reducing the Cost Burden of Diabetes

Reducing the Cost Burden of Diabetes:

The Potential Impact of the Accountable Care Organization

Provisions of the Patient Protection and Affordable Care Act

Ataa Nyamekye

Innocent Ogbue

Mabel vonGoins

New York Medical College

School of Health Sciences and Practice

Capstone, Spring 2013

Executive Summary

I will not edit this until you are finished with your final draft. This will then be rewritten obviously

In regards to President Obama’s Patient Protection and Affordable Care Act (Public Law 111-148, 2010) or ACA, the goal is to offer all Americans affordable health care, health insurance reform, improve patient resources and reduce hospital and operation cost.

The goal of this project is to ensure that Gotham Hospital continues to operate efficiently while meeting President Obama’s new ACA criteria and continue to provide quality care to its patient community. The team plans to offer several recommendations that will ensure Gotham is in compliance with ACA/ACO, as well as compare and analyze the effects of Pre and Post ACA hospital operations and elaborate on the hospital’s concern about how it can reduce the cost of chronic diseases particularly diabetes using its disease management program.

The project outcome is simple; to increase enrollment/utilization of the diabetes disease management and prevention at Gotham Hospital taking into account its diverse uninsured/underinsured population. The team will assess the current diabetes program at the hospital, offer recommendations and design a proactive program that will help increase utilization of diabetes care services at the Gotham Hospital.

Table of Contents

Executive Summary Page 2

Introduction Page 4-35

Methodology Page 35-55

Recommendation Page 55-70

Conclusion Page 70-72

References Page 72-82

Appendix Page 83-92

Introduction

Healthcare cost in the United States (U.S) has been increasing steadily. One of the major contributors to the rising costs [this is plural throughout your paper] of healthcare is chronic diseases. Addressing this growing burden continues to be a major policy priority. The Affordable Care Act (ACA) signed into law by the Obama Administration on March 23, 2010 was aimed at controlling the cost of health care.

The ACA represents the first major piece of social legislation toward comprehensive reform of the U.S. healthcare system since 1965 with the enactment of the Medicare Act. Components of these enacted reforms seek to change aspects of both private and public health insurance programs by expanding affordable coverage without exclusions, exceptions, or community rating (Manchikanti, Caraway, Parr, Fellows & Hirsch, 2011). The legislation is intended to curb the current trend of national medical spending and decreasing the national debt. More specifically, the essential element of the act seek to provide quality and affordable healthcare for all Americans; expand the role of public programs to increase access to people living at or below the federal poverty line; improve the quality and efficiency of healthcare through evidence based health outcomes; prevent chronic diseases through public health and community health programs; emphasize primary care through the education of the current and future healthcare workforce; increase the transparency and accountability of healthcare providers; improve access to innovative medical therapies and procedures; provide community living assistance and support services; and revenue provisions that seek to promote cost efficiency. (Manchikanti, Caraway, Parr, Fellows & Hirsch, 2011). The reform act, it is estimated will provide access to care to 34 million uninsured Americans (Sharamitaro, 2011).

One of the provisions of the ACA is the establishment of the Accountable Care Organization (ACO); a form of payment and delivery reform model that tie provider reimbursement to reductions in the total cost of care for an assigned population of Patients (Center for Medicaid and Medicare Services (CMS) 2010). It was formed in part to be used as a tool to check the cost of chronic diseases by encouraging cost effective disease management approach.

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