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What best describes an integrated delivery system
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Ambulatory care also known as outpatient care involves services provided to patients who are not admitted to hospital or nursing home. Traditionally, ambulatory care includes settings like clinics, medical practices, hospital outpatient and emergency department. Other care that is considered not nontraditional are settings such as home health care, urgent care centers, diagnostic imaging centers clinical laboratories etc. that are steadily growing. According to chapter one of the text book, the cost of ambulatory care is high thus, increasing portion of the healthcare expenses. As the approaches to control the outpatient spending are enhanced, the policies and procedures for ambulatory care are effective (Gapenski, 2018). In the military …show more content…
Most long-term care isn't medical care, but rather helps with basic personal tasks of everyday life sometimes called activities of daily living. Some of the services provided are for individuals who lack all or some functional ability specifically in the activities of daily living such as eating, bathing, and movement. Although this type of care usually covers an extended period and may be given as an inpatient or out patient service but the most common users are the elderly and also available to individual of all ages. Medicare does not cover long-term care, if that's the only care needed but they cover lonterm care in hospitals. Individuals become candidates for long-term care when they become too mentally or physically incapacitated to perform daily living tasks and when their family members are unable to provide the help needed. These services tend to offer a higher quality of life, although they are not necessarily less expensive than institutional care. Home health care, provided for an extended time period, is an alternative to nursing home care but is not as readily available in many rural areas. Generally, patient won't pay more for care in a long-term care hospital than in an acute care hospital. Under Medicare, patients are only responsible for one deductible for any benefit period. This applies whether they are in an acute …show more content…
The benefits attributed to integrated delivery systems are the fact that patients are kept in the corporate network of services; providers have access to managerial and functional specialists, such as reimbursement and marketing professionals; Information systems that track all aspects of patient care, as well as insurance and other data, can be developed more easily than under a disjointed care model, and the costs to develop them can be shared; Larger, multipurpose organizations have better access to capital; The ability to recruit and retain management and professional staff is enhanced; Healthcare insurers can be offered a complete package of services; A full range of healthcare services, including chronic disease management and health status improvement programs, can be better planned and delivered to meet the needs of a defined population. Many of these population-based efforts typically are not offered by stand-alone providers (Gapenski,
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 challenges that all acute care hospitals and facilities faces are the demand for highly specialized services has increased. The US population is constantly aging and the elderly tend to need more acute care services. Because many people lack health insurance, they tend to use emergency rooms in the hospitals as their source of care. The increase demand in acute care prompted hospitals to expand their facility
Integrated Managed Care Organization- The organization is properly aligned for the primary driver being cost cutting services. Since all entities within the organization are responsible and affected by any expenses endured on any entity being unfavorable or favorable, the foundation serves as a primary motivator to reduce costs at all levels. This alignment eliminates any financial gains from driving high utilization of services or higher intensity services within the organization. Ultimately, this system allows the physician medical group to drive patient care, being responsible for the clinical care decisions as opposed to health plan making those decisions as designed in other organizations. This is the preferable model for Medicaid
- Wolper, Lawrence F. Health Care Administration: Planning, Implementing, and Managing Organized Delivery Systems. Gaithersburg, MD: Aspen, 1999
Integrated services help arrange services that are easy for users to scroll through. It provides financial and medicine management to work together on a goal and make the most of resources provided in the hospital (World Health Organization, 2008). For instance in the case study the hospital had a health food store, a physiotherapy clinic, an alternative medicine clinic, a pharmacy, and a home health care store under one management, making it a lot more easier for patients to access. Overall integrated services in health care can escalate the quality of care, enhance access to services and lower overall health care expenditures. Due to the fact that is more economically efficient to share human resources than have health care systems be dedicated to one particular disease, and it makes more sense to deal with all of the problems the patient is facing rather than focussing separately on just one health problem (World Health Organization,
For patients, when ACOs are fully functional they represent an increase in patient experience in several ways. First ACOs allow open communication between physicians from different specialties coordinating together to determine solutions. Second, ACOs also establish a single point of contact for all questions concerning care. Finally, these organizations represent a centralized network of physicians for the patient, creating a team to deliver comprehensive care. In fact, there is mounting evidence that suggests the potential benefits of care coordination in ACOs for both patient experience and quality, including reduced hospital admissions, improved quality of chronic disease management, improved patient satisfaction, and better access to specialty care (Stille, 2005). For providers, ACOs provide an opportunity for better collaboration on the various modalities they use on their patients, as well as improved workflow and communication. There are several stakeholders in which the large scale implementation of ACOs would affect. Federal and state government health insurance programs like Medicaid and Medicare, one type of stakeholders. With the implementation of ACOs and the shared savings model, Medicaid and Medicare now have a financial incentive to partner with healthcare organizations to deliver better outcomes at lower costs. If done correctly, Medicaid and Medicare stand to save large
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.
Managed care dominates health care in the United States. It is any health care delivery system that combines the functions of health insurance and the actual delivery of care, where costs and utilization of services are controlled by methods such as gatekeeping, case management, and utilization review. Different types of managed care plans came into development by three major factors. These factors include choice of providers, different ways of arranging the delivery of services, and payment and risk sharing. Types of managed care organizations include Health Maintenance Organizations (HMOs) which consist of five common models that differ according to how the HMO is related to the participating physicians, Preferred Provider Organizations (PPOs), Exclusive Provider Organizations (EPO), and Point of Service Plans (POS). `The information management system in a managed care organization is determined by the structure of the organization' (Peden,1998, p.90). The goal of a managed care system is to provide subscribers and dependants with needed health care services at the lowest possible cost. Certain managed care plans also focus on prevention by trying to keep members healthy.
reimbursement determinations. As a result, the camaraderie among physicians has developed into a more aggressive approach to impede competition (Shi & Singh, 2012). Little information is shared with patients in regards to procedures or disease control. The subjects are forced to rely on the internet for enlightenment on the scope of their illnesses (Shi & Singh, 2012). Furthermore, the U.S. health care system fails to provide adequate knowledge on billing strategies for operations and other medical practices. The cost in a free system is based on supply and demand and is known in advance of hospital admission (Shi & Singh, 2012). The need for new technology is another characteristic that is of interest when considering the health care system. Technology is often v...
The national pay for value based system development has positive and negative aspects. System implementation will require multiple entity participation. Hospitals, physicians, outpatient centers, and clinics all will be responsible for collaboration in developing an integrated communication system which will present additional expense on the front end. Government mandates will be required; from implementation dates to specified circumstances in which assistive funding may be available. Multi provider ...
Managed care, managed care has become the dominant health care delivery source. Gaining popularity in 1990s, managed care increased from 27% in 1988 to 99% in 2009 and enrollment in Fee for Service plans decli...
Patients with chronic diseases do not receive established and operative treatments to help them successfully manage their condition. These complications are aggravated by an absence of organization of care for patients with chronic diseases. Nevertheless, the fundamental disintegration of the health care system is not unexpected given that health care providers do not have the imbursement support or other tools they need to interconnect and work together successfully to improve patient care (Brennan et al., 2009; Renders et al., 200;).
Shi, L. & Singh, D. A. (2010). Delivering Health Care in America: A System Approach 5th ed. Baltimore, Maryland: Jones & Bartlet
With the rise of health care costs, many seek to adapt into the integrated healthcare
Managed health care actually combines health care delivery with the financing of services provided. This was intended to replace conventional fee-for service plans with much more affordable quality of care to the health consumers as well as the providers who was in agreement with the restrictions. However, managed care is becoming challenged due to the growth of consumer-directed health plans, which defines employer continuations and asking employees to be more responsible within their health care decisions and cost-sharing. The Americans health care system has been changing the way their health care services are organized and delivered. As seen by the movement from traditional fee-for-service systems to managed care networks. Ranging from structured staff model HMOs to the lesser structured preferred provider organizations (PPO). Statistics show that 60 million Americans are enrolled with some type of managed care program within the response to regulatory initiatives which affect health care cost and quality. Managed care organizations are responsible for the health of their enrollees, which can be administered by a physician’s group, health system, or even a hospital. Much of the managed care financing is through a method called capitation, and the enrollees are assigned to a select primary care provider, which serves as a gatekeeper.