Complex Disease Care Models
The management of complex disease states usually requires care coordination across multiple providers and settings over a long period of time. Describe how two financial and payment models in health care, such as capitation, value-based care, or fee-for-service, impact the delivery, access, and quality of care for patients requiring complex disease management. Students may use other financial and payment models of health care outside of those listed here.
Initial discussion question posts should be a minimum of 200 words and include at least two references cited using APA format.
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Complex Disease Care Models
Impact of Capitation on Complex Disease Management
Capitation is a payment model where providers receive a fixed amount per patient regardless of services rendered. In complex disease management, this model can encourage cost-effective care by promoting preventive services and reducing unnecessary treatments (Song et al., 2019). Providers are motivated to coordinate care to avoid hospitalizations and high-cost interventions. This model often leads to better access to continuous care due to its focus on long-term management strategies. However, capitation may pose risks for under-treatment if providers aim to reduce costs excessively. Patients with complex diseases benefit from improved coordination, but only if providers balance cost control with comprehensive care delivery.
Value-Based Care and Quality Outcomes
Value-based care ties payments to the quality rather than the quantity of services. This model supports patients with chronic or complex conditions by rewarding outcomes, not procedures. It encourages collaboration among healthcare teams to manage all aspects of a patient’s condition. Value-based care models foster access to multidisciplinary support services, improving disease monitoring and reducing hospital readmissions (Porter & Lee, 2013). These models emphasize evidence-based practices, enhancing quality of care and patient satisfaction. Despite implementation challenges, such as data tracking and outcome measurement, value-based care remains a promising approach for managing long-term illnesses effectively.
