Healthcare Payment Trends Matrix
Healthcare Payment Trends Matrix
(Healthcare Payment Trends Matrix)
HCS/385 – HEALTH CARE FINANCE: Finance Environment Matrix
Create a matrix in which you:
- Identify at least 3 economic trends of the health care payment system.
- Identify ethics and compliance issues associated with those trends.
Cite 3 peer-reviewed, scholarly, or similar references to support your chosen trends and issues.
Note: This assignment is meant to be a high- level look at these issues where you primarily identify what the issues are. You will cover the issues in more depth in the Week Five Finance Trends assignment.
please if you do this assignment i really will like you to do week five assignment to because they are connected both.
Finance Environment Matrix
| Economic Trend | Description | Ethics Issues | Compliance Issues |
|---|---|---|---|
| Value-Based Care Models | Value-based care shifts reimbursement from volume to quality, rewarding providers for improved patient outcomes rather than number of services. | Ethical concerns arise over equity in access; providers may avoid high-risk patients who could hurt quality metrics. | Compliance requires accurate coding, outcome documentation, and transparency in reporting performance metrics. |
| Rising Out-of-Pocket Costs for Patients | Patients bear a larger share of costs through deductibles, copays, and coinsurance, affecting affordability and access. | There is an ethical obligation to ensure financial transparency and to protect vulnerable populations from being priced out of care. | Compliance with cost transparency laws (e.g., Hospital Price Transparency Rule) is mandatory. |
| Growth of Alternative Payment Models (APMs) | APMs such as bundled payments and accountable care organizations (ACOs) are expanding to promote cost-efficiency and coordination. | Ethical concerns include fair distribution of shared savings and avoiding cost-cutting that compromises care quality. | Must comply with Centers for Medicare and Medicaid Services (CMS) regulations and anti-kickback statutes. |
References
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Berwick, D. M., Nolan, T. W., & Whittington, J. (2008). The triple aim: Care, health, and cost. Health Affairs, 27(3), 759–769. https://doi.org/10.1377/hlthaff.27.3.759
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Rice, T., & Unruh, L. Y. (2016). The economics of health reconsidered (4th ed.). Health Administration Press.
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Mechanic, R. E. (2017). Value-based payment and health care delivery reform: The urgent need for alignment. Health Affairs, 36(3), 436–444. https://doi.org/10.1377/hlthaff.2016.1050
