Government Policies Affecting Coordination of Care
Government at both state and federal levels enact legislations and policies that impact coordination of care. These policies offer a framework for how healthcare organizations like the American Diabetes Association work to attain their goals and offer comprehensive care to different patients with diabetes. These policies include the Affordable Care Act; especially on the expansion of Medicaid, and the Health Insurance Portability and Accountability Act (HIPAA). As such, let’s focus on how these policies affect care coordination for individuals benefitting from the American Diabetes Association.
i). Affordable Care Act 2010
The Affordable Care Act enacted over ten years ago expanded different aspects of health insurance to improve access to medications and other aspects of care for diabetic patients. The act expanded Medicaid to improve overall access for people with chronic conditions as it ensures that even those with preexisting conditions have health insurance coverage. The ACA stresses reforms in the healthcare sector based on better provisions for access through the value-based model and the Quadruple Aim goals. The Centers for Disease Control and Prevention (CDC) (2022) opines that after the Medicaid expansion, newly insured individuals like Hispanic diabetic patients had better control of their diabetes compared to non-Hispanic whites. According to the CDC, the Affordable Care Act reduced ethnic disparities in diabetes detection and treatment.
The ACA also expanded Medicare benefits and continues to push for reforms aimed at increased quality as opposed to quantity. The value-based purchase model is an indication of the ACA’s focus on quality for all patients, especially those who require insulin supplementation to improve their quality of life. The Centers for Medicare and Medicaid Services (CMS) has increased funding for diabetes care through innovative models to expand accessibility and reduce the overall cost of care (Timpel et al., 2019). As such, these efforts through the policy mean that care coordination should take a holistic approach involving all the stakeholders, from patients and their families to care providers, and government entities through following or adhering to the set regulatory frameworks.
ii). Health Insurance Portability and Accountability Act (HIPAA)
HIPAA was enacted in 1996 and requires the Health and Human Services Department (HHS) to develop regulations to protect the privacy and security of health information. A core part of these provisions is the Privacy Rule which establishes national standards for the protection of certain health information by healthcare organizations and providers. These protections ensure that while providers share health information, they should not make certain disclosures. Before the HIPAA enactment, there were no privacy standards in health care and due to evolving technology, these provisions must exist to protect patients who require care in most instances (Hill-Briggs et al., 2021). As such, HIPAA streamlines care coordination as it requires providers to follow certain provisions when sharing information concerning patients. The implication is that through HIPAA, patients get involved in their care plans and can only allow their providers to disclose certain information based on their consent.
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