Problem Statement
Historically, Gotham Hospital has a reputation of providing needed services to the poor and underserved in its community. The ACA/ACO provision requires that hospitals save cost in managing their patients with chronic diseases. With the implementation of individual mandate of the ACA in 2014, most of the 216,000 presently uninsured in the Bronx (Kaiser Family Foundation, 2009) will be eligible for one form of medical insurance or the other, especially Medicaid. Most of the patients are more likely to have access to Gotham hospital as the major healthcare provider in the Bronx. According to statistics from CDC (2010), about 12% of the Bronx 1,385,108 residents (US Census Bureau, 2011) have diabetes. Most of these roughly 120,000 diabetes patients in the Bronx account for $503 million in healthcare spending. This constitutes a huge financial burden. As it relates to diabetes, compliance with the ACA mandate will require Gotham’s hospital ACO structure to coordinate care in the management of these diabetes patients to ensure that the amount spent on diabetes post ACO is well below the $503 million spent annually pre ACO.
Pre ACA/ACO, Gotham has an established reputation in providing high quality care to the underserved and uninsured in the Bronx community. The diabetes management team at Gotham is no exception. Some of the diabetes management and prevention programs are sometimes made available at no cost to the underserved community Pre ACO. However, Gotham hospital’s diabetes program has a common challenge: Underutilization. While these services are available as well as the needed manpower to give the necessary diabetes care, enrollment into the program by members of the community with diabetes remains low.
Using enrollment into the diabetes program as a measure of access by the community to the services at Gotham, some questions remain to be answered. Why are the underserved and uninsured in the Bronx community not utilizing the diabetes program? How has access to the underinsured and uninsured improved post ACO implementation at Gotham Hospital? How has the incidence of diabetes changed pre and post ACO? [these are good questions which I hope you will answer in your paper].
To effectively answer these questions, the team will research the following areas: 1) the effect of implementing the ACO provision on Gotham Hospital and its uninsured and underinsured population in the Bronx community; 2) how the ACO provision affects the Hospital’s operating budget without compromising quality of care; 3) how the stimulus package affects Gotham Hospital and its patient population; and 4) relevant stakeholders and their perspectives on the ACO. 5) Comparative analysis of standard practice in diabetes management (Literature review) and what is obtainable at Gotham Hospital; 6) Identify possible factors responsible for the underutilization of diabetes management program at Gotham by The Bronx community; 7) Offer recommendations on how to increase enrollment into the program.
