Assignment Description:
Signature Assignment: Medicare and Medicaid
Consider how people qualify to receive Medicare and/or Medicaid and write a paper that addresses the bullets below. There should be four (4) sections in your paper; one for each bullet below. Separate each section in your paper with a clear brief heading that allows your professor to know which bullet you are addressing in that section of your paper. Start your paper with an introduction and include a “Conclusion” section that summarizes all topics. This paper should consist of at least 1750 words and no more than 2000.
This week reflect upon the Medicare and Medicaid programs to address the following:
- Describe the Quality Improvement Organization (QIO) and explain how the QIO improves policies and healthcare for Medicare beneficiaries.
- Briefly define the qualifications for Medicare and Medicaid benefits. How can qualifications be modified to serve more people who are considered a vulnerable population?
- Discuss the impact (including at least two positive and two negative aspects) that the ACA has had on benefits and coverage for Medicare and Medicaid recipients.
- Describe your role(s) as a healthcare leader as it applies to the practice of advocating for cost effective care for vulnerable populations.
Solution:
Medicare and Medicaid
The government of the United States (U.S.) has been working to implement programs, policies, and plans that seek to improve healthcare quality for all while maintaining costs at low levels, under Medicare and Medicaid (Zhao et al., 2020). The U.S healthcare reform has been focused on reducing the uninsurance rates, increasing healthcare affordability, and improving care quality, driven by the nation’s economy, average per capita expenditure on healthcare, the structure of the insurance sector, government support, and research and development (Moody-Williams, 2020). This paper discusses Medicare and Medicaid programs including the quality improvement organization (QIO), qualifications for the programs, the impact of ACA on the programs, and the role of healthcare leaders in advocating for vulnerable populations.
Quality Improvement Organization
The Quality Improvement Organization (QIO), as described by the Centers for Medicare and Medicaid Services (CMS), is a private group of clinicians, health quality experts, and consumers intended to improve Medicare beneficiaries’ care quality (CMS.gov., 2022). The QIO Program is a renowned federal program and a part of the National Quality Strategy (NQS) for cost-effective and better care by the U.S Department of Health and Human Services (HHS), devoted to improving the quality of healthcare for Medicare beneficiaries through the improving the efficiency, effectiveness, quality, and economy of services provided (Moody-Williams, 2020). Per the Centers for Medicare and Medicaid Services (CMS), the QIO program’s key functions include improving beneficiaries’ care quality, safeguarding the integrity of the Medicare Trust Fund, protecting beneficiaries by attending to their complaints, dealing with any breaches of the Emergency Medical Treatment and Labor Act (EMTALA), and notice appeals by providers, among other functions (CMS.gov., 2022)………