Accountability in Healthcare analysis

Accountability is one of the basic principles in attaining an effective healthcare system capable of improving the quality of health in a society. In today’s world, the healthcare sector is considered a vital area with new policies and rules being created to enhance health welfare. Accountability in healthcare improves positive treatment outcomes, physician-patient trust, and minimizes wastage of resources. The high demand for quality healthcare and the limited funds available for the sector demand that the healthcare providers are accountable, as it promotes efficiency and improves healthcare quality.

One of the approaches to accountability in healthcare is the accountable care organization (ACO). ACO is a group of medics, hospitals, and other health professionals, who coordinate in providing healthcare services. ACO unites various parts and processes of patient care to ensure that they receive optimal care at the right time and place. ACO ensures that there is no duplication of treatment practices as the healthcare providers share the health information of the patient with other providers. The association formed by the healthcare professionals supports a holistic approach to treatment since ample information and insights are shared to improve the treatment process. ACO’s effect on the healthcare providers has been positive since they have shared ideas and information and avoided repeating time and money consuming procedures on patients. The effectiveness of healthcare providers has been improved along with their satisfaction in treating patients. ACO has also improved accountability by the healthcare providers as they are expected to share responsibility for the treatment outcome of a patient. Additionally, ACO has made healthcare providers more connected and open in sharing information, which has enhanced their effectiveness, as they can get fresh ideas from their counterparts.

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The health maintenance organization (HMO) is a form of health insurance plan that restricts coverage to a given range of hospitals, medics, and other healthcare providers. Patients going beyond the stipulated network are not covered by their insurance provider. HMO requires the patients to have a primary healthcare provider from whom they always get treatment and referrals to visit other healthcare specialists. HMO is an earlier treatment plan and differs from the modern ACO approach. One significant difference is that HMO involves the insurance providers taking the responsibility to link hospitals, doctors, and other healthcare professionals, while under ACO, it is the hospitals, doctors, and other healthcare professionals that unite on their own accord. Thus, under the HMO physicians and other healthcare providers are not fully committed to the program as they are passive participants. HMO places the burden of coordination on the patients as they must abide by the provided network of hospitals and healthcare providers. On the other hand, the burden of coordination is placed on healthcare providers and not the patients. Another difference between the two is that HMO is cost-oriented as its primary goal is to control the costs of care, while ACO is quality-oriented in that it aims at providing the patients with the best care.

Health information technology (HIT) is the use of information processing entailing computer hardware and software, which perform the roles of storage, sharing, retrieval, and processing of healthcare data for decision-making and communication (Yen et al., 2017). An example of HIT is the electronic health record (EHR). HIT plays the roles of information sharing, storage, retrieval, and decision-making in the newer models of healthcare. For instance, under ACO, the healthcare providers are expected to coordinate in the treatment process, which requires that they share the information they have about a patient with another healthcare professional. HIT, which has information about patients, is used in this case to share to retrieve the stored data and communicate it to the other healthcare providers treating the involved patient. Additionally, under coordinated care, HIT is used to help healthcare providers make informed decisions by using the data stored by the computer and the trends generated from its analysis. HIT is also used to improve healthcare quality in modern healthcare models by providing evidence-based information that is used to make rational healthcare policies and choices. Overall, HIT plays the critical role of information provider under which it collects, stores, shares, and analyzes it to help in policy and decision-making.

Collaboration between hospitals and primary healthcare providers provides an overall benefit of improved healthcare quality. However, Sun et al. (2019) note that a partnership between hospitals and primary healthcare providers leads to focuses on community health interventions. The partnership ensures that the specific health needs of the people are understood and the appropriate health programs designed. The partnership improves health quality through effective prevention programs that are based on the health needs of the people. Additionally, partnering between primary health providers and hospitals provides the benefit of changed health behaviors by the people. The collaboration of the two healthcare providers ensures that sufficient information about the people is gained and used to influence their health practices. Besides, the partnership allows information exchange between the two health stakeholders. Kash et al. (2017) assert that one benefit of information exchange is a reduction in readmission rates in hospitals. Thus, improved communication between primary health providers and hospitals leads to better health quality by reducing readmissions.

Bundled payment is a system that covers all the costs involved in the treatment processes of an illness, rather than paying separately for every health service towards the treatment of a given disease. As noted by Agarwal et al. (2020), bundling payments contains healthcare costs by reducing the costs incurred in treating illnesses. Since compensation is based on all the treatment procedures involved, healthcare providers are more efficient in treating or preventing diseases, which results in reduced health costs. The system pushes medics to practice more coordinated care that aims at lowering treatment procedures since the reimbursement is limited to the estimated bundled cost.

The pay for performance model improves the quality of care by improving the efficiency of the healthcare providers. Under this approach, healthcare providers receive monetary incentives to enhance the quality of treatment and positive treatment outcomes. Unlike the traditional fee-for-service approach in which the medics focused on treating many patients, pay for performance system pushes the doctors to focus on positive treatment outcome that requires the improved quality of care. Under the new model, there is improved communication among healthcare providers to ensure that there is no duplication of treatment, and patients are provided with the best medical intervention practice since it is the basis for compensation. Pay for performance makes the quality of treatment the measure for compensation, which pushes healthcare provides to improve the quality of healthcare to enjoy higher earnings.

A value-based purchasing program is a system designed to motivate hospitals to provided quality health services by using quality of services as the reimbursement metric. The program holds healthcare provides accountable for the quality and cost of healthcare services provided. The approach was authorized by the Patient Protection and Accountable Care Act 2010 and allows hospitals to be compensated based on how well they offer their services (Lee et al., 2020). Value-based payment affects reimbursement in hospitals be making payments dependent on quality. Thus, hospital reimbursement is dependent on how well they provide health care. Irrespective of the patient numbers and times a patient is treated, such statistics are not used in compensation.

Value-based reimbursement benefits healthcare providers and patients. The healthcare providers benefit from policies and standards that aim at improving the quality of care rather than the number of patients visiting the hospitals. However, the value-based program mainly helps the patient mainly by allowing them to be provided high-quality services (Lee et a., 2020). Hospitals and medics collaborate to ensure that illnesses are prevented and that positive treatment outcome is attained in most occasions. To achieve optimal health quality, patients enjoy better health and are avoid being in an out of the hospital for the same illness. Additionally, the approach ensures optimal use of medical funds, which means that the available funds can be enough to cater for more health needs than before. The patients can access a wide range of health services from the available funds since they are not misused on irrelevant healthcare services. Although healthcare providers benefit from value-based reimbursement, the patients enjoy the most benefits.

Value-based purchasing measures hospital performance using the patients’ ratings along with core standards that are used to determine the level of quality. Such core standards evaluate whether pain was well controlled and whether the appropriate steps were followed in emergency and surgery procedures. In today’s world, where healthcare is a core concern for the people, quality health programs are being created to promote positive treatment outcomes and raise the level of health welfare in society.


Agarwal, R., Liao, J. M., Gupta, A., & Navathe, A. S. (2020). The Impact Of Bundled Payment On Health Care Spending, Utilization, And Quality: A Systematic Review: A systematic review of the impact on spending, utilization, and quality outcomes from three Centers for Medicare and Medicaid Services bundled payment programs. Health Affairs39(1), 50-57.

Kash, B. A., Baek, J., Davis, E., Champagne-Langabeer, T., & Langabeer II, J. R. (2017). Review of successful hospital readmission reduction strategies and the role of health information exchange. International Journal of Medical Informatics104, 97-104.

Lee, S. J., Venkataraman, S., Heim, G. R., Roth, A. V., & Chilingerian, J. (2020). Impact of the value‐based purchasing program on hospital operations outcomes: An econometric analysis. Journal of Operations Management66(1-2), 151-175.

Sun, X., Palm, D., Grimm, B., & Chen, L. W. (2019). Peer-Reviewed: Strengthening Linkages Between Public Health and Health Care in Nebraska. Preventing chronic disease16.

Yen, P. Y., McAlearney, A. S., Sieck, C. J., Hefner, J. L., & Huerta, T. R. (2017). Health information technology (HIT) adaptation: refocusing on the journey to successful HIT implementation. JMIR medical informatics5(3), e28.


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