Review the different health care environment factors

Reference no: EM133509636

Assignment:

Respond to colleagues who selected different health care environment factors. For each, propose how your HSO or an HSO with which you are familiar may be affected by the environment factor your colleague selected APA and references

Colleagues

Healthcare financing is an environmental factor in a health services organization (HSO) which refers to how healthcare services are funded and paid. This factor is an important area of concern in HSOs as it shapes how patients access healthcare with an implication for health outcomes. The financing in healthcare includes the mechanisms used to allocate funds from public and private sources, structure healthcare systems, and determine where services are delivered and their prices (National Academies of Sciences, Engineering, and Medicine, 2020). Profit and not-for-profit healthcare organizations require adequate financing to maintain increased technology and appropriate staff training in an always-improving environment.

One key area the government has put into legislation is the Affordable Care Act (ACA) to improve access to healthcare. Healthcare finance relates to a level of ensuring individuals can access necessary services regardless of their ability to pay, which the ACA aims to improve through expanding Medicaid coverage with health insurance marketplaces (Miller et al., 2019). This approach does have an ongoing debate on its effectiveness, rising healthcare costs, and how legislation and policy decisions affect a vulnerable population.

Another aspect of healthcare finances is the complexity of the claims processing and administrative costs related to getting payment. The Health information exchange (HIE) has created an efficient and streamlined process to process claims and reduce time, resources, and overall claims processing costs (Valvi et al., 2023). While this streamlined process has developed ways to eliminate some healthcare finance costs, other areas, such as prior authorizations, have taken on additional resource needs, increasing healthcare finances.

Healthcare finances are challenging to the HSO I am a part of, as they are throughout the country. Reimbursement increases not matching inflation in costs of supplies, goods, and services have left not only the HSO I am a part of but a vast majority of healthcare systems across the country looking into healthcare finances more than ever. This challenge has forced employee layoffs, new technologies to increase efficiencies, and limiting upgrades related to capital growth opportunities in some areas. These challenges have forced my organization to review all service areas to ensure a positive profit margin, leading to a decrease in services serving our population.

The future of healthcare finances continues to look challenging. While the HSO I am a part of is a healthcare system, we are forced to continue to look for new merger options to decrease costs and limit additional services to maintain a margin of essential healthcare services. The legislative decisions on staffing ratios, payment incentives, and healthcare coverage will continue to affect and forces decisions made in all HSOs.

References:

Miller, S., & Wherry, L. R. (2019). Health and access to care during the first 2 years of the ACA Medicaid expansion. New England Journal of Medicine, 380(11), 947-956.

National Academies of Sciences, Engineering, and Medicine. (2020). Accounting for social risk factors in Medicare payments: Identifying social risk factors. National Academies Press.

Valvi, N., Allen, K. S., Fourie, C., & Dixon, B. E. (2023). Healthcare finance data exchange: toward universal health coverage. In Health Information Exchange (pp. 343-355). Academic Press.

Reference no: EM133509636

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