Healthcare organizations are continually striving to meet the health care needs of those they serve. According to the Institute for Healthcare Improvement (IHI), “successful health and health care systems of the future will be those that can simultaneously deliver excellent quality of care, at optimized costs, while improving the health of their population.” (2015, para 2.). The purpose of this paper will be to explore how UnitedHealth Group is striving to for improved patient outcomes and satisfaction. Their dedication to innovation and resource management, strong and promotion of nursing excellence United Health Group can change the needs of the healthcare landscape. UnitedHealth Group In 1974, Dr. Paul Ellwood realized his concept of a new type of health care organization. Charter Med Incorporated was one the first health maintenance organizations (HMO) bringing together core principles of evidence-based practice combined and sound business practices. In 1977, he and Dr. Richard Burke incorporated the HMO establishing UnitedHealth Care Corporation in the city of Minnetonka, Minnesota (UNH, n.d.). Over the next 40 years, UnitedHealth Care Corporation has continued to expand through a variety …show more content…
Through the exploration of new technology, building relationships with partners and organization expansion, UNH has proven itself as a leader in the industry. As the nation’s largest health insurer, the UNH’s provider network includes approximately 850,000 doctors and 6,100 hospitals (2014). UNH continues to prosper through expanding services areas and diverse product offerings. Successful programs such as the UnitedHealthcare Marketplace, NOT ME, diabetic prevention program and innovative predictive modeling used to analyzes encounter and claims data to plan initiatives, were implemented in 2014 to improve healthcare outcomes. (Hoovers,
Membership Services (MSD) at Kaiser Permanente used to be a modest department of sixty staff. However, over the past few years the department has doubled in size, creating minor departmental reorganization. In addition the increase of departmental staffing, several challenges became apparent. The changes included primary job function, as well as the introduction of new network system software which slowed down the processes of other departments. These departments included Claims (who pay the bills for service providers outside of the Kaiser Permanente network), and Patient Business Services (who send invoices to members for services received within Kaiser Permanente). Due to the unforeseen challenges created by the system upgrade, it was decided that MSD would process the calls for both of the affected departments. Unfortunately, this created a catastrophic event of MSD receiving numerous phone calls from upset members—who had received bills a year after the service had been provided. The average Monday call volume had risen from 1,800 to 2,600 calls per day. The average handling time for each phone call had risen as well—from an acceptable standard of 5.6 minutes to an unfavorable 7.2 minutes. The department continued to be kept inundated with these types of calls for the two years that these changes have been effect.
SGH has been plagued with patient quality issues, therefore SGH finds itself in a situation which is inherently antithetical to the mission of the hospital. The costs of healthcare continue to rise at an alarming rate, and hospital boards are experiencing increased scrutiny in their ability, and role, in ensuring patient quality (Millar, Freeman, & Mannion, 2015). Many internal actors are involved in patient quality, from the physicians, nurses, pharmacists and IT administrators, creating a complex internal system. When IT projects, such as the CPOE initiative fail, the project team members, and the organization as a whole, may experience negative emotions that impede the ability to learn from the experience (Shepherd, Patzelt, & Wolfe, 2011). The SGH executive management team must refocus the organization on the primary goal of patient
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).
WellStar Health Systems is currently the preeminent and largest health care provider in Metro Atlanta. WellStar Health Systems is a not-for-profit institution that is composed of 5 hospitals and an abundance of physician groups. Physician specialty groups included within WellStar are: ENT, Psychiatry, Endocrinology, Pulmonary Medicine, Infectious Disease, General Surgery, Rehabilitation, Pathology, and Rheumatology. WellStar’s organizational design is composed of internal and external factors that define the organization’s size, organizational structure, and processes. Internal and external factors are the basis for influencing managerial conclusions in decision-making. These factors vary from organization to organization and are the rationale for understanding WellStar’s strengths, weaknesses, opportunities, and threats. Understanding these variables is a necessity for the sake of WellStar’s survival
Health Care workers are constantly faced with legal and ethical issues every day during the course of their work. It is important that the health care workers have a clear understanding of these legal and ethical issues that they will face (1). In the case study analysed key legal and ethical issues arise during the initial decision-making of the incident, when the second ambulance crew arrived, throughout the treatment and during the transfer of patient to the hospital. The ethical issues in this case can be described as what the paramedic believes is the right thing to do for the patient and the legal issues control what the law describes that the paramedic should do in this situation (2, 3). It is therefore important that paramedics also
The Centers for Medicare and Medicaid Services (CMS) have recently begun requiring hospitals to report to the public how they are doing on patient care. Brown, Donaldson and Storer Brown (2008) introduce and explain how facilities can use quartile dashboards to transform large amounts of data into easy to read and understandable tool to be used for reporting as well as to determine areas in need of improvement. By looking at a sample dashboard for an inpatient rehab unit a greater understanding of dashboards and their benefits can be seen. The sample dashboard includes four general areas, including nurse sensitive service line/unit specific indicators, general indicators, patient satisfaction survey indicators and NDNQI data. The overall performance was found to improve over time. There were areas with greater improvement such as length of stay, than others including RN care hours and pressure ulcers. The areas of pressure ulcers and falls did worse the final quarter and can be grouped under the general heading of patient centered nursing care. The area of patient satisfaction saw a steady improvement over the first three quarters only to report the worst numbers the final quarter. A facility then takes the data gathered and uses it to form nursing plan...
Reinventing Healthcare-A Fred Friendly Seminar was produced in 2008. The film explores the current issues in health care at that time. This paper explores the issues that were addressed in the movie and compares them to the problems of health care today.
Patients make up a huge part in achieving service excellence for the healthcare industry. My healthcare facility helps the patients redeem themselves and correct with sensitivity. The patients are my customers, and my healthcare facility must remember our mission and vision of giving spectacular healthcare to our customers who are our priority. By giving quality customer service, my healthcare facility earns the gratitude and patronage of its patients. The patients pass their experiences to their families and that keeps my healthcare facilities’ reputation successful
“KP is the largest non-profit health care delivery system in the United States, and operates in 8 states and the District of Columbia. KP is made up of 3 entities: the Kaiser Foundation Health Plan (KFHP), Kaiser Foundation Hospitals (KFH), and the regional Permanente Medical Groups,” (Selevan, Kindermann, Pines, and Fields (2015). Selevan al et (2015) state that the members of Kaiser Permanente can be compared to other insurance companies in regards to age, race, and employment status, although the members are known to have lower income levels. Additionally, they found that Kaiser Permanente’s model of care focuses on improving the health of patients, promoting population
According to Harry A. Sultz and Kristina M. Young, the authors of our textbook Health Care USA, medical care in the United States is a $2.5 Trillion industry (xvii). This industry is so large that “the U.S. health care system is the world’s eighth
It is enthralling to note that in spite of the advances in healthcare systems, such as our hospital’s ability to provide patients with lower cost, managed One being the Health Maintenance Organizations (HMO), which was first proposed in the 1960s by Dr. Paul Elwood in the "Health Maintenance Strategy”. The HMO concept was created to decrease increasing health care costs and was set in law as the Health Maintenance Organization Act of 1973, after promotion from the Nixon Administration. HMO would, in exchange for a fee, allow members access to employed physicians and facilities. In return, the HMO received market access and could earn federal development funds.
Healthcare organizations are designed to meet the healthcare needs of individuals and promote a healthy community. The three healthcare organizations that interest me are: The Heart Hospital Baylor of Plano, Texas Health Center for Diagnostics & Surgery Plan, and Parkland Health and Hospital System. Due to the evolving healthcare industry, focusing on just patients and physicians is no longer a marketing strategy. According to Mycek (2015), “Marketing teams need to expand their consideration set and focus on the new 5 P’s of Healthcare Marketing” (p. 1).
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...
WellPoint, CIGNA, Aetna, Humana, United Healthcare and BlueCross BlueShield, are the 6 largest health insurance companies. “They insure approximately half of the insured population, or well over 100 million people. “( Baltazar, A , the balance , the big five insurance companies https://www.thebalance.com/the-big-five-health-insurance-companies-2663838). Per the CDC chronic disease accounts for 86 % of heath care cost. CDC, June 2015. In conjunction with the CDC healthy people by 2020, insurance companies such as Humana Inc. and The Kaiser Permanente foundation, began their own healthy people initiatives with a program called HEAL , Which stands for Healthy Eating Active Living (HEAL) cities Campaign.. Their mission is to improve the health of communities throughout their northwest service region. https://www.northwesthealth.org/kpcf . As of today, there are roughly 300 cities that have adopted The Kaiser Permanente foundation HEAL program. People, Partnerships and Place: A Formula to HEAL Cities, October 7,2015. “These HEAL Cities have adopted resolutions to join the campaign and support more than 17 million community members in making healthy choices such as walking to school, accessing fresh produce or staying well at work” https://share.kaiserpermanente.org/article/people-partnerships-and-place-a-formula-to-heal-cities/ Humana Inc. has a similar program called Humana 2020, a Bold moves. Humana has committed to getting the communities they serve 20% healthier by 20/20. One example of this is in bell County KY. Local participants were to for the Team up 4 health program, which met bi weekly for 10 months they focused on things such as reading nutrition labels, participated in health and fitness class. After the 10 months 49 % of them were eating healthier while 82 % of the group reported and increase in their physical activity.
Carpenter, D. (2007). Visions of health care’s future: Bigger, more patient-focused systems?. Hospitals & Health Networks, 81(5), 4-7.