question archive NATURE OF ASSIGNMENT The relationship between healthcare providers and healthcare payers often can be adversarial
NATURE OF ASSIGNMENT The relationship between healthcare providers and healthcare payers often can be adversarial
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NATURE OF ASSIGNMENT The relationship between healthcare providers and healthcare payers often can be adversarial. Yet, at the same time, a healthy and positive relationship between these two critical stakeholders is a prerequisite to the overall success of the healthcare triangle. We have discussed numerous tension points between providers and payers during this course, including the impact of certain laws that mandate particular types of relationships (i.e., ACA, EMTALA), payment risk, and the concept of cooperative benefit and network design as a means to reduce the increasing cost of healthcare. As your final exam, please write between six and ten double-spaced pages describing the impact of the soon-to-be-enacted hypothetical FINAL Act (Future Incentives Needed to Advance heaLthcare Act). This hypothetical federal law is designed to change any aspect of the healthcare provider-payer relationship you desire and will go into effect the date after you turn in your exam. The goal of the FINAL Act is to reduce the overall cost of healthcare while increasing healthcare outcomes. As part of your paper, please address the following three areas: Please begin by describing what aspect(s) of the provider-payer relationship would be changed by your version of the FINAL Act. For example, “changing the contractual relationship of payers and providers by mandating that all providers be contracted with the largest payer in their state” or “changing the way parties negotiate over payment by mandating that every payer publish their rates of reimbursement online.” Please note this is not intended to be written in an overly “legal” sense. You will not lose points for not writing a “good statute.” Please describe and explain why your version of the FINAL Act mandates those changes. Be sure to justify your position and explain how the changes would reduce overall healthcare costs while also improving healthcare outcomes. Be sure to differentiate and explain the possible advantages and disadvantages of your version of the FINAL Act to both payers and providers both in the immediate future and the longer term. GRADING Your grade will be based primarily on how fully and accurately you are able to explain the basis for making the changes you propose in your FINAL Act. I would rather you make a handful of meaningful changes with thoughtful, careful, detailed analysis rather than selecting five or six areas simply to increase the number of modules your FINAL Act touches upon. It is not important that I agree with your proposed change(s) or even that I agree that your FINAL Act will even actually lower healthcare costs and improve healthcare outcomes. However, it is very important that you have a rational explanation and justification for why you believe those things will happen. Again, please do not get caught up on the idea that you are writing or describing a new “law.” Do not worry about including legalese or attempting to make your description of the FINAL Act sound like a lawyer wrote it. Your exam will score well if you focus on selecting changes that relate to the modules we covered during our course and on the bigger picture concepts we have discussed. In addition, you do not need to do outside research to strengthen your argument or support your position. In fact, I prefer if you give me your explanation and analysis rather than merely citing several outside sources. Reasonable, common sense analysis and explanation is fine. Finally, please be sure to focus on substance over form. Do not alter the margins of your paper, which should be 1-inch on all sides, or otherwise try to “stretch out” your work to meet the minimum page requirement. A well-written paper of six pages will score higher than ten pages of fluff.
