Essay on Confronting Top Issues Facing Hospitals

Part: Identification of Issue

Issue 1: Complying with new government requirements and mandates

Three challenges that face healthcare providers in terms of complying with government requirements include;

Understanding the new guidelines for the protection of personal health information.

This is a challenge because healthcare providers are required to understand what protection of personal health information means and how it relates to them on a daily basis.

Understanding the use of protected health information in research activities.

This has been a major challenge since the beginning of the MU program because healthcare providers have to understand what information is being collected in their healthcare facilities and then figure out how they can best decide on whether they want to comply with government regulations.

Understanding the “meaningful use” (MU) program.

This has been a huge challenge facing healthcare providers because each provider has to understand how the MU program can be used to their benefit. In terms of the MU program, there have been changes in terms of how vital signs are collected and stored. Under the new guidelines, healthcare providers will only be able to store vital signs for seven days (“Top 6 challenges healthcare executives will face in 2020,” 2020). This is meant to reduce costs and medical errors through a better understanding of risk factors for heart disease, kidney disease, diabetes, stroke, and other chronic diseases.

Issue 2: Shifting to value-based payment models

Shifting to value-based payment methods has been faced with a number of challenges. The three major challenges are:

Developing and implementing processes to determine optimal payment models. When shifting to value-based payment methods, healthcare professionals have to understand what ways they can use these new models in order to determine whether or not they are worth it for the organization.

Implementing the new payment models.

Once healthcare providers determine that they want to shift their payment processes to value-based payment methods, there are a number of challenges that come into play. One of the major challenges that healthcare professionals have faced is how to implement these new models.

Transitioning value-based payments to payers, healthcare providers, and pharmaceutical companies.

This third challenge has been faced by all stakeholders in the new payment models. Under the new payment models, there is a large incentive for pharmaceutical companies to make sure that products are priced fairly in order to avoid any penalties or other financial consequences for not pricing products with fair market value.

Issue 3: Using big data

Using big data has been faced with so many challenges. The three major challenges facing the issue of using big data are: 1) how to make the most of the information; 2) how to mitigate privacy concerns; 3) how to integrate big data with other information sources.

How to make the most of the information.

This is a challenge because healthcare organizations have to make sure that they are using all the information they have in order to get the most out of their resources. There are a number of ways that healthcare organizations can do this. One way is to use big data analytics programs, which are used to examine large amounts of data and then make associations between patient data and prescription medication use, disease management, or other quality measures.

How to mitigate privacy concerns

This is a challenge because there are new guidelines for the protection of personal health information. These new guidelines make it clear that any use of protected health information in research activities will not be allowed unless it falls under certain guidelines (“Top 6 challenges healthcare executives will face in 2020,” 2020). Healthcare providers have to make sure that they are adhering to these new guidelines when using big data.

How to integrate big data with other information sources.

This is another major challenge because of the need to make sure that big data and other information sources are integrated. Healthcare organizations have to make sure that they are using both of these information sources to get the most out of their resources.

Issue 4: Implementing cyber-security measures.

Implementation of cyber-security measures has been faced with three main challenges. These challenges are: 1) having the right skills and knowledge to make the decision; 2) making sure that data is safe; 3) making sure to use the data wisely.

Having the right skills and knowledge.

One challenge facing healthcare professionals when it comes to implementing cyber-security measures is that they have to understand whether or not they want to implement these new measures into their organization. Having a business analyst in place, who can do this, would help in making decisions about what resources should be used for cyber-security initiatives.

Making sure data is safe.

When implementing cyber-security measures, healthcare organizations have to make sure that they are protecting the data of their patients. This involves making sure that their current security policies are being focused on and executed. To do this, healthcare organizations have to make sure that they know exactly what threats face them and how they can protect against those threats before implementing new security measures.

Making sure to use the data wisely.

One of the major challenges facing healthcare organizations when it comes to implementing cybersecurity measures is to make sure that they are making the most out of the data that they have. Using data wisely means making use of all this information in a way that will benefit their organization.

Issue 5: Rising cost of healthcare.

Healthcare as an industry has been experiencing an increase in the cost of providing healthcare. This issue has been faced with many challenges; three of these challenges are;

Changing consumer expectations.

Healthcare providers have changed in many ways that they expect healthcare to be provided. The three major challenges faced are: 1) the role change of physicians, 2) the role of technology, and 3) changing patient expectations.

Managing the shift from volume to value-based care.

When shifting to value-based care, patients want to have the best care at the lowest price. The two major challenges that healthcare providers have faced when implementing this shift are: 1) what kind of services will be provided and 2) how will this be paid for?

Being able to manage costs

Healthcare providers have had a major challenge in managing cost increases. One of the main challenges in doing this is integrating changes from both volume and value-based payment models.

Part 2: Analysis of the Challenges

Complying with new government requirements and mandates

Understanding the new guidelines for the protection of personal health information.

This challenge presents broad and far-reaching implications for improving the health of the US population because there is a clear connection between better data protection and improved health outcomes. Specifically, it becomes difficult for healthcare providers to do their jobs when they do not have the correct information regarding the implementation of new regulations (“Top 6 challenges healthcare executives will face in 2020,” 2020). Healthcare policies and procedures, as well as privacy and security policies, can be significantly affected by changes in government regulation.

Understanding the use of protected health information in research activities presents broad and far-reaching implications for improving the health of the US population by allowing researchers to conduct research into real-world health problems and epidemiology. A major problem that faces healthcare providers as they work with patients is the fact that it is difficult to get their permission for this type of research. A lot of the time, an individual will not understand what kind of research can be done with their personal information, and they may not even realize that their personal information has been used in research studies.

Understanding the “meaningful use” (MU) program presents broad and far-reaching implications for improving the health of the US population by making and using electronic health records (EHRs) in clinical settings. The use of MU has been shown to be beneficial because it allows both healthcare providers and patients to access their health records, as well as share them with other healthcare providers (“Top 6 challenges healthcare executives will face in 2020,” 2020). This helps save time and improve the quality of care that is provided by the healthcare provider. When it becomes a challenge, the MU program can cause major issues for healthcare providers in terms of losing money and time because they are unable to meet the new guidelines. The major challenge that surrounds MU is the fact that there is no overall standard for electronic health records; therefore healthcare providers need to understand what standards need to be met by the government in order for them to be able to continue using the program.

Shifting to value-based payment models

Developing and implementing processes to determine optimal payment models.

This makes the healthcare system more efficient. As healthcare payers and providers look to shift to value-based care, many different questions must be answered regarding how this system should function. If this is not looked into, then healthcare payers can be disadvantaged because they will have to reimburse for services that are not truly cost-effective or have a positive effect on the patient’s health.

Implementing the new payment models.

This enables healthcare payers to shift to value-based payment methods. Healthcare payers are often faced with many different options when making reimbursement decisions, and they must understand all of these options before deciding on which one they should choose. Some of the issues that have been faced by healthcare payers are not being able to provide adequate data and having a difficult time figuring out how this new model will actually work in the long term.

Transitioning value-based payments to payers, healthcare providers, and pharmaceutical companies.

Healthcare providers and pharmaceutical companies are having difficulty being able to come up with new payment models in order to meet the new guidelines. Other healthcare providers are concerned that they will be at a disadvantage when it comes to making money because of their inability to come up with value-based reimbursement methods.

Using big data

How to make the most of the information.

There is a close correlation between the use of data and healthcare costs. Healthcare organizations are using big data to find ways to save money, but they are also using it to determine which treatments are most effective for their patients and how to treat their patients more effectively. Healthcare organizations use big data to improve the quality of care received by the patient and see why this method will help increase costs over time. The only way for big data to improve health care is for healthcare providers to use the data that they have collected to establish trends and then use this information to benefit their patients.

How to mitigate privacy concerns

Failure to protect patient data can lead to several different issues arising. Some of these issues include the fact that patients will not want to seek out healthcare services because they do not feel safe sharing their health information. Privacy is an issue in healthcare because there is a consistent effort to share as much information as possible between multiple parties, including patients, doctors, and payers (“Top 6 challenges healthcare executives will face in 2020,” 2020). Patients are often asked for their personal information during the registration process, when they check into a hospital, and even when they go for appointments.

How to integrate big data with other information sources.

Failing to integrate data can lead to some different issues arising. These issues include the fact that there will not be enough data to make an effective decision on how to proceed with healthcare policy, which can lead to the failure of the big data initiative. The integration of big data has been an ongoing project, but it cannot be rushed in any way because it is dependent on so many different pieces of information that need to be collected and stored properly.

Implementing cybersecurity measures.

Having the right skills and knowledge.

If you do not properly implement cybersecurity measures can lead to several different issues arising. These issues include the fact that cyber-attacks on healthcare organizations have been very frequent and that they continue to increase in frequency. Cybersecurity is such an important issue because the information that is collected and stored by healthcare organizations contains extremely sensitive private information about millions of patients. Cybersecurity is especially important for protecting the information that healthcare providers, insurance companies, and pharmacies store because bad actors can steal patient’s personal health information.

Making sure data is safe.

Failure to protect data can lead to a number of different issues arising. These issues include the fact that cyber-attacks on healthcare organizations have been very frequent and that they continue to increase in frequency. Cybersecurity is such an important issue because the information that is collected and stored by healthcare organizations contains extremely sensitive private information about millions of patients (Alromaihi et al., 2018). Cybersecurity is especially important for protecting the information that healthcare providers, insurance companies, and pharmacies store because bad actors can steal patient’s personal health information.

Making sure to use the data wisely.

When you do not use the data collected in a way that benefits patients can lead to a number of different issues arising. These issues include the fact that many of the measures for improving healthcare are based on randomized controlled clinical trials, and if these efforts were implemented inefficiently, they would not be effective. Making sure to use this data is crucial because it will help improve health outcomes directly.

The rising cost of healthcare.

Changing consumer expectations.

This challenge has broad and far-reaching implications for improving the health of the US population because rising healthcare costs affect the entirety of the population, not only those who are insured. To lower costs, consumer expectations must change from a demand-driven market to a supply-driven market.

Managing the shift from volume to value-based care.

The quality of care is significantly affected by how healthcare providers are paid. For quality to be maintained, there needs to be a shift from paying for the volume of services that are performed in one day to paying based on the value provided by those services.

Being able to manage costs.

Paying for healthcare services directly implications what services get covered by patients and their insurance companies. Additionally, the cost of paying for healthcare services has driven many families into financial hardship, leading to an increase in social issues.

Discuss how the population health paradigm can contribute to the solutions for each of the five issues discussed above.

The population health paradigm can contribute to the solutions for each of the five issues discussed above by taking a more macro view of how healthcare is delivered to patients. The paradigm can also contribute by allowing for data to be collected to improve care, rather than collect data simply because it can be collected or it is easy to collect. A major contribution of population health is that it allows for a shift from fee-for-service reimbursement to value-based reimbursement.

Complying with new government requirements and mandates. Here the population health paradigm can contribute to the solutions for this issue by supporting the efforts of private insurers in creating plans that improve health outcomes while lowering costs. Furthermore, a framework can be set in place that guides how the different stakeholders perform their important roles, including physicians, hospitals, and insurers. In addition, a framework can be created that will ensure transparency for all stakeholders involved in healthcare delivery and will allow them to communicate more effectively.

Shifting to value-based payment models. The population health paradigm can contribute to the solutions for this issue by providing a framework that can be used for determining the value of healthcare services. Furthermore, a specific “road map” can be created to help guide the transition from volume-based payment to value-based payment. Also, a framework can be created that provides a mechanism for the reporting and publication of outcomes of medical interventions. Such a framework can include “what, where, when, and how data” are collected.

Protecting data from cyber-attacks. The population health paradigm can contribute to the solutions for this issue by factoring cybersecurity into the design of care delivery and payment models. This design can ensure maximum data privacy as well as maximum data security. An example of such a design has a Population Health Coordinator who is responsible for keeping patient records safe and secure (“Top 6 challenges healthcare executives will face in 2020,” 2020). In addition, the population health paradigm can contribute to the solutions for this issue by lowering healthcare costs by empowering patients with their healthcare data and giving them away to share this data within a community of fellow patients easily.

Using big data. The population health paradigm can contribute to the solutions for this issue through one of two methods. The first method involves sharing up-to-date health care data with physicians and other providers to develop targeted treatments for specific conditions or patients. The second method involves using big data to help provide better quality care and reassess itself every two years to see if there has been any improvement in patient outcomes over time. In addition, the population health paradigm can contribute to the solutions for this issue by providing a framework that allows for standardized reporting of outcomes by care providers. This standardized reporting can then be used to show how providers improve their quality of care over time. “How do you balance the need to protect patient privacy with the ability to share health information for research?” (“Top 6 challenges healthcare executives will face in 2020,” 2020): The use of data science and machine learning can help ensure that findings do not contain identifiable information while still maintaining overall accuracy. Another consideration is that anonymizing data is extremely challenging and often results in inaccurate conclusions due to incomplete data sets. Therefore, it might be better for researchers and physicians to use pseudonym zed data rather than de-identified or anonymized data.

Implementing cybersecurity measures. The population health paradigm can contribute to the solutions for this issue by creating a framework for cybersecurity. This framework would include policies and procedures that are required to be followed in order to protect data, as well as rewards and punishments in the case any of these policies or procedures have been violated (Alromaihi et al., 2018). This framework will ensure that the right cybersecurity measures are taken while ensuring a fair process for any healthcare provider accused of violating these policies and procedures.

Reducing costs. The population health paradigm can contribute to the solutions for this issue by lowering costs by supporting value-based reimbursement models and protecting data from cyber-attacks. A care coordination process can be created to lower healthcare costs through improved patient outcomes to improve quality of care. Lastly, adopting a population health culture can help promote better communication between suppliers, purchasers, and providers to provide patients with the best possible treatment options.

Part 3: Recommendations

Assess the solutions above and their detractors, supporters, and possible bias in the recommendations. Discuss how these solutions will be implemented, funded, supported, and received by various stakeholders such as medical professionals, the public, and the government.

Shafer’s recommendation for improving value-based payments is to offer employees incentives to participate and take a leadership role in the process. Incentives could be in the form of higher bonuses, performance-based pay raises, or even stock options. Shafer noted that growing salaries could also have the effect of decreasing costs. The detractors for the above recommendations include the United States Department of Justice that said that “…sharing health information is a responsibility of all providers.” Another detractor, and one I believe should also be included as a proponent, is Dr. K.J. Kim, who said that “only so much can be done before taking the risk” when using big data and analytics. The biggest supporters include “The United States Environmental Protection Agency and Merck.” The EPA supports the use of big data and analytics to make healthcare providers more accountable and effective with their resources. At the same time, Merck is a pharmaceutical company that also supports big data and analytics since it would better understand patient needs. These are all the major stakeholders that should have an impact on implementing value-based payment models. These solutions are likely to be met by a mixed reaction. These solutions can be implemented through various means such as incentives to providers, buy-in from stakeholders or the government, legislation, and regulation. The public and the healthcare professionals are likely to be mixed in their response to these solutions. Some believe that these are good and should be implemented immediately, while others think it is too soon for this change. Different stakeholders can also receive these solutions by different means (“Top 6 challenges healthcare executives will face in 2020,” 2020). The public could be happy with the new level of accountability, and in return, the healthcare providers will have little say. The government will likely be satisfied with the levels of accountability and quality of health care, but at the expense of decreased cost for all. The solutions can be funded through various sources such as incentives placed on providers and decreased costs of health care, buy-in from stakeholders or the government, legislation, and regulation. Funding can be through various revenue-sharing agreements, Medicare and Medicaid reimbursements, or new taxes.

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