Healthcare Policy
Bryan Cridell
American Military University
American Government
2022/08/21
Healthcare policies are integrated solutions implemented toward gearing the well-being of federal citizens and creating a healthy environment. Many solutions can be put in place to cater for safe healthcare, and in this essay, we look at two main solutions at the federal level. We discuss one more viable solution to solidifying the health crisis by minimizing health costs and delivery methods. The solution is based on goals and actions that determine the federal legal protocols observed in how care and medicine are delivered to patients. Therefore, the healthcare policy solution is important in organizing the healthcare systems and controlling the population with good healthcare coverage, especially the vulnerable people.
The state government offers real-world solutions to healthcare and coordinates with the federal government to deliver the best healthcare coverage and treatment to patients. The federal agencies are on the frontline in approaching emerging healthcare issues and working with experts. The first solution the federal agencies would offer is healthcare quality measurement, development and implementation. This can be done through research using advanced technological techniques and experts who oversee recent and emerging healthcare improvements (Essien et al., 2021). The metrics used for the quality measurement are the results of patients offered healthcare by the healthcare teams such as the nurses, coders, analysts and IT experts.
The federal agencies come in handy at recruiting the best experts by raising the bar and matching the global health requirements needed in administering healthcare. The policy of licensing nurses should be implemented in nurse education throughout their service delivery because of the emerging issues in healthcare practices. The agency’s collaboration with the analysts in discovering the emerging complications would help in measurements being put in place to ensure the larger population is not affected. The IT professionals are entitled to the innovation of better working materials such as physiotherapy equipment through inquiries from other organizations (Blumenthal et al., 2020). The organizations share a common initiative in delivering to the clients by collaborating hence developing solutions that close the gap between the government and the industry through an agency portfolio review of agency investments.
The second solution is the program integrity and compliance measures that would investigate fraud, waste and abuse of the healthcare practices, such as the drugs and medical practitioners put in place to serve the patients. The federal agencies have formulated laws that scold the people who practice the unfair distribution of drugs to ensure healthcare coverage is met. The lawbreakers engage in fraud activities where they practice sell of drugs meant for patients in various states by finding markets in the outside world and selling the drugs. This denies the clients and patients the proper service delivery in medical services where the healthcare amongst citizens is compromised, endangering the people’s lives. The federal agencies have also put in place measures to control the people who abuse drugs and use them for recreational purposes (Freij et al., 2019). The solution to such abuse is carrying out drug tests on individual citizens who have suspected of abusing the drugs, especially the rural residents in various states, and the federal agencies coordinate with the government in implementing the drug tests.
There is also a waste of drugs and abuse of different healthcare facilities, such as using them for illegal purposes that are not geared towards achieving healthcare coverage for the people. The integrity programs by the federal states are set to ensure the taxpayers’ money is used in delivering the services through the Medicaid Integrity Program. The managed care initiative reviews the state operations in curbing waste and fraud in medical institutions.
The integrity and compliance of healthcare practices is the solution that is geared towards enhancing the healthcare services offered to the population at large. There are integrity programs initiated by the federal agencies in collaboration with the government to ensure the drugs are not wasted, abused and fraud (Guild et al., 2018). The federal efforts have been directed to how transactions for drugs administered are paid for and the accountability of the relevant authorities. Through their federal agencies, the states must submit every report in the medical coverage activities with the capitation rates corresponding to the number of people covered in the managed care program.
The managed care program has been credited with relevant information to review and address the fraud and abuse conducted within healthcare delivery operations. The state staff has been given special training that helps them evaluate the information collected on healthcare delivery which would be instrumental in detecting and reporting Medicaid fraud, abuse and waste. The managed care program has also been mandated to interrogate the federal level responsibilities by reviewing the documents that contain the contracts given to the organizations. The organizations given contracts to deliver in the healthcare exercise such as the drugs distribution and rightful allocation to the people are mandated to give the detailed report such as invoices that indicate the drugs have been given to the right people.
The federal law describes that the Office of Financial Management is responsible for auditing and investigations of both Medicaid programs, evaluates the data in every transactional aspect, and makes recommendations to improve efficiency in reducing fraud and abuse. Therefore, federal laws have required that states have mechanisms that identify and refer suspected fraud cases to relevant state enforcement agencies. The mechanisms include independent audits on contracts in periods less than every three years showing truthfulness and accuracy in encountering the financial data submitted. The federal rules have put in place control measures that include medical providers contracting with the state in drug delivery and the experts to minimize improper payments made.
This enables easy evaluation of procedures undertaken to provide healthcare services because the policies are clear. The policies and compliance programs have been written down, and various investigative committees are set to implement disciplinary actions in monitoring the audit reports (Langer et al., 2018). The main compliance risk is always the overpayment for the drugs and ghost experts, which influences the diversion of public money to illegal entities. Federal laws are shared within states to ensure every department in healthcare service delivery is held accountable for every action undertaken. This particularly focuses on auditing the taxpayers’ money and documentation of every financial report through every organization and finding solid solutions in minimizing fraud and abuse of the healthcare programs.
The federal laws have adopted the Alliant turnkey approach that helps recover money lost to fraudulent billing and abusive healthcare practices through a software system that ensures compliance with federal requirements. This sophisticated software creates a system that monitors every activity in service delivery and outlines the financial activities engaged in healthcare programs across the states. The software data collected is also instrumental in preventing fraudulent activities and abuse of healthcare power. The software focuses on the patterns of conducting the healthcare service delivery used to determine the future occurrence of the healthcare routine programs.
In conclusion, the above-described solutions are policies geared towards delivering the best healthcare activities and transparency to improve the livelihoods of the larger population. We focused on integrity compliance measures as the best solution because when the resources are allocated in the best way, the healthcare programs are easier to administer because of the trust built between the clients and the citizens. Integrity ensures the financial resources are used for the intended purposes and minimize corruption.
References
Essien, U. R., Dusetzina, S. B., & Gellad, W. F. (2021). A policy prescription for reducing health disparities—achieving pharmacoequity. Jama, 326(18), 1793-1794.
Blumenthal, D., Fowler, E. J., Abrams, M., & Collins, S. R. (2020). Covid-19—implications for the health care system. New England Journal of Medicine, 383(15), 1483-1488.
Freij, M., Dullabh, P., Lewis, S., Smith, S. R., Hovey, L., & Dhopeshwarkar, R. (2019). Incorporating social determinants of health in electronic health records: qualitative study of current practices among top vendors. JMIR medical informatics, 7(2), e13849.
Guild, A., & Figueroa, I. (2018). The neighbors who feed us: farmworkers and government policy-challenges and solutions. Harv. L. & Pol’y Rev., 13, 157.
Langer, C. S., Antonelli, R. C., Chamberlain, L., Pan, R. J., & Keller, D. (2018). Evolving federal and state health care policy: toward a more integrated and comprehensive care-delivery system for children with medical complexity. Pediatrics, 141(Supplement_3), S259-S265.
