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Running header: ACA title III, subtitle A

Transforming the Health Care Delivery System


David Elson, Abdullah Alhurani, Sarah Pinso, Larry Snodgrass & Sabrina Tribble
Sullivan University: HCA535
11/15/2014

ACA title III, subtitle A

Transforming the Health Care Delivery System


Statement of Work
Purpose and Background
Our main aim is ensure that the healthcare facilities and providers are in compliance with
Centers for Medicare & Medicaid Services (CMS) guidelines. In doing so, it is our goal and
intention to make sure there are checks and balances in place so that guidelines are being
followed and implemented so that there is quality and affordable healthcare within the
Affordable Health Care for America Act (ACA) guidelines. The ACA was a bill that was crafted
by the United States House of Representatives on November 7, 2009 (Affordable Health Care for
America Act, 2014). According the Health & Human Services (HHS), under the ACA, Patients
Bill of Rights gives the American people the stability and flexibility to make informed choices
about their health. Under the ACA, it allows people with pre-existing conditions to have
benefits, lower costs, ensure the majority of Americans are covered, and provide preventative
care at zero cost (About the Law, 2014).
Objectives
Through transforming the healthcare delivery system better care will be provided, better
health will be provided, and lower costs will be accessible. In order for this process to happen
successfully it will take about seven years and in the beginning the cost will be substance, around
$40 billion within the first three years. As Americans become health and we begin to expect and
demand a better lifestyle the more healthcare will be affordable and more money will be saved.

ACA title III, subtitle A

Scope
Some strategies that can be accomplished to improve the healthcare delivery system are
aligning incentives and instituting effective cost control, providing accountable, coordinated
care, providing payment incentives, and ensuring leadership accountability. In order to ensure
coordinated care the use of Electronic Health Record (EHRs) would be helpful. EHRs will lower
data errors, providing care providers with patients information in real-time.
Products and Services
Implementing a delivery system that provides quality care that reduces cost from fewer
visits to the emergency rooms or hospitalization. In the midst of the makeover of our fragmented
system we will provide more healthcare facilities that cater to patients needs such as medical
homes until of hospital type settings. The most feasible approach is to implement interoperable
electronic health record systems; the cost savings estimates $102,000 for 19% patients in the first
stage (commonwealthfund.org, 2014). Along with encouraging EHRs, we will make sure all
personnel utilize training and learning modules to ensure adequate care.
Schedule/Key Milestones
Data Software Upgrade- November 11, 2014
Period of Performance Begins- November 13, 2014
Provider Training Completion- December 15, 2014
Performance Evaluation- February 13, 2015
Implementation Complete- February 16, 2015

ACA title III, subtitle A

Risks
There are always risks in any field or industry that you are and healthcare is definitely
one to have risks. A few risks that are associated with transforming a better delivery system are
insurance, political, and medical care.
Requirements
Some special technical and functional requirements is a sophisticated data analytics,
negotiation among a third party insurers to pay for quality. Having significant learning modules
so that the providers, nurses, and other personnel are up to date with current changes in policies
and regulations.
Key Assumptions/Constraints
Some key assumptions that we are facing is the limited financial resources, with little
investments to help fund the sophisticated technology and assistance with third party insurers.
We are also assuming the need for nurses and possible physicians with the increased of insured
citizens. With this healthcare reform being new, there are always the unknown so we are
predicted so unforeseen obstacles in dealing with regulations.
Specifically Excluded Scope
To ensure quality care among patients, general practice doctors should see a minimum of
2 patients per hour for a normal 8-10 hour shifts. With the training refreshers, all staff has to
score 85% percentile and above to pass modules and if not completed in a timely manner there
will be point system.

D e liv e ry S y s te m

ACA title III, subtitle A

Work Breakdown Structure

Title III Improving the Quality and Efficiency of Healthcare Flowchart


Control the data(EHRs; data analytics)

EXCLUSIONS the Secretary will set up exclusions


Negotiate
with third party issuers

Secretary will establish Strategy

Measure & Report Performance(check


each other work)

Congress will receive report

Educate the Board, providers, and


policies and performance)

Secretary will have an independent analysis


completed
staff(regarding

The Comptroller General of the United States will create a study and Report

Implement
The Secretary shall establish performance standards

The Secretary will establish incentive

payment
incentives(bundles)

The Secretary will develop standard internet website reports

Organization Summary

The Secretary will set up an appeals process


The Secretary develop methodology for the performance scoring

The Secretary will inform the appropriate areas of updates

ACA title III, subtitle A

Schedules

Resource Allocation

ACA title III, subtitle A

Resources can vary from one organization to another. They can be identified as
personnel, equipment, and facilities. It is termed as all-inclusive. The ACA of 2010 has many
resources that include thousands of people and billions of dollars of funding. The ACA provides
grant programs to Medicaid, CHIP, and Medicare. There are healthcare centers that provide for
underserved areas. State agencies have received the most funding. In 2012 the ACA helped to
expand use of health information technology. The Health Resources and Services Administration
(HRSA) announced new grants for some thirty-seven Health Center Networks across the U.S.
The grants totaled more than $18 million in ACA funds (Fangmua, Eller & Udow-Phillips,
2013).
Budget and Cost Estimates
Budget and cost are closely related. They are also related schedules and resource
allocation. Most budgets have both estimates and projections. The Congressional Budget Office
has evaluated the cost estimate and projections for the Affordable Care Act. Their findings are
depicted in the graph below.

ACA title III, subtitle A

(Updated Estimates of the Effects of the Insurance Coverage Provisions of the Affordable Care
Act, 2014)
The graph shows net cost, gross cost, and partial offsets. The total cost addresses only insurance
coverage provisions of the ACA. The gross costs of $1,839 billion for subsidies and related
spending. The partial offsets are $456 billion. Offsets included penalty payments, excise tax on
high insurance plans. This was $61 billion less than previous projection.
Management, Planning, and Control
Obtaining a brief synopsis from Whitehouse.gov website (2014), which is ran by the
Obama administration. Holds the purpose of the Affordable Care Act (ACA) title III, Improving
the Quality and Efficiency of Health Care, is to cut the so called donut hole. Thus making the
main objective to close the gap between quality of care and efficiency while saving money.

ACA title III, subtitle A

Planning
Within title III of the ACA the focus point of this plan is subtitle A, Transforming the
Health Care Delivery System; this subtitle has three sections under title A, that consist of:

Linking payment to quality outcomes under the Medicare program


National strategy to improve health care quality
Encouraging development of new patient care models

Thus stating that that title III under ACA will be confusing on EHR, which by proxy will be
geared towards the HCIT and RHIO. Therefore, plans need to be made to upgrade the HCIT to
support a larger influx of information within the systems.
Technical/Work Performance Planning
For section 3001-3008 under ACA goes over quality insurance, a lot of these can be fixed
with a simple check and balance program. Therefore providing monthly training for employees
to ensure that they are up to date on the different programs. This will allow a refresher course to
confirm that all employees are meeting all standards.
This leads into section 3011-3015, which sets the standards in EHR, HCIT and RHIO.
These sections cover the data collection and standardization on how data will be handled.
Therefore IT needs to insure their systems are up to date on all regulations, and can handle the
high demands of the network. These systems will be key for EHR standards and demands. Thus,
the IT department needs to assess what is the appropriate Intranet and Internet that is needed for
the company (whether it is a T1, T2, T3 or T4 system).
Section 3021-3027 refers to the Center for Medicare and Medicaid Innovation (CMI).
Therefore, we need to stay in contact with CMS to keep up with the constant changes for CMI.

Review Process /Work Authorization Process

ACA title III, subtitle A

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There will be a manager meeting on November 17, 2014 at 0900 to conduct training over
the ACA title III, subtitle A policy. This Authorization for this plan is directed from the ACA
while the in-house authority comes from Team A (A. Alhurani, D. Elson, S. Pinso, L.
Snodgrass, S. Tribble). If any question arrives from this plan please contact the appropriate
manager, otherwise contact a member from Team A for further resolution.
Change Control
Everyone within the organization should understand what is happening and what is
expected from each person in the implementation process. Be prepared to calm the fears of some
employees. The need for change will be questioned but referencing the benefits of changing over
more affordable health care system will help assure employees and customers that the change is
for the better. Employees will need incentives to change their habits. Offer incentives to all
employees for training and maintaining the new organizational goals that come with
implementation. Maintain good communications by keeping an open channel and encouraging
participation at each step. The plan should also include a time line of actions for completion.
Make sure to give employees all the required information in the implementation process
(Kerzner, 2009).
Employees will be expected to learn new skills. Problems can be expected these may
push back the system go-live date, and the effects will reverberate throughout the organization.
Use the correct degree of flexibility to manage these effects. Employees should get involved at
every level; so that everyone feels they contributed to the outcome. A committee of staff
members, formed to create a proposal for delivery to the physicians and other health care
providers, is another excellent tool. This committee should be representative of those who will

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ultimately use the new plan: administrators, business staff, and medical assistants (Glandon,
Smaltz, Slovensky, & Boxerman, 2008).
Always make identifications and assessments of core values and beliefs in a cultural
assessment, including possible sources of conflict or resistance. People often become set in their
ways, resisting change as a general rule. The department managers should first be trained in the
new system as super-users and then passing the info on through training classes to others within
the organization (Kerzner).
In the end all employees need to buy-into the change, and for this to occur successfully, a
helpful framework is known as the ADKAR model (Hiatt, 2006):

A = Awareness of why the change is needed


D = Desire to support and participate in the change
K = Knowledge of how to change
A = Ability to implement new skills and behaviors
R = Reinforcement to sustain the change

Summary
Closing the gap between money while having quality and efficiency. This is the main
concept of ACA title III, subtitle A. Thus ensuring our company is to date on the EHR policies.
Along with making sure the IT department is up to date with supplies and equipment that is need
to conduct their task in hand. While ensuring our employees are trained on the network while
also making sure they are up to date on all training needed for their job.

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Reference

About the Law. (2014, October 21). Retrieved November 14, 2014, from
http://www.hhs.gov/healthcare/rights/
Affordable Health Care for America Act. (2014, October 11). Retrieved November 14, 2014,
from http://en.wikipedia.org/wiki/Affordable_Health_Care_for_America_Act
Fangmua, J., Eller, P., & Udow-Phillips, M. (2013, December 19). Affordable Care
Act Funding: An Analysis of Grant Programs under Health Care Reform - FY2010FY2013.
Retrieved November 13, 2014, from http://www.chrt.org/publications/price-ofcare/affordable-care-act-funding/
Hiatt, J. (2006). ADKAR : a model for change in business, government, and our community (1st
ed.). Loveland, Colorado: Prosci Learning Center Publications.
Kerzner, H. (2009). Project management : a systems approach to planning, scheduling, and
controlling (10th ed.). Hoboken, N.J.: John Wiley & Sons.

Schoenbaum, S., McCarthy, D., Shih, A., Nuzum, R., Davis, K., & Gauthier, A. (2008, August
1). Organizing the U.S. Health Care Delivery System for High Performance. Retrieved
November 14, 2014, from http://www.commonwealthfund.org/publications/fundreports/2008/aug/organizing-the-u-s--health-care-delivery-system-for-high-performance
Title III. Improving the Quality and Efficiency of Health Care. (2014, April 18). Retrieved
November 6, 2014, from http://www.whitehouse.gov/health-care-meeting/proposal/titleiii
Updated Estimates of the Effects of the Insurance Coverage Provisions of the Affordable Care
Act, April 2014. (2014, April 14). Retrieved November 13, 2014, from
http://www.cbo.gov/publication/45231

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