...Assignment 2 Financing and Restructuring Health Care Dr. David Tataw HSA 500 Health Services Organization January 28, 2012 Abstract: This paper analyses the Financing and Structuring Health Care by analyzing four important notions. Firstly it Identifies and describe the three main types of health insurances in the U.S. Secondly it explains the three methods for categorizing health insurance in the U.S. This is followed by a synthesis of the pros and cons of managed health care for the health care provider, insurer, and patient. Finally the papers describe the impact of managed care on both the Medicare and Medicaid programs. Identify and describe the three main types of health insurances in the U.S. Rodts (2010) talks about the new Healthcare system in US and the challenges it brings for healthcare providers but there is always challenge when one has to select the certain type of health cover for himself. It is therefore important to understand main types of health insurance in the US. While Hall (2010) outlined the three different types of reinsurances brought about by the health reform, Health Insurance Info (2010) notes that are a number of different types of health insurance coverage designed to meet the needs and budget of a variety of individuals. In essence, health insurance is a risk management tool that ensures you and your family has access to the healthcare you need, when you need it without causing a tremendous financial burden. The cost of health insurance...
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...health care coverage and services. Within the past thirty to forty years, the scope and cost of health care coverage and services has drastically changed, altering the manner in which health care was previously managed. There are several factors that have affected the cost of health care coverage over the course of the past two to three decades. One of these factors is the introduction and rapidly increasing enrollment in managed health care insurance plans. Managed care health insurance plans can, in most cases, help to alleviate the rising costs of effective medical coverage. Another important factor that has affected health care costs is the invention and implementation of new medical technologies. As prominent researchers and economic analysts have discovered, there is a distinct and direct correlat! ion between advancing medical technologies and rising health care costs. Medical innovation has been proven time and again to be an important determinant of health care cost growth. It would appear that managed care health insurance plans, which attempt to lower health care costs, and highly expensive new medical innovations and procedures are at cross purposes, pulling against one another in very different directions. Market-level comparisons have found the cost growth of health care in markets with greater managed care penetration to be generally slower than that of non-managed care health insurance markets. However, managed care...
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...Course Project Anise Hutcherson Approaches to Disease Management in Managed Care DeVry University `12/11/15 Table of Contents 1. Introduction…………………………………………………………….. Page 3 2. Background…………………………………………………………….. Page 4 3. The Challenges and Problems Associated with Disease Management…….. Page 6 4. Review of the Research and Literature…………………………………… Page 8 5. Challenges/Problems Analysis with Disease Management……………….... Page 9 6. Recommend Solutions of Improvements in Disease Management…………..Page 10 7. Implementation of Solutions in Disease Management in Managed Care Industry..Page 11 8. Justification………………………………………………………………… Page 12 9. Summary and Conclusion…………………………………………………...Page 14 10. Works Cited-References………………………………………………….. Page 16 Introduction It is very well known how most physicians or healthcare facilities and organizations handle diseases in our society in my opinion. Managed care for diseases are mostly not focused on, it is for large populations. But typically physicians do try to focus on individuals however once you throw MCO in the mix it becomes similar to a farmer caring for cattle which I hate to say. And I am very much passionate about this subject because of my experience in the very arena. Before I had a stable job with wonderful health insurance, I relied on government paid insurance for a minute and during that time I was diagnosed with Lupus which is a autoimmune disease with no cure. However...
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...markets in health care can offer patients greater quality, more options, and lower costs. The Federal Employees Health Benefits Program and Medicare Part D serve as two illustrative examples of competition in health care today. Proper reforms to add further competition to the health care industry would be quite significant and would further America’s position as the world’s leader in health care for years to come. KEY POINTS 1. The body of peer-reviewed academic literature suggests that health care can and should operate like a traditional market. 2. Market-oriented reforms have the potential to improve the quality and cost-effectiveness of care, as demonstrated by the Federal Employees Health Benefits Program (FEHBP) and Medicare Part D. 3. Consumer-driven health plans are viable alternatives to traditional plans, and consumers should have the option of choosing such plans. 4. Proper risk adjustment mechanisms can prevent adverse selection. 5. Migrating toward value-based payment systems will result in greater quality of care at lower costs, in part by incentivizing the health care industry to make great strides in offering integrated care, innovative treatments, and personalized medicine. ABOUT THE AUTHOR Kevin D. Dayaratna, Ph.D.Senior Statistician and Research Programmer Center for Data Analysis Over the course of the past several decades, federal and state lawmakers have proposed a variety of initiatives to reform America’s health care system and reduce...
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...characteristics of those dying in the United States, to determine life expectancy, and to compare mortality trends with other countries.” ("Mortality data," 2013). Furthermore, Fleming notes three different kinds of rates, which are crude rates, specific rates and adjusted rates (2008). Based on the statistics from table 6.7 (Fleming, Pg. 141, 2008), the managed care organization BGE has a higher mortality rate (290 per 100,000) when compared to the managed care BGW (160 per 100,000) by 130 cases. To calculate which MCO has the higher morality rate (Age-specific mortality data, table 6.7), we first have to compare the results from the following equation: a) For BGW: (968,800/280,000,000) x 100,000 = 346 per 100,000. b) For BGE: (956,200/280,000,000) x 100,000 = 341.5 per 100,000. After comparing the results we can see that BGW (346 cases) has a higher mortality rate when compared to BGE (341.5 cases). To calculate the age-gender adjusted mortality rates for the managed care organizations BGW and BGE both have to be analyzed independently and the results will ten be compared. a) For BGW: (1,019,150/280,000,000) x 100,000 = 364 cases per 100,000. b) For BGE:...
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...Case 2: A report on the case of Intermountain Health Care Introduction: This report analyses the case of Intermountain Health Care (IHC) which presents the idea of integrated model of health care system and provides perfect explanation of medical organization. The purpose of this report is to outline various lessons learned from the case of IHC and set an example for other medical organization by explaining success criteria of this case. Success criteria of the IHC: IHC has succeeded to deliver uniform quality medical care with continuous enhancement by implementing strategic vision in the organization and co-ordination among staff. For the health care organizations patient’s satisfaction is the essential key to success, by knowing this fact and to gain the satisfactory level of the patients, Intermountain has analysed and implemented qualitative principles for the satisfaction of patients. Also, with the help of these principles, Intermountain has planned the system. In this process of transformation at IHC, Dr. Brent James, a biostatistician and a surgeon, has played very important role and addressed the basic issues of quality management with the help of integration system. Simultaneously, as a result of integration system and as a part of organisational structure, Intermountain has found Dr W. Edwards Deming within the medical practice by mounting the cure percentage of patients which has made Intermountain unique from other health care organizations. To manage the delivery...
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...CASE STUDY Week Two Assignment You Decide Professor: Mary Black, PhD. Kingsley Agharese (HIMC) What are Medical benefits, and who should provide such benefits to company’s employees? Most Americans know what Medical benefits entail and they know how to shop around for the most affordable benefits. Should Medical benefits be mandated and priced across the board? Cooper Pearson Corporation became a victim of circumstance because they did not conduct sufficient research in regards to the best Medical benefits for their employees. Having a PPO you have a lot more flexibility, you don't have to wait for referrals and you choose your own doctor. To be honest, you also get better care with PPO. With an HMO, doctors only get a paid capitation fee which is like $5 per patient a month and some small fee for some major treatments, so that is $0 for a checkup and cleaning. On the other hand, PPO pays $120-$250 for a recall visit; so who do you think is going to get the best care and sooner appointments? Some doctor’s offices no longer accept HMOs, due to the lengthy paperwork involved, and it's simply not worth it. I realize that health care in America isn't as inexpensive or accessible as we'd like, but if faced with the option between choosing an HMO and a PPO without one being cost prohibitive, I'd pay the extra money to get the PPO because that added flexibility, in my opinion, is definitely worth it. Most PPOs have a preferred provider list, much like the HMO provider list...
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...MSTM- 6023 Strategic Planning & Policy Development Unit 2: Strategic Planning- Case Study Analysis 1 Drucker, P., 2008: Case # 13- What are “Results” in the Hospital? Table of Contents Overview ……………………………….………………………...……….. 2 Problem Statement ……………………….……………………...………… 2 Alternatives ………………………………….………………...…………... 3 Pros and cons ……………………………….………………………………4 Course of Action ……………………………..……………………………. 8 References ………………………………………………………………... 12 Overview Robert Armstrong, an ex-Navy sailor managed a successful family business for twenty years. During this time he also served as the chairman of the hospital board of directors. Healthcare had always been an interest if his. Armstrong had planned to become a physician before being drafted to the Navy while in college. After many years of business management he had begun to resent the time spent travelling and growing his business. He had secured what he described as an “over competent” team of managers within his family business and was ready for change. When the opportunity to become the hospitals administrator became available Armstrong accepted the challenge. However not being experienced in heath care management he was initially reluctant. Armstrong consulted with the hospital’s chief of medical services to inquire, “How do I measure performance?” Familiar with the definition of...
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...understanding of HIPAA and HITECH Act for health information privacy and security ▪ Six Sigma Green Belt certified PROJECTS - MS Management Information Systems Effectiveness of Nurse Communication, Spring 2012 ▪ Assessing the risks for business continuity and patient safety ▪ Study of the culture, processes, and models of communication used in hospitals Methodologies Used: Delphi, Focus Group interviews for Needs Analysis and Requirement Gathering Factors Affecting Employees’ Compliance to IT Security Policies, Fall 2011 ▪ Reviewed the various threats to information systems in an organization and the theoretical models explaining the factors that influence an employee’s adherence to IT policies. ▪ Completed a literature review of factors that affect employees’ compliance to security policies in IT industries and the measures to be taken by the senior management to improve compliance. Quality Assurance in Managed Care Organizations, Fall 2011 As a part of my course in Medical and Health Informatics, I evaluated all the features of a managed care and accountable care organization. Issues and challenges involved in assuring quality in Managed Care Organizations Specialities • MANAGERIAL SKILLS: IT PROJECT MANAGEMENT, CLIENT INTERFACING SKILLS, PROCESS MODELING, OPERATIONS STRATEGY AND MANAGEMENT, STATISTICAL DATA ANALYSIS,...
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...significance of the study 5 1.5 Nature of the study 6 1.6 Research questions and hypothesis 6 1.7 Conceptual or theoretical framework 7 1.8 Definition of terms 8 Strategic management 8 Employee welfare 8 Risk management 9 Public Health care sector 9 1.9 Assumptions 9 1.10 Scopes, limitations and delimitations 9 Chapter 2: Literature review 10 2.1 Resource management 10 2.2 Employee management 12 2.3 Risk management 15 References 18 Topic: The performance of doctors and administrators in the management of healthcare facilities Chapter 1: Introduction The management of health care facilities has been a major concern especially within public funded health facilities. Public health facilities have experience various cases of mismanagement and they have been unable to handle the increasing and changing demands towards health care (Dunn et.al, 2007). The private health institutions are considerably managed in an admirable manner because most owners treat them as an investment hence leading to the usage of strategic management in the running of these private health care centers. The public health care centers have less levels of accountability because of laxity by the funding authorities in instituting better management teams. Most public health care centers are managed by trained doctors who do not have any kind of training in the management of institutions (Dunn et.al, 2007). Owing to numerous reports regarding mismanagement of public health care systems, it is significant...
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...installation is done by determining the system configurations, staff training, which includes training the staff, Conversion, which includes converting the data and testing the system, Communications; very important component where identification and addressing of problems and concerns are established, and lastly, Preparing for the go-live date, which is very important because this is where reporting of issues and correction of problems is done, this component should be done when there is low patient volume, and staffing should be sufficient (Wager, Lee, & Glaser, 2009). How did the process described in the case study fail to include the fundamental activities identified in Ch. 7 of Health Care Information Systems? The process that is described in the case study failed to include several of the fundamental activities that were identified in Ch.7 of Health Care Information Systems. There wasn’t...
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...Decision-Making Case Study The looming changes in health care are a frequent topic in many meetings with health care providers. Budget cuts are not just a speculation but are a reality. Decision-making to provide quality patient care with less money is a challenge at best. The Informed Decisions Toolbox can assist administrators and managers with evidence-based decisions that will allow patients to receive the quality care they deserve while reducing expenses. The Informed Decisions Toolbox The Informed Decisions Toolbox (IDT) is the result of a research study to aid managers with making evidence-based decisions that improve organizational performance. The IDT has an approach of six steps to decision-making (Rundell, et al, 2007): (1) framing the management question, (2) finding sources of information, (3) assessing the accuracy of the information, (4) assessing the applicability of the information, (5) assessing the actionability of the evidence, and (6) determining if the information is adequate (p. 325). As a facilitator for the use of evidence-based research in decision-making, the IDT assists decision-makers with estimating how operational and strategic decisions will have an effect on the organization. Evidence-based decision-making is not new to the health care industry. Clinicians have incorporated evidence-based research for years when making patient treatment determination. The use of evidence-based research for decision-making in other realms of healthcare...
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...Health care Markets Ashley Jackson HSA 510 Strayer University Professor Renita Blake Health care Markets Analyses of the Health care delivery system The United States has no special type of nationwide system of the health care delivery. In order to obtain health care insurance, the individuals must buy it in the private marketplace, or it is given to them by the government. Part of the traditional health insurance plans, permits the unrestricted selection of the health care provider and compensates on the fee for the service basis, recently, it covers less than 30% of all the employees. There are basically two kinds of MCOs: Health Maintenance organizations and Preferred Provider Organizations. About 70% of the employees registered in MCOs. HMO is the health care delivery system that associates the insurer and producer operations. PPOs are the third party payer that provides financial incentives like low out of pocket prices, to registers who achieve medical care form the preset sequence of physicians and hospitals. The Medicare plan contains two parts: Part A is necessary and gives the health insurance coverage for the inpatient hospital concern, very limited nursing home services and some of the home health services. Part B the willingly or supplemental plan gives the advantages for the physician services, outpatient hospital services and the home health services. The US health care system is more expanded in terms of the production procedures...
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...Evolving Practice of Nursing and Patient Care Delivery Models The Speech Hello, my fello nurses. Thank you for being here at the Summit of Nursing Evolution. My name is Chhay Yann-Ly and I am a nurse. We are living in an era where the United States (US) health care system is going through tremendous changes and challenges, with sky-rocketing health care costs, fragmented and poor quality of care, high volume of aging population, and passage of the Patient Protection and Affordable Care Act (PPACA) in 2010. A summary of the PPACA is basically to improve the health care delivery system, expand coverage, and control cost (Democratics Senate Gov/Reform, n. d.). With these changes, comes the evolutionary nursing professional transformation process. This speech is a crash course on the evolving practice of nursing and patient care delivery models. The goal of this speech is to discuss the continuity or continuum of care in relation to accountable care organizations, medical homes, and nurse-managed clinics health care models. Since nursing is the backbone of health care, all of these care delivery models require a robust nursing contribution for success (American Nurses Association (ANA), 2010). The first model is the accountable care organizations (ACO). ACOs is a “shared savings” with Medicare (part A & B). The ACO, according to the ANA (2010), is “a collaboration among primary care clinicians, a hospital, specialists and other health professionals who accept joint responsibility...
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...Health Organization Case Study: United Healthcare Many selections of healthcare plans are available for consumers to choose from to match their own personal needs, preferences and budget. The health care system is most often complex, inconsistent and costly. To maintain and improve the business, healthcare organizations are continuously innovative and evolving to meet the demands of consumers. The purpose of this paper is to discuss a case study of UnitedHealthcare Group, what they are about, their network and resource management, their view on nursing and how they satisfy their patients. About United Healthcare The largest for profit healthcare carrier in the United States (US) is UnitedHealth Group, the parent of UnitedHealthcare. Headquartered in Minnetonka, Minnesota, UnitedHealth Group is a diversified managed health care company founded in 1977 and ranking #17 in the top 500 companies in the US, according to Fortune magazine. UnitedHealth Group has a total workforce of approximately 150,000 in the 50 US states and 20 other countries and serves more than 85 million individuals worldwide (UnitedHealth Group, 2013). They offer a wide spectrum of health care services and products through two operating businesses: UnitedHealthcare, which provides benefits services to individual consumers and employers of all sizes and health care coverage: and Optum, which provides technology health services and information in care delivery and improving the operating and clinical elements...
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