Abstract
Psychologists delivering integrated care to VA patients may work in VA facilities, or they may work in private sector provider organizations under the Community Care Program. In either situation, these clinicians may provide care to patients who receive some types of care covered by the VA and other types of care covered by Medicare, Medicaid, or private sector insurance. These clinicians will coordinate care funded through multiple sources that is delivered by multiple provider entities. In addition, these individuals are working in a system that is continually evolving and creating opportunities and challenges for healthcare providers and entrepreneurs. This chapter provides an overview of components of the US healthcare system, relationships among those components, and impacts of payment systems on healthcare provider strategies. While we frequently hear complaints about the system, and we might have opinions about strategies to improve the system, this chapter focuses on the task of understanding the existing public/private blended system that has evolved over several centuries. This perspective is useful for clinicians and managers working to build collaborative relationships and systems for coordinating patient care that span public sector and private sector provider organizations.
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Notes
- 1.
These percentages are computed from the National Health Expenditure Data, which are maintained by the Centers for Medicare & Medicaid Services (CMS). In these data, personal healthcare expenditures are defined to include “the total amount spent to treat individuals with specific medical conditions.” These expenditures do not include expenditures for public health programs, federal research programs, or expenditures to fund administrative costs of running government programs or health insurance company operating expenses. Source: National Health Expenditure Accounts: Methodology Paper, 2019 Definitions, Sources, and Methods. P 6. https://www.cms.gov/files/document/definitions-sources-and-methods.pdf
- 2.
Veterans Access, Choice, and Accountability. Act of 2014. 38 USC 101 note. Aug. 7, 2014. [H.R. 3230].
- 3.
S.2372—115th Congress (2017–2018). Public Law No: 115–182 (06/06/2018).
- 4.
The CMS payment incentive system for providers with patients enrolled in traditional Medicare, MACRA, includes cost control incentives.
- 5.
Activity-based costing is a direct costing approach that traces all actual costs required to produce a defined service or product. When true activity-based costing is used as the basis for cost reimbursement, reimbursements are for documented costs of production only. Unallocated funds and reserve costs cannot be expensed to the service.
- 6.
The 2010 ACA defined Accountable Care Organizations (ACOs) for patients enrolled in traditional Medicare. An Accountable Care Organization is an organization of providers, typically led by a hospital or a physician organization. Medicare assigns a panel of patients to an ACO and makes capitated payments to the ACO. The ACO is responsible for providing care as specified in the contract while demonstrating strong performance on quality metrics. Because ACO members include hospitals, physicians, and other healthcare providers, the capitated payment gives the ACO members a strong incentive to collaborate, communicate, and coordinate.
- 7.
This chapter of the Bankruptcy Code generally provides for reorganization, usually involving a corporation or partnership. A Chapter 11 debtor usually proposes a plan of reorganization to keep its business alive and pay creditors over time. People in business or individuals can also seek relief in Chapter 11. https://www.uscourts.gov/services-forms/bankruptcy/bankruptcy-basics/chapter-11-bankruptcy-basics#:~:text=This%20chapter%20of%20the%20Bankruptcy,and%20pay%20creditors%20over%20time
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Paterson, M., Wendel, J. (2022). The US Healthcare System: Components and Functional Areas. In: James, L.C., O’Donohue, W., Wendel, J. (eds) Clinical Health Psychology in Military and Veteran Settings. Springer, Cham. https://doi.org/10.1007/978-3-031-12063-3_2
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