...Partners HealthCare System (PHS): Transforming Health Care Services Delivery through Information Management Case Description According to government sources, U.S. expenditures on health care in 2009 reached nearly $2.4 trillion dollars ($2.7 trillion by the end of 2010). Despite this vaunting national level of expenditure on medical treatment, death rates due to preventable errors in the delivery of health services rose to approximately 98,000 deaths in 2009. To address the dual challenges of cost control and quality improvement, some have argued that what is needed is an integrated electronic medical record (EMR) system and associated information technology-enabled processes. While the information systems currently available may meet the needs of the industry, the question remains as to what is required within and by the health care services organization to achieve a satisfactory response to these dual challenges. At the present time, Partners Healthcare System (PHS) maintains a centralized digital records library on over 5 million patients, augmented in real-time by data, textual comments, and artifacts (i.e. x-rays, MRI’s, EKG’s, etc.) as these patients visit doctor offices, receive hospital-based or home care services, and obtained prescription medications and other therapies. Procedures are in place to ensure the data quality and integrity of these patient files. Going forward, any health care professional across the network can access a patient’s complete...
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...United Healthcare require the therapist to submit an on-line claim form (www.liveandworkwell.com) . First step, therapist must click the tab “Submit Claim Form” on the right side of the webpage , second step, therapist must fill out the basic information such as name, place, phone etc… third step must click on “Behavioral/Mental Health Services” section, which therapist needs to describe the following: primary mental health diagnosis of the client , what type of therapy will be provide, # of counseling sessions and time frame of each sessions, an whom the therapy is for (e.g. individual, couple, martial, and family therapy) ensure appropriate treatment for all parties involved. 2. United Healthcare Insurance view behavioral/mental...
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...In reviewing Mrs. Miller’s Medicare payments, I noticed that a wound specialist saw her at least 8 times. I am responsible for Emma’s healthcare and no treatment, unless an emergency should be done without my knowledge. I would assume this is an error and would be seen as such by licensing and the Ombudsmen’s office. I perfectly expect you to provide any emergency attention immediately without notifying me until after the issue is taken care of. Likewise a consultation for a diagnosis was ordered, completed and billed by a psychiatrist – without my knowledge, without any follow up from him or without the doctor even calling for information on her previous behaviors and personality. I am also a licensed mental health professional. I have...
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...institute, 2015). This huge size of immigrants and diversity is putting huge pressure on the healthcare infrastructure of the nation. Since most of the immigrants originate from poor countries with poorly equipped health care system, their health conditions is relatively poor. They have a variety of health problems, including infectious diseases, musculoskeletal and pain issues, mental health problems, social health issues, and longstanding undiagnosed chronic illnesses(Migration policy institute, 2015). Many of them are unvaccinated. Not only they land to the US unvaccinated and with poorer health, but also they have lower access to US healthcare system putting them at cumulative disadvantage of higher mortality and morbidty....
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...Mexico has made great strides in trying to provide healthcare for its 115 plus million citizens. Healthcare in Mexico comes in three different and distinct varieties. There are the government-run institutions that provide limited health-care benefits administered by the Ministry of Health at very long wait times. There is the upper-echelon private sector, which represents a very small percentage of Mexicans and is comprised of individuals whose health-care funding is met through private insurance carriers at a price most Mexicans cannot afford. Then there are the emerging low cost private sector healthcare providers such as Primedic, whom provide access to select healthcare services via membership plans at a very reasonable price. While these three different systems tackle Mexico’s healthcare needs in various ways, Primedic and the emerging “entrepreneurial niche sector” is a perfect example of how entrepreneurs can play a significant role in improving and reshaping the healthcare system Mexico. Entrepreneurship simply by its nature tends to solve/create a solution to a need/concern that hasn’t already been met. With the current structure of Mexico’s healthcare system, many gaps in coverage and services provided exist. Primedic and other entrepreneurial oriented private healthcare companies have capitalized on these gaps and along with the growing demand of consumer-driven health care across Mexico. These companies provided needed services and provide opportunities for medical...
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...1. Using the historical data as a guide, construct a pro forma (forecasted) profit and loss statement for the clinic's average month for all of 2014 assuming the status quo. With no change in volume (utilization), is the clinic projected to make a profit? The below pro forma profit and loss statement states that the clinic is currently operating at a loss of $3,173 per month, considering that subtraction of fixed and variable costs. The contribution margin per month totals $48,138 or divided out equals to $35.67 per visit. The hospital is not sustaining itself at this point or even paying for its fixed costs. 2. Now consider the clinic's situation without the new marketing program. How many additional daily visits must be generated to break even? Construct a breakeven graph that can be included in your report. Without the new marketing plan, the clinic will need an additional 19.8 - 20 patients each day to break even. 40.66(net revenue/visit)X =79,059 X= total number of visits that are needed to break even X= 1944.39 1944 Average # of JanFeb 1,350 visits 3. Repeat the Question 2 analysis, but now assume that the new marketing program is implemented. With the new marketing plan, the breakeven point is at an additional 32 patients visits per day. 40.66(net revenue per visit)X =93,861 (92,511-1350,)/30days= 31.94patients per day 32 patients per day 4. Now focus solely on the expected profitability...
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...to create better clinical trials and to help oncologists in their practice. After narrowing the field of applicants, Precision HealthAI and Tempus were chosen because they could commercialize, cleanse and analyze the data. The two companies will complement each other as they work toward the shared goal. At Precision HealthAI, the AI platform will be used to compile, manage and utilize the clinical data. Researchers will be able to effectively analyze the different datasets. Meanwhile, Tempus will create unique datasets by combining molecular and clinical data. This innovative development will allow personalized cancer care to become a reality. Tempus was founded by Eric Lefkofsky in 2015. While Lefkofsky never planned on working in healthcare, his entire life changed after a close friend was treated for cancer. He noticed how little data and technology were used in the clinical practice. After realizing a need for new technology, Lefkofsky decided to form Tempus. He had spent his entire professional life as a technological entrepreneur. Previously, he co-founded Groupon in 2008 and still serves as the chairman. Over the years, he has founded tech innovators like Echo Global Logistics, Uptake and Innerworkings. Currently, all of these businesses are based in Chicago. With his wife, Lefkofsky has signed on to the Giving Pledge...
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...Molina Healthcare is one of the largest organization administrator in the United States for Medicaid, Medicare, and Marketplace for medical and dental programs. The organization was founded in 1980 by David Molina in Long Beach, California and remanded to be a family run the business until 2017. Molina Healthcare is a government-based health care program that provides care for medical and dental providers, members and Health Maintenance Organizations, also known as HMO. Currently, they have approximately 4 million members across the US they offer at a lower cost. Throughout the year, Molina Healthcare has created new ways to deliver effective care by working with state and local partners to raise awareness and effectiveness for oral health and promote oral health solutions. Molina Healthcare has a mission statement, “To provide quality health care to people receiving government assistance.” Which they currently stand by to this day. They are driven to ensure their mission aligns with the organization's goals internally and externally. Within the organization, they have begun to have an issue with the Customer Service Department. Since this organization is a third-party administrator, they are required to uphold certain guidelines by...
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...Case Study: Partners HealthCare Systems Case Study: Partners HealthCare Systems Partners HealthCare is a non-profit, health system located in Boston that created a data based transformation (Davenport, 2013). It integrated a new system that aligned the participating organizations to cohesively run as one and to help shape the future of the organization. The system didn’t stop there as it was responsible for bettering the patient financing experience and the delivery of healthcare information to other organizations (Davenport, 2013). The initial goal of the organization was making patient care more affordable and accountable by providing integrated, evidence based, patient-oriented care. Problem Identified Partners HealthCare, which was created by major contributing hospitals and medical facilities in the Northeast, initially began as a way to focus on the patient needs; however, the company soon found themselves separating from their initial goal. There was more than one problem identified within the realms of the company. There are three main issues that this case study produced. The first outlying issue is called Alert/Warning Fatigue (Davenport, 2013). This derives from alerts that were placed in the system to warn doctors of notices that could be anything from mixing prescriptions to simple notifications that most doctors already knew or was not in their field of study. A second issue that requires resolution to create a successful working system is the sense...
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...Professional Goals: To obtain a position in a Medical Billing and Coding Department where I can use my skills and education to enhance the efficiency and productivity of the organization while continuing to develop my skills. Strengths and Skills: • Knowledge in ICD-9/Cpt Coding • Hospital Billing • Physician Billing • Electronic claim submission • Research resubmit denials • Reliable • Trilingual ( French, English and Haitian Creole) • Computer proficient in Microsoft Word, Excel, PowerPoint, Outlook, Quick Book, and Windows XP • Knowledge in Medisoft • Team player focused on involving others • Capable of doing multiple tasks easily • Self motivated • Medicare/Medicaid/Third Party regulations • Well developed skills in customer relations • Goal Oriented • Proficient in data entry • Knowledgeable in computer software and maintenance • Eager and energetic to learn Certifications: Associate Degree in Medical Insurance Billing and Coding November 2009 CPC April 2009 CPR certified Member of American Academy of Professional Coder April 2009 Ecole Normale Superieure June 1996 Haiti Université Quisqueya June 2004 Education: Everest University – South Orlando, FL Associates of Science Degree – Medical Insurance Billing and Coding Class of 2009 University of Phoenix – Maitland, FL Bachelors Degree – Health Care Administration ...
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...Case study of fixing healthcare from the inside Statement of the problem Many policy makers and management scholars believe that the problems with American health care are rooted in regulatory and market failures. They think the best treatment is strengthening market mechanisms. While, the author believes that market-based solutions will cause professionals and policy makers to ignore opportunities for improving health care’s quality, increasing its availability, and reducing its cost. The problem happens in the industry which can be solved without market-based solutions is the ambiguity and the work-around culture. That makes trouble. In the ICU, professionals don’t know who should take charge of the patient which delays the cure. In the treatment, nurse uses the wrong medicine. Analysis Those situations happen many times in the industry. What is the root cause? What we can do? Many reasons can lead to such mistakes. Ambiguities are everywhere. That’s the main reason lead to so many mistakes in healthcare delivery. For Mrs. Grant story, medicine with the similar size and shape, with labels that were hard to read and they were located next to each other on the cart were the root cause. If nurses can work carefully maybe they could aware the mistake and correct it. And in most of time, they can figure it out and correct it immediately. However, the reality is, nurses work 12 hours a shift and they are tired with delivering care to 4 or 5 patients. That makes them easily...
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...Week 5 Case Study HSM 544 Healthcare Industry The American health care industry is one of the nation's largest and most profitable industries (Healthcare, 2011). The American healthcare industry "has consistently increased its share of GDP from only 7.2% in 1970 to more than 16.0% in 2008" and that figure is still growing (Van Horn, 2010). It is also one of the few American industries that is expected to grow in the next few decades. In fact, the healthcare industry in America is expected to generate 3.2 million new jobs through the year 2018, which is more than any other American industry (Healthcare, 2011). This industry includes everything "from small-town private practices of physicians who employ only one medical assistant to busy inner-city hospitals that provide thousands of diverse jobs" (Healthcare, 2011). It includes things such as doctors' offices, phlebotomy laboratories, research laboratories, outpatient care centers, nursing homes, residential care facilities, clinics of all sizes, and large hospitals (Healthcare, 2011). It is not only a large industry, but a very broad one with many potential investment opportunities and many potential risks. Government and Healthcare The role of government in the healthcare industry is a topic that leads to very active and divisive debate. People are either of greater government involvement or deeply opposed to any government involvement. Currently, healthcare remains an industry with a high degree of regulation, in terms...
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...Assignment Agency for Healthcare Research and Quality HCM 4002 Risk Management February 12 , 2014 Introduction “The Agency for Healthcare Research and Quality, (AHRQ) is responsible for producing guidelines for improving the quality of healthcare” [ (Agency for Healthcare Research and Quality (AHRQ), 2014) ]. Mission “AHRQ's mission is to produce evidence to make health care safer, higher quality, more accessible, equitable, and affordable, and to work with the U.S. Department of Health and Human Services (HHS) and other partners to make sure that the evidence is understood and used” [ (Agency for Healthcare Research and Quality (AHRQ) , 2014) ]. Goals AHRQ has four primary goals. First, they aspire to “Improve healthcare quality by accelerating implementation of patient-centered outcomes research (PCOR)”. They hope to be successful in doing so by “developing PCOR methods, training PCOR researchers, and disseminating PCOR findings” [ (Agency for Healthcare Research and Quality (AHRQ) , 2014) ]. In response to the rapid changes in the delivery of healthcare and the impact of The Affordable Healthcare Act, AHRQ is currently attempting to penetrate the primary care practice environment. The Affordable Healthcare Act requires a change in the current system. One goal is to improve healthcare quality and be cost-efficient in delivering services and; in line with doing so, specialty physician practices will be minimal. On the upside of this change...
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...According to our text, the organization’s mission statement defines their purpose of existence (Parnell, 2014). Methodist Le Bonheur Healthcare or MLH purpose of existence is to be a leader in health through “quality, cost-effective-and family-centered care”. Because the mission of MLH holds all associates accountable for providing quality healthcare to our communities, it has to be concise, clear, and easily remembered. MLH is committed to its mission. In fact, the mission serves as the foundation for the organizational culture experienced at each MLH facility. Through continuous training and accountability, associates are energized, thus buying in and taking ownership of the mission of MLH. MLH is not only the abbreviation for the...
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...How can group practices be value-based and profitable? Quality and value have historically been associated with profitability. This was the case in medicine as well. Those who were recognized as being quality providers of healthcare received increased business and subsequently increase profits. However, in today's competitive market a push for increased volume has often resulted in a inverse impacted quality. This is largely due to fee for service payment schedules which encourages providers to perform larger numbers of services and higher revenue generating procedures and tests. To push back against this government providers such as Medicare as well as other insurers are seeking new ways to provide reimbursement based on value rather than volume. When providers initially look at what is involved in...
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