The delivery of primary care is crucial in the delivery of primary as well as preventive care to people that demand these kinds of services. Having access to primary care is essential in improving and maintaining health. Those who receive primary care obtain greater preventive services and are likely to conform to their treatment. Moreover, those who receive primary care are less prone to illness as well as premature death (Starfield et al., 2005). For a primary care to be effective, it must be coordinated, comprehensive, prompt, and focused on the needs of the patients. An effective delivery of primary care leads to improved health, reduced hospitalization rates and visits to emergency room, and ultimately, greater financial savings.
Efficient technology and adequate funding is necessary factory for attaining health benefits, but in various nations, experience suggests that these two factors are not enough. Efficient and effective service delivery improves lives and provides the chance to realize health benefits. Delivery performance and health service pertains to access and utilization of effective health care to deliver health benefits; effective use of resources; and adaptable organizations that have the capacity to learn and improve (Berman et al., 2011).
This paper provides data and recommendations for Accountable Care Organization in order for them to deliver effective services to patients.
Accountable Care Organization
Physicians provide medical services and play the most critical role in the delivery of health care (Patel et al., 2014). On the other hand, nurse practitioners deliver care both in large and small group settings as well as large and small group organizations (Naylor & Kurtzman, 2010). Nurse practitioners often take accountability for clinical and management roles (Iglehart, 2014). In ACO, for health service delivery to be productive, it is essential to have 100 physicians and 150 nurse practitioners in order to accommodate the 300,000 expected clinical visits each year. There are two setups for health care workforce. The first set up consists of employed physicians and nurses who are earning $200,000 and $100,000 each year, respectively. The second set up consists of contracted workforce of physicians who are paid $100 per patient visit and nurses who are paid $50 per patient visit.
Contracted Providers
If there are 100 physicians and each physician receives 3000 visits per year and are paid $100 per patient visit, then ACO will have to spend $30,000,000 for the physicians’ fee. On the other hand, if there are 150 nurse practitioners and each nurse practitioner receives 2000 visits per year and are paid $50 per patient visit, then ACO will have to spend $15,000,000 for the nurse practitioners’ fee. On top of this, ACO will also have to pay the financial incentive of $1 per patient visit to ensure efficiency. This adds another $600,000. Overall, the productivity of health providers is sufficient; yet, the organization has to spend $45,600,000 for the professional fee.
Employed Providers
Physicians who are employed at ACO receive an annual salary of $200,000 while nurse practitioners receive $100,000. To equal the spending among contracted providers, each physician and nurse practitioner needs to have 150 patient visits. With the 10% bonus for each employed worker, ACO will be spending $45,450,000. With a total of 300,000 visits per year and productivity entails each physician having 3000 patient visits, the number of contracted physician should be 100. In the case of employed primary care workforce, there is a supplier-induced demand.
Recommendation
It is more advantageous to employ physicians and nurse practitioners rather than pay for a contracted workforce. Employed physicians and nurse practitioners are readily available to accommodate patient visits and deliver primary care. It is important to realize that physicians are the most important people in healthcare delivery (Getzen, 2015). Since employed workforces at ACO are experiencing too many visits with an average salary, it is recommended that ACO increases the compensation, including bonuses, of employed primary care workforce (Khullar et al., 2015). A good compensation increases motivation among workers and can inspire them to be productive despite the increased demands (McClellan, 2015). ACO contract shows that employed health workers receive lower pay than contractual health workers. However, the employed health workers’ bonus is a lot higher than the contractual. Notwithstanding, ACO earns greater profit if they employ health workers rather than hire contractual ones. It is recommended that ACO increases the salary of employed health workers in order to motivate them to work harder and answer the supplier-induced demand. Moreover, employed health workers are always accessible and available.
References
Berman, P., Pallas, S., Smith, A. L., Curry, L., & Bradley, E. H. (2011). Improving the Delivery of Health Services: A Guide to Choosing Strategies. The World Bank.
Getzen, T. (2015). Health economics for the healthcare administrator (Laureate custom edition). New York: Wiley.
Iglehart, J. (2014). Meeting the demand for primary care: Nurse practitioners answer the call (Expert Voices in Health Care Policy Report). Washington, D.C.: National Institute for Health Care Management. Retrieved from http://www.nihcm.org/pdf/Meeting-the-demand-for-primary-care-nurse-practitioners-answer-the-call-John-Iglehart-Expert-Voices-10-2014.pdf
Khullar, D., Chokshi, D., Kocher, R., Reddy, A., Basu, K., Conway, H., & Rajkumar, R. (2015). Behavioral economics and physician compensation—Promise and challenges.New England Journal of Medicine, 372(24), 2281–2283. Retrieved fromhttp://www.nejm.org/doi/full/10.1056/NEJMp1502312
McClellan, M. (2015). Accountable care organizations and evidence-based payment reform. Journal of the American Medical Association, 313(21), 2128–2130. Retrieved from the Walden Library databases.
Naylor, M. D., & Kurtzman, E. T. (2010). The role of nurse practitioners in reinventing primary care. Health affairs, 29(5), 893-899.
Patel, K., Nadel, J., & West, M. (2014). Redesigning the care team: The critical role of frontline workers and models for success. Washington: Brookings Institution.
Starfield, B., Shi, L., & Macinko, J. (2005). Contribution of primary care to health systems and health. Milbank quarterly, 83(3), 457-502.
