The Parity of Healthcare is a model that integrates two other models together in a unified way that allows organizational leaders to forecast the effects decisions and policies may have on an organization’s horizontal environment. The two models contained within the Parity of Healthcare are the Managed Care Quaternion (MCQ) and the Iron Triangle. To better understand the effectiveness of the Parity of Healthcare, it is necessary to look into its relationship with the Managed Care Quaternion (MCQ) and Iron Triangle. The Iron Triangle model was developed by William Kissick in the early 1990’s during the managed care revolution in the U.S. The model was called Iron Triangle to help express the level of difficulty in prioritizing healthcare …show more content…
as it related to costs, quality and access. Understanding these three fundamental aspects of the triangle would help healthcare organizations in prioritizing logistical matters. Each side of the triangle only accounts for one aspect or resource within the healthcare industry. All three sides’ together account for the expectations, goals and economics set forth by a society that supports the healthcare industry. Each side or element of the triangle may be increased, but only at the expense of the other two. For example, a healthcare organization may choose to increase costs thereby restricting access to a population group. The Managed Care Quaternion (MCQ) model was developed by Dr. Nick Coppola in 2003. The model, which has steadily gained popularity within government organizations, is used to forecast healthcare needs. Generally, it is a tool that is used in tandem with the Iron Triangle for policy and decision making. The four elements of the MCQ model are patient, payer, employer, and provider. The payer stakeholder, who includes patients, is important to any organization because they provide reimbursement for services rendered. Payers will always seek the lowest possible cost and are willing to sacrifice to find it. Patients are the users of the healthcare system and facilities and ultimately pay for their services.
This group is more focused on satisfaction, access and quality of care. Providers, or practitioners, are also key stakeholders within an organization. The term provider can encompasses not only physicians and surgeons, but also nurses, physical and occupational therapists, technicians, and other members of a clinical staff. Providers fall into two categories, primary, which includes hospitals and health departments and secondary, which includes educational institutions and pharmaceutical companies. Providers are focused on the best treatments for patients and are involved in delivering health services and products. The final element of the MCQ model is the employer who by far is the largest paying and purchasing stakeholder of an organization. The employers focus is primarily on their return on investment within an organization. Cost and quality is a focus for employers when choosing health benefits but are mindful that access is just as important. Within the Patient Healthcare model, MCQ explains the interactions between the four elements of employer, patient, provider and payer while the Iron Triangle focuses on the factors of cost, quality, and access. The Patient Healthcare model charges healthcare leaders with the task of balancing satisfaction with the stakeholder (employer, patient, provider, and payer) in relation to cost, quality and access. This may be very difficult since stakeholders may have competing priorities. Changes and variations made in how healthcare organizations operate may have profound effects on how stakeholders perceive the quality, access and cost. For instance, a patient may consider cost to be a top priority when seeking healthcare and at the same time the healthcare organization may consider raising costs and therefore devaluing access and quality. Patients who begin to incur high out-of-pocket costs may begin to perceive a financial
motive on the part of the physician and healthcare organization.The burden of high medical costs may begin to affect the patients trust in care givers since they will view their visits to hospitals and clinics merely as monetary transactions and nothing else. This will marginalize the perceived benefits of care in relation to the high costs incurred and patients will become suspect of the quality of care received. Even if the perceived lack of quality by the patient is not factual, it can be detrimental to the long term goals of a healthcare organization. According to Ledlow and Stephens (2014), “Given this complexity associated with forecasting only one stakeholder’s priorities over a sustained period of time, it becomes clear why it is so challenging for health leaders to accurately predict all future needs for all stakeholders” (p.319). Healthcare organizations can only be successful if they understand the influence that stakeholders have. An organizational leader should be able to successfully forecast the needs of the stakeholders and integrate them into the decisions made by the organization.
Many sources identify the Triple Aim as a derivation of the Iron Triangle’s evolution. The Iron Triangle addresses the ambiguous quality of services, the accessible nature of healthcare delivery, and the affordability of the care. In complete opposition, Triple Aim seeks to optimize performance by improving the patient experience, improving the health of a population, and reducing per capita health care costs. Furthermore, the Triple Aim framework supports the reduction of waste and increase in operational efficiency through the usage of integrators that oversee the three components. The topics addressed in each triangle’s vertices do not have a one-for-one correlation and hence further reveal the differentiation among the ideas. However, both the Iron Triangle and Triple Aim have continued to remain common knowledge among educators and healthcare policy makers and have contributed to health policy changes over the
To guarantee that its members receive appropriate, high level quality care in a cost-effective manner, each managed care organization (MCO) tailors its networks according to the characteristics of the providers, consumers, and competitors in a specific market. Other considerations for creating the network are the managed care organization's own goals for quality, accessibility, cost savings, and member satisfaction. Strategic planning for networks is a continuing process. In addition to an initial evaluation of its markets and goals, the managed care organization must periodically reevaluate its target markets and objectives. After reviewing the markets, then the organization must modify its network strategies accordingly to remain competitive in the rapidly changing healthcare industry. Coventry Health Care, Inc and its affiliated companies recognize the importance of developing and managing an adequate network of qualified providers to serve the need of customers and enrolled members (Coventry Health Care Intranet, Creasy and Spath, http://cvtynet/ ). "A central goal of managed care is containing the costs of delivering care, but the wide variety of organizations typically lumped together under the umbrella of managed care pursue this goal using combination of numerous strategies that vary from market to market and from organization to organization" (Baker , 2000, p.2).
The HealthSouth business model stresses four basic steps from diagnosis to rehabilitation and this model served as its mark of distinction among other healthcare providers (Jennings, 2012, p. 183). From 1987 through 1997 HealthSouth’s stock rose 31 percent per year and Mr. Scrushy told analysts that HealthSouth had matched or exceeded earnings for forty-seven quarters in a row (Jennings, 2012, p. 183-184).
‘Since its launch in 1948, the NHS has grown to become the world’s largest publicly funded health service. NHS employs more than 1.7m people and deals on average with 1m patients every 36 hours. It is also one of the most efficient, most egalitarian and most comprehensive. Even though NHS services in England, Wales, Scotland and Northern Ireland are managed separately and each might have some system differences, they remain similar in most respects and belong to a single, unified system. The NHS core principle is that good healthcare should be available to all, regardless of wealth.’ (NHS, 2010) Success of NHS depends on how well the organisation balance quality and customer (patient) satisfaction with adequate financing and long-range goals. Health care organisations such as NHS must deal with government oversight, managed care, new technologies, and increasing pharmaceutical prices.
Pay-for-performance (P4P) is the compensation representation that compensates healthcare contributors for accomplishing pre-authorized objectives for the delivery of quality health care assistance by economic incentives. P4P is increasingly put into practice in the healthcare structure to support quality enhancements in healthcare systems. Thus, pay-for-performance can be seen as a means of attaching financial incentives to the main objectives of clinical care. However, reimbursement is a managed care payment by a third party to a beneficiary, hospital or other health care providers for services rendered to an insured or beneficiary. This paper discusses how reimbursement can be affected by the pay-for-performance approach and how system cost reductions impact the quality and efficiency of healthcare. In addition, it also addresses how pay-for-performance affects different healthcare providers and their customers. Finally, there will also be a discussion on the effects pay-for-performance will have on the future of healthcare.
...lthcare system is slowly shifting from volume to value based care for quality purposes. By allowing physicians to receive payments on value over volume, patients receive quality of care and overall healthcare costs are lowered. The patients’ healthcare experience will be measured in terms of quality instead of how many appointments a physician has. Also, Medicare and Medicaid reimbursements are prompting hospitals, physicians and other healthcare organizations to make the value shifts. In response to the evolving healthcare cost, ways to reduce health care cost will be examined. When we lead towards a patient centered system organized around what patients need, everyone has better outcomes. The patient is involved in their healthcare choices and more driven in the health care arena. A value based approach can help significantly in achieving patient-centered care.
In her paper emerging model of quality, June Larrabee discusses quality as a construct that includes beneficence, value, prudence and justice (Larrabee, 1996). She speaks of quality and value as integral issues that are intertwined with mutually beneficial outcomes. Her model investigates how the well-being of individuals are affected by perceptions of how services are delivered, along with the distribution of resources based on the decisions that are made (Larrabee, 1996). She speaks of the industrial model of quality and how the cornerstone ideas of that model (that the customer always knows what is best for themselves) does not fit the healthcare model (Larrabee, 1996). Larrabee introduces the concept that the patient va provider goal incongruence affects the provide (in this case the nurse) from being able to positively affect healthcare outcomes (Larrabee, 1996). The recent introduction of healthcare measures such as HCAHPS: Patients' Perspectives of Care Survey has encouraged the healthcare community to firmly espouse an industrial model of quality. HCAHPS is a survey where patients are asked questions related to their recent hospitalization that identifies satisfaction with case based solely on the individuals’ perception of the care given. This can lead to divergent goals among the healthcare team or which the patient is a member. Larrabee’s model of quality of care model
Davidson, Stephen M. Still Broken: Understanding the U.S. Health Care System. Stanford, CA: Stanford Business, 2010. Print.
When one examines managed health care and the hospitals that provide the care, a degree of variation is found in the treatment and care of their patients. This variation can be between hospitals or even between physicians within a health care network. For managed care companies the variation may be beneficial. This may provide them with opportunities to save money when it comes to paying for their policy holder’s care, however this large variation may also be detrimental to the insurance company. This would fall into the category of management of utilization, if hospitals and managed care organizations can control treatment utilization, they can control premium costs for both themselves and their customers (Rodwin 1996). If health care organizations can implement prevention as a way to warrant good health with their consumers, insurance companies can also illuminate unnecessary health care. These are just a few examples of how the health care industry can help benefit their patients, but that does not mean every issue involving physician over utilization or quality of care is erased because there is a management mechanism set in place.
The American Healthcare system is a very complicated system. It is very difficult for an average individual to comprehend it. In order to understand the healthcare system you must also understand the iron triangle of health. The iron triangle of health is a concept or theory that was proposed by William Kissick in 1994. The three vertices of the iron triangle of health are cost, quality and access. According to this theory those three vertices are connected to each other, therefore, an increase in quality will either result in an increase in cost or a reduction in access. Also, if access is increased that will result in a decrease in quality and an increase in cost. Therefore, one of the most important purposes of creating the affordable Care
The United States health care system is one of the most expensive systems in the world yet it is known as being unorganized and chaotic in comparison to other countries (Barton, 2010). This factor is attributed to numerous characteristics that define what the U.S. system is comprised of. Two of the major indications are imperfect market conditions and the demand for new technology (Barton, 2010). The health care system has been described as a free market in
Stephen Jonas, Raymond G, Karen G, “An Introduction to the US healthcare System” 6th Edition, Page 118, 25 May 2007
The rapid growth of managed care is the response to limited financial resources and the demand for healthcare services to be affordable. Economic viability is a crucial aspect of health care. Managed care plans were developed to provided health care services, but also to be a method to collect payment for services. There are different types of managed care plans. For example, health maintenance organization (HMO), preferred provider organization (PPO), and point-of-service (POS) plans. For brevity of this paper the HMO managed care system will be discussed along with the relevance of the role of the advance practitioner practicing in HMO setting.
The balance between quality patient care and medical necessity is a top priority and the main concern of many of the healthcare organizations today. Due to the rising cost of healthcare, there has been a change in the focus of reimbursement strategies that are affecting the delivery of patient care. This shift from a fee-for-service towards a value-based system creates a challenge that has shifted many providers’ focus more directly on their revenue. As a result, organizations are forced to take a hard look at the cost of services they are providing patients and then determining if the services and level of care are appropriate for the prescribed patient care.
Competitive advantage matters greatly to those responsible for the management of healthcare institutions. Together with rapidly escalating healthcare costs, increasingly complex medical technologies, and growing regulatory and legal pressures, healthcare organizations face a critical need to improve the quality of care at reduced costs (Cu...