...Sciences HCS/531 Version 3 Health Care Organizations and Delivery Systems Copyright © 2012, 2011, 2007 by University of Phoenix. All rights reserved. Course Description This course is a comprehensive approach to health care delivery systems that provides the student with an in-depth understanding of health systems and organizations. Students will examine historical evolutions of the health care industry and recent impacts that influence the delivery of health care. Policies Faculty and students will be held responsible for understanding and adhering to all policies contained within the following two documents: • University policies: You must be logged into the student website to view this document. • Instructor policies: This document is posted in the Course Materials forum. University policies are subject to change. Be sure to read the policies at the beginning of each class. Policies may be slightly different depending on the modality in which you attend class. If you have recently changed modalities, read the policies governing your current class modality. Course Materials Shi, L., & Singh, D. A. (2012). Delivering health care in America: A systems approach (5th ed.). Boston, MA: Jones and Bartlett. All electronic materials are available on the student website. Assignment Breakdown Week One Individual Assignment: Significant Health Care Event Paper 10 Week Two Learning Team Assignment: The Evolution of Health Care Paper and Timeline 10 ...
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...The US Health Care System Danny Gomez HCS/531 February 7, 2012 The healthcare system in the United States is very complex. Both its inherent composition and the external factors that shape it include a multitude of elements that add to its complexity. This paper will present a definition of the health care system in the US, describe the implications of beliefs and values on this system, and offer examples of the various health care delivery models that comprise it. A health care system can be defined, as a grouping of organizations, institutions, and resources functioning with the intention to fulfill the health care needs of communities and/or populations. Such a system includes components that cover four major functions – financing, insurance, delivery, and payment. In a functioning system one would expected to find its components carefully coordinated and interrelated. However, the US this system is comprised of independent components that work simultaneously but not always collaboratively to deliver and fulfill the requirements of health care. The reality of the US health care system is that its components function independently, in a loosely connected fashion, and without a single central agency governing and regulating it. This characteristic is contrasting to systems in many other countries that have a national heath care program designed to provide a set of equitable health services to all its citizens. Access to health care services in the US varies,...
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...HSA 510: Economics of Health and Medical Care Student: Lucy Njoya Assignment 3: The Management Challenge of Delivering Value in Health Care Strayer University Professor: Dr. Jeff Kaluyu Due: Week 8 Introduction: The healthcare industry is evolving both nationally and globally, and as a result, the challenges facing health care services delivery organizations are also increasing. Health care professionals are the decision-makers and also the ones closely associated with the day-to-day decision making processes affecting the delivery of health care services and goods to patients. The economic evaluation of the health care services delivery systems has proven to play an important role in the different types of health care decision-making. For example, formulary decisions, reimbursement decisions, high health cost decisions, and e-prescribing. This makes it a point of interest to assess the influence of economic evaluations on health care decision-making both at the macro, me so, and micro levels. Even though the impact of economic evaluation studies on health care decision making has been limited, there is an increasing requirement for the cost-effectiveness of the health care intervention to be considered when formulating and implementing guidelines for clinical practices. What is encouraging at this moment is the fact that health care decision-makers do recognize the usefulness and necessity of published economic evaluations that rightly inform the public about...
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...the U.S. health services system (4th ed.). Chicago: Health Administration Press. * Course Text: Understanding the U.S. Health Services System * * Chapter 8, "The Health Services Workforce" * Chapter 9, "Hospitals" (Note: This chapter was assigned in a previous week; review it as needed with this week's focus in mind.) * Chapter 10, "Biomedical Research, Health Services Technology, and Technology Assessment" * Chapters 11, "Overview of the U.S. Health Services Delivery System" * Chapter 13, "Primary Care" * Chapter 14, "Secondary Care" * Chapter 15, "Long-Term Care" (pp. 349–369 only) * Chapter 16, "Tertiary Care" * Chapter 17, "Palliative Care" * Chapter 18, "The Care of Special Populations and Special Disorders" (pp. 399–406 only) * Chapter 19, "The Health Services Delivery System: How Managed Care Has Influenced Delivery" (Note: This chapter was assigned in a previous week; review it as needed with this week's focus in mind.) * Article: The Scan Foundation (2011). Improving the continuum of care: Progress on selected provisions of the affordable care act one year post-passage. http://www.thescanfoundation.org/improving-continuum-care-progress-selected-provisions-affordable-care-act-one-year-post-passage As you have learned, health care services are provided through a range of organizations. For this Discussion, you will consider how direct- and indirect-care organizations integrate...
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...How Does Cost Affect the HealthCare Delivery System? An In-Depth Look at the Health Care Delivery System and Cost. | | Princess L. Brigham | 11/23/2010 | HSA 6414: Social Dimensions and Issues in Health Care | ABSTRACT How does cost affect the health care delivery system? This research focuses on the cost of the health care delivery system and how it affects today’s society. High costs, gap-ridden coverage, and sporadic quality are the health care problems that most concern Americans. Yet most of the policy discussion is focused on the issue of coverage. Health care is expensive because of the pervasive entitlement attitude held by literally everyone in the system: patients, providers, suppliers, insurers. Government insurance (Medicare, Medicaid, veterans, Department of Defense) covers 87 million; tax breaks subsidize 176 million in employer coverage; insurers and other third-party payers take care of the bills for 85 percent of Americans. There is little awareness of the full cost or value of medical treatment on the part of consumers or providers, and little opportunity for individuals to choose their own coverage or make informed decisions with their doctors about treatment. Health care costs are far higher in the United States than in any other advanced nation, whether measured in total dollars spent, as a percentage of the economy, or on a per capita basis. And health costs here have been rising significantly faster than the overall economy or personal incomes...
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...DEVELOPMENT OF NURSING PROFESSIONALS In 1970, The National Academy of Sciences established the Institute of Medicine (IOM), a non-governmental, non-profit organization, developed to provide advice on the national level that addresses issues of medical care, education, and research. Through research, collected data, and nurse-led solutions, the IOM created an informative report in 2010 called The Future of Nursing: Leading Change, Advancing Health, which provides specific recommendations on the improvement of the nursing workforce and the healthcare delivery system. The report is directed towards various entities; individual policy makers, national state and government leaders, licensing bodies, educational institutions and consumer advocates, are just to name a few. Three particular recommendations, transforming education, transforming practice and transforming leadership, will be further discussed to display how each transformation will impact changes in the nursing profession and the health care delivery system. Transforming Education The first recommendation to be discussed that will impact change in the nursing profession and the health care delivery system is the transformation of education. The IOM report states that “nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression” (IOM, 2010, p. 163). Several educational pathways have become available for nurses to smoothly transition from...
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...Integrated Delivery Systems What conditions need to be in place for an integrated delivery system to work properly and achieve the financial benefits possible from such a system? Integrated healthcare systems offer an array of healthcare services as a chain; in fact integrated delivery systems are forms of joint ventures. For such a system to work properly, its primary focus should be making sure it meets the local population’s general health needs. An integrated healthcare system should be able to match the services required and must have the capacity to take care of the population’s requirements and the care offered must be coordinated and integrated across the continuum. It should have a management information system good enough to link its patients, the providers and payers across the whole system. An integrated healthcare system should be able use financial incentives and the organization’s structures to support day to day running, physicians in the network and other caregivers so as to meet the goals of the organization. Care provided must be continuously improved and the integrate network should be willing to work with others in the region to make sure that the community’s health objectives are fulfilled in continuum of care. Cost effective measures that still fulfill good patient care must be used because one of the main objectives of the integrated care system is providing care in the lowest cost setting, Gapenski 2012 (p.15). The success of integrated health systems...
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...CHAPTER 8 HEALTH SERVICE DELIVERY MODULE 8.1 Overview This chapter presents the health delivery module of the assessment. Section 8.1 defines health service delivery and its key components. Section 8.2 provides guidelines on preparing a profile of health service delivery for the country of interest, including instructions on how to customize the profile for country-specific aspects of the health delivery process. Section 8.3 presents the indicator-based assessment, including detailed descriptions of the indicators. Section 8.4 discusses how to summarize the findings and develop recommendations. 8.1.1 What Is Health Service Delivery? The World Health Organization (WHO) defines service delivery as the way inputs are combined to allow the delivery of a series of interventions or health actions (WHO 2001b). As noted in the World Health Report 2000, “the service provision function [of the health system] is the most familiar; the entire health system is often identified with just service delivery.” The report states that service provision, or service delivery is the chief function the health system needs to perform (WHO 2000). As such, Figure 8.1 (see also Chapter 1, Figure 1.1) shows the relationship between service delivery and the other modules of this health systems assessment and their relationship with health system objectives. Because of the limited time to conduct this assessment, more emphasis will be placed on personal health (as opposed to public health) services and service...
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...Information System Briefing HCS/483 February 27, 2012 Information System Briefing The process of selecting and acquiring an information system in today’s health care organization can be a huge investment, and there are many factors that need to be considered to develop the best course of action. One of those factors is the consideration of the organizations goals and if the implementation of a new information system will be able to meet those goals. Another factor is to be aware of the roles of the organization’s stakeholders and how they are an important part of the selection and acquisition process of the new system. Each step in the selection process of a new information system for a health care organization is vital to quality, safe, and efficient delivery of patient health care. This briefing will discuss the process for selecting and acquiring an information system, how the organization’s goals drive the selection of a system and what roles the organization’s stakeholders have an impact on in the selection process. The selection and acquisition process of an information system must be managed effectively to meet the organizations system goals. A team or implementation committee would need to organize and appoint a project manager to oversee each aspect of the implementation project. This team would consist of the stakeholders of the organization to include physicians, nurses, IT analyst, business managers, and other sources that have an investment...
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...Online U7A1: MBA 663-8: Health Insurance and Managed Care LEGAL AND ETHICAL ISSUES Legal and Ethical Issues The current landscape of the healthcare industry changes rapidly with new rules and regulations, placing many healthcare insurance and managed care organizations in jeopardy of litigation because of legal and ethical issues. Controversy surrounds the healthcare industry because of the decisions made by managed care organizations regarding patient treatment and payment to providers. The following examines the legal and ethical issues surrounding the everchanging healthcare insurance and managed care organizations. Managed Care Conflict The problem facing managed care organizations and health insurance is the inherent conflict with their goal of cost containment by reducing service utilization, with the healthcare delivery system that places the patient’s health first (Kongstvedt, 2013). According to Saunier (2011), the definition of managed care is: 2 Processes or techniques used by any entity that delivers, administers and / or assumes risk for health services in order to control or influence the quality, accessibility, utilization, costs and prices, or outcomes of such services provided to a defined population. (Saunier, 2011, p. 22) Saunier (2011) describes the purpose of these organizations that manage care is the control of costs by “implementing aggressive cost containment mechanisms” (p. 22). The main goals of the healthcare delivery system include: 1. The provider...
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...Analysis of Managed Care Name: Institution: Medical costs progressively consume a large part of the Gross Domestic Product of the United States. Various sectors that seek health services including the government are increasingly turning to a regulated form of financing and delivery of health services termed as managed care. All citizen in the United States is eligible for this form of care whose purpose is to make medical care accessible for all. This paper seeks to provide a thorough analysis of managed care detailing its role in the transformation of health services, its impact on various heath aspects including access, delivery of care and financing as well as the role of managed care in promoting costs. Exploration of Managed Care Managed Care involves a system of medical provision in which patients choose preferred doctors and hospitals to visit when in need of health services and the cost of treatment is monitored by a managing company. Managed care is key to the control of health care costs that focuses on preventive care to lower cost associated with curative care. Manage Care has three forms. They are Health Maintenance Organizations (HMO), Point of Service (POS), and Preferred Provider Organizations (PPO). Managed care strategies offer financial incentives to members who control their own health care expenses for instance through the lowering the prices of prescribed drugs (Shortell, Gillies, and Anderson, 1994). Health Maintenance...
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...Health Care Information Systems Abstract The U.S. government plays a large role in all areas of the health care delivery system, from financing to organizing, overseeing and providing care. Because of the large scale of the integration of the health care delivery system, government should lead the way and model the rest of the nation after two health care systems run by the government, which provide quality care and are up to date with information technology systems. Health Care Information Systems The United States health care delivery system is not meeting the needs of the American population. With the advancements in medical science and technology, Americans are living longer, and we are seeing an increase in chronic conditions that need coordinated and integrated care. As the cost of health care in the United States escalate, attempts to control those costs also increase. Controlling costs and access and quality improvements to the health care system are the issues pushing the Information Technology policies. Studies are consistently showing that the adoption of Information Technology is one answer to alleviating the rising costs to both patients and health care organizations and providing evidenced based health care management and organizational changes, providing and protecting consumers confidential and private health care information, ensuring the reduction of medical errors and waste. The Institute of Medicine’s, Crossing the Quality Chasm has...
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...Accountable Care Organization is a healthcare organization characterized by a payment and care delivery mode. lt seeks to tie provider reimbursements to a quality metrics and reductions in the total cost of care for an assigned population of patients. A group of coordinated health care providers form an ACO, which then provides care to a group of patients. The ACO may use a range of payment methods, (e.g. capitation, fee-or-service with an asymmetric or symmetric shared savings). The ACO is accountable to the patients and the 3rd party payer for quality, appropriateness, and efficiency of the health care provided. The Centers for Medicare and Medicaid Services (CMS), an ACO is considered an organization of health care providers that agree to be accountable for the quality, cost, and overall care of Medicare beneficiaries who are enrolled in the traditional fee-for-service program. This paper identifies the differences between HMO’s and ACO’s but also correlates the similarities between ACO’s and Patient Center Medical Home (PCMH). The ACO’s place a degree of financial responsibility on the providers in hopes of improving care management and limiting unnecessary expenditures while continuing to provide patients freedom to select their medical services. The success and challenges of ACO are identified and explored. By increasing care coordination, ACO’s can help reduce unnecessary medical care and improve health outcomes, leading to a decrease in utilization of acute care services...
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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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...and Marketing Channels are essential to the success of the health care system today. The role of pricing is to give the product or service its image. A health care facility that has quality products and services has to make sure that they also have a good pricing mix to attract new customers and to appeal to its customers loyalty. In today's society, customers are beginning to be sensitive to pricing of products and services because of the economic change. With the rise in prices, loss of employment and the health insurances issues on the minds of citizens in the United States, many are now searching for the best service or product that they can obtain for less. This paper will display the importance of pricing strategies and the use of intermediaries in the health care system. It. will explore the concepts of pricing strategies and marketing channels and their relevance to the health care system. Explain at least four of the seven steps for setting an initial price for a product or service, In the past, many physicians, customers and health care professionals thought it to be unethical and unprofessional to market the sales of health care products and services (Kreidler, 2008). The following will addresses how the health care facility can be successful in marketing its products and services. :These next four steps will show the importance of price setting. Selecting the Pricing Objective is when the health care facility positions its market offering. To obtain this, the...
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