specifically identified ACA-related improvements in health-care utilization by people who had chronic conditions. They found improvements in multiple measures: affordability of care, regular care for the chronic conditions, medication adherence, and self-reported health.

A related study by Sommers et al. They echoed the findings in the report by suggesting that regular care for chronic conditions increased substantially after Medicaid expansion. The findings of those two studies were consistent with the findings of an earlier study by Sommers et al.

Although evidence suggests that on average people who had chronic conditions experienced an increase in access to regular care for those conditions, coverage effects vary among diseases Baicker et al. Because of the many design features that are common to the ACA, the Massachusetts health-care reform of , and the Oregon Medicaid lottery of , the experiences of Massachusetts and Oregon are informative about potential effects, and in particular long-term effects, of the ACA on utilization.

A study by Cole et al. It found no effect of Medicaid coverage on diagnoses or on the use of medication for blood pressure and high cholesterol, but Cole et al. The Oregon Medicaid study Baicker et al. The evidence on cancer care is also mixed. One study of the Massachusetts health-care reform did not find any changes in breast-cancer stage at diagnosis Keating et al.

A third study of the Massachusetts reform echoed the improvement in cancer care by revealing that coverage expansion was associated with an increase in rates of treatment for colon cancer in low-income patients and a reduction in the number of patients waiting until the emergency stage for treatment Loehrer et al. In addition to health-care service utilization, the use of prescription drugs serves as an important measure of the ACA's effect, especially given their prominent role in the management of chronic conditions.

Mulcahy et al. They attributed the increase in treatment rates for chronic conditions and the reduction in out-of-pocket spending to the decrease in financial barriers to care under the ACA. The ACA has many provisions that are important for people who have disabilities. For example, denial of coverage because of pre-existing conditions is no longer allowed. Removal of a lifetime cap on benefits will enable people with disabilities to continue to receive care. Perhaps most important, the expansion of health insurance coverage through the Medicaid program, the health insurance exchanges, and the dependent coverage provision will allow many Americans who have disabilities to obtain health insurance coverage without having to qualify for SSDI or SSI.

And the ACA authorizes federally conducted or supported studies to collect standard demographic characteristics that include disability status Krahn et al. In this section, we summarize the early literature on those effects.

The ACA's dependent coverage provision appears to have benefited young adults who have disabilities. Porterfield and Huang analyzed the periods before and after implementation of the dependent coverage provision in the ACA and compared adults who had disabilities and were 19—25 years old with adults who had disabilities and were 26—34 years old.

People in both age groups experienced coverage gains after the ACA dependent coverage provision took effect in , but for people in the older group who were unaffected by the dependent coverage provision, the coverage gains were entirely attributable to changes in public insurance. In contrast, the coverage gains for people in the younger group who were affected by the dependent coverage provision were driven by changes in private insurance.

By , low-income and moderate-income nonelderly adults—including both those who had and those who did not have chronic illnesses—also experienced coverage gains. The Kaiser Family Foundation KFF, c notes that in some states and the District of Columbia, those gains resulted from the Medicaid expansion to adults who had incomes up to percent of the federal poverty level.

In other states and the District of Columbia, the coverage gains for people who had disabilities resulted from subsidies for qualified health plans offered on the health insurance marketplaces combined with private insurance reforms, such as the prohibition of discrimination based on health status. The ACA appears to have brought about improvements in treatment for mental disorders and substance abuse.

Saloner and LeCook examined the effect of the ACA on young adults who had mental health or substance-use disorders by using data from the — National Survey of Drug Use and Health. The authors found that after implementation of the ACA, mental health treatment of people who were 18—25 years old and had possible mental health disorders increased by 5. Uninsured visits by people who used mental health treatment decreased by Consistent with those findings, Ali et al.

If those possibilities are fully realized, that would represent a 40 percent increase in behavioral services utilization, primarily for mental health services. Golberstein et al. A recent study Hall et al. The authors noted that people who have disabilities often experience psychologic distress and comorbid health conditions and have low income and employment.

New coverage options under Medicaid expansion that allow people to work more and accumulate assets could benefit people who have disabilities because they would no longer need to apply for SSI or live in poverty to qualify for Medicaid.

Results from the Hall et al. Those changes were not statistically significant, because of the small sample in the pre-ACA period. However, after the ACA, those who had disabilities and lived in expansion states were more likely to be employed The authors concluded that Medicaid expansion is an important policy for reducing disparities in access to care for people who have disabilities and for supporting their employment and financial independence.

Despite the many positive benefits of the ACA, there remain barriers to access to care among people who have disabilities. Among them is the complexity of the Medicaid application process Gettens and Adams, Cost-related difficulties present another barrier. Despite the ACA's subsidies for qualified health plans, which have reduced premium costs to some degree, deductibles and other out-of-pocket costs remain high and pose financial challenges to many people who have disabilities Gettens and Adams, Health care in the United States is financed by a combination of public and private insurance, employers, and out-of-pocket payments by individuals.

In , 37 percent of the US population received health care through a public insurance program at some point during the year. The US health-care delivery system consists of an array of clinicians, hospitals and other health-care facilities, insurance plans, and purchasers of health-care services, all of which operate in various configurations of groups, networks, and independent practices. The healthcare delivery system historically has been organized around the concept of fee-for-service medicine.

Because provider revenues increase as more services are provided—and insured and some uninsured patients do not bear the full cost of the services—the fee-for-service model creates incentives to increase utilization of health-care services and leads in many cases to overutilization of physician and hospital visits. It brought about structural changes in the health-care system, which included sweeping efforts to improve access to health insurance through expansion of the Medicaid program and through subsidized and lower-cost health insurance plans made available through new health insurance marketplaces exchanges , elimination of pre-existing condition restrictions on coverage, elimination of lifetime caps on health-care spending, and efforts to slow growth in health-care costs through innovative payment reforms.

The plan had two major components: expansion of the Medicaid program and new structures to support the individual and small-group health insurance markets.

As a result, only 32 states and the District of Columbia elected to expand Medicaid. For the individual and small-group markets, the ACA established health insurance exchanges in states to allow individuals and small groups to buy standard insurance policies with income-based subsidies from percent to percent of the federal poverty level. The ACA eliminated medical underwriting and imposed a legal mandate to purchase health insurance, with a penalty for those who did not comply.

The ACA's individual mandate was designed to compel healthier people to purchase insurance and thereby balance the risk pool and lower premiums for everyone. The ACA included payment-reform provisions to incentivize the adoption of more effective care delivery models. The new models involve some combination of shared risk among providers to enhance collaboration and coordination of care in an effort to reduce avoidable hospitalizations, ED visits, and other forms of expensive or unnecessary care.

Beyond payment models, the ACA encouraged perhaps unintentionally the narrowing of provider networks and reshaped the delivery of LTSS, all of which have implications for how people who have disabilities receive care and the documentation of that care in the medical record.

The expansion of health insurance coverage through the Medicaid program, the health insurance exchanges, and the dependent coverage provision will allow many Americans who have disabilities to obtain health insurance coverage without having to qualify also for SSDI or SSI. A comprehensive review of the literature on the effects of the ACA Medicaid expansion on health-care use finds that health insurance coverage overall has expanded, access and use of care have increased, self-reported health status has improved, and the flow of federal health-care resources into expansion states has risen.

Coverage categories are not mutually exclusive; some people switch coverage during a year or have multiple forms of coverage. Federal law requires that state Medicaid programs make DSH payments to qualifying hospitals that serve a large number of Medicaid and uninsured people. The CLASS Act would have created a voluntary and public long-term care insurance option for employees, but in October the Obama administration announced it was unworkable and would be dropped.

Turn recording back on. Help Accessibility Careers. Search term. Narrowing Provider Networks The change in provider network size is another indicator of how the ACA has transformed the care that people get. The Affordable Care Act's payment and delivery system reforms: A progress report at five years. New York: The Commonwealth Fund; The implications of the Affordable Care Act for behavioral health services utilization. American College of Emergency Physicians.

The Oregon experiment—effects of Medicaid on clinical outcomes. Considering success can equate to a facility improving their efficiency and their ability to provide the best care possible, honing these skills to their highest level if critical. These skills can help administrators guide healthcare facilities with confidence and earn the trust of their employees.

A weak leader in the role can have a ripple effect on an entire organization. Trust can decline among all faculty members, and sometimes it may make sense to remove a long-tenured leader in favor of someone who possesses the necessary qualities to nurture a team.

The coronavirus pandemic caused significant stress to the healthcare delivery system. Hospital staffing, for instance, has been an ongoing challenge that has evolved into a significant problem during the pandemic. The industry was already struggling with a nursing and physician shortage, particularly in rural areas.

The trauma and exhaustion that waves of COVID cases have caused have further highlighted the seriousness of the issue, making it all the more urgent for hospital administrators to find creative solutions to mitigate the effects of these shortages and keep patient care at a high level. Limited resources to sufficiently handle the pandemic have also been a grave concern for hospital administrators. This is a multilayered issue impacting numerous levels of healthcare, from making it difficult to secure adequate equipment to straining patient capacity.

Additionally, the surge of COVID patients in healthcare facilities kept other patients from seeking treatment. This became a multilayered issue; in addition to patients not receiving the care they needed, facilities experienced substantial dips in revenue.

Because of this, hospital administrators had to come up with creative solutions to mitigate the effects of reduced revenue. Many of the issues that COVID has generated or heightened are expected to remain after it subsides.

It will be up to hospital administrators to guide facilities to provide optimal, efficient care delivery in a post-pandemic world. Despite the need for MHAs with the requisite leadership skills, the healthcare industry will also need professionals who understand electronic health records EHRs. These professionals must also strive toward maintaining an EHR system that can effectively build and maintain a comprehensive patient record in order for a patient to get the best care possible.

Since many patients visit more than one physician, healthcare administrators will have to promote open communication so that all medical professionals have access to the same data. Without this transparency, patients may not receive optimized care, potentially affecting outcomes. Learn how USC can help you embark on the next phase of your career.

Frontline Issues in Healthcare. Physician Leaders: Bridges to Better Care. Skip to main content. Pre-Qualify Now Learn More. Job Opportunities Will Remain Plentiful With the combined healthcare law and population growth, healthcare administrators can anticipate strong job potential in the future. Professionals Must Develop Well-Rounded Skills While job opportunities will continue to grow, healthcare administrators will need more well-rounded skills to succeed in this field.