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Review the World Health Organization’s (WHO) global health agenda and select one global health issue to focus on.

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Review the World Health Organization’s (WHO) global health agenda and select one global health issue to focus on.

A summary of the global health issue you selected and explain how it has impacted the local population. Be specific and provide examples.

Then, explain the data you would need to best inform/educate the local population about this global health issue.

Describe at least one source you might consult and use to gather this data and provide a rationale for why you would consult this source.

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Application Essay

May 7, 2019/in Uncategorized /by admin

Application Essay

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Purpose of Assignment

The third program learning outcome (PLO) for the Communication Studies major at San Francisco State is that its majors can apply course content to personal, professional, and community contexts. This essay allows you to explain what “application” means in the context of the Communication Studies major and how you applied specific course content within the major.

Requirements

Write a 4.5 to 5 page essay (typed, double-spaced, 1-inch margins, 12-pt font) in which you adhere to the following content guidelines.

Your first paragraph should make clear that the ability to apply course content is developed within the Communication Studies major at SFSU, explain what “application” means, and explain that you have engaged in different types of application within the major (e.g., writing an essay in which you analyze communication, creating a performance, developing and delivering a speech, conducting a research study).
Your second paragraph should explain that the ways in which you have applied course content within Communication Studies relate to communication in your personal, professional, and community life.
Your third paragraph should explain why the ability and opportunity to apply course content is important.
The remainder of your essay (3-4 pages) should identify and explain how a specific assignment you completed for the major exemplifies application of course content. You should be specific regarding the focus of the assignment you completed, what course content it applied, and how you applied that content.
Be clear in your essay how the application you are describing relates to personal, professional, and/or community communication contexts.
Provide closure to your essay.

** See the sample Application essay within this iLearn Assignment Book.

** Choose a different assignment and class than the ones you used to illustrate theory and ethics.

** You can draw upon the Freire reading to help you explain why being an active learner and applying knowledge is important, but use your own words, explanations, and examples as much as possible. If you paraphrase the source, be sure to make clear who Freire is (e.g., “Paolo Freire, a well-known and respected education scholar, describes…”).

Evaluation

You can earn up to 20 points for this assignment, based on the degree to which you clearly address and fully develop the required parts of the essay, and based on the quality of your writing. This essay will become part of the central focus of your ePortfolio. You want to represent yourself well; therefore, the quality of your writing is especially important. Edit and proofread carefully!!! Be clear and accurate.

Helpful Hints

1) Think about the different forms of application in which you have engaged and paint a dynamic picture for your readers. You may have created a performance using principles of embodiment and performativity. You may have analyzed a text using a set of communication principles. You may have created an informative website based on research regarding a specific topic. A performance, an analytic paper, and a website are just a few examples of forms of application. Think about what you have done with the knowledge you developed in your classes!

2) Think about the different contexts to which application relates (i.e., personal, professional, and/or community/political contexts). In Interpersonal Communication, you may have used a conceptual framework to analyze communication climate in a specific relationship. In Social Semiotics, you may have used a theoretical framework to analyze public texts that attempt to influence consumers. Although you are applying course content to analyze communication in both cases, you are applying course content to a personal and/or professional context in one case and applying course content to a personal and/or community context in the other case. Be clear that the applications in which you have engaged relate to diverse contexts!

3) Be specific regarding the nature of your application (e.g., paper, speech, performance, creation of a website, etc.) as well as what knowledge it is you were applying. For example, you may have applied course content regarding specific forms of communication that contribute to communication climate in a paper analyzing communication in a relationship. You would explain the course content (i.e., forms of communication impacting climate) and how you applied it. Or, maybe you worked with a team to create a webpage re: a specific health condition. You were applying knowledge regarding the health condition as well as principles of effective mediated communication. Explain those principles and how you applied them.

sample essay:

Applying course content threads throughout the Communication Studies major at San Francisco State. Application means doing something with what you are learning. It is one thing to develop understandings of communication theories, concepts, principles, and practices, but it is another to be able to do something with those understandings. All of my Communication Studies courses required me to apply what I was learning in some way. Throughout the major, I wrote papers, developed speeches, created performances, and even facilitated a public dialogue and created a blog. All of these assignments enabled me to apply the knowledge I was developing.

        Within Communication Studies, applying course content relates to personal, professional, and political contexts. For example, in my Discourse and Interaction class, we studied how people manage positive face in interaction and how face can be threatened; this enables me to be more mindful of how communication with important people in my life impacts the positive self-images we want to maintain. In my Advanced Pubic Speaking class, I developed and delivered a speech regarding Alzheimer’s disease. My ability to apply principles of public speaking relates to professional communication contexts, as I may need to clearly present complex information in the workplace. My application of public speaking principles also relates to political communication contexts as I have the skills and confidence to advocate for policies relevant to my community.


        The ability to apply course content is significant. By applying course content throughout the Communication Studies major, I have been an active learner. I have been a leader, not just a follower. I did not just passively received information; I engaged ideas and helped contribute to my and my peers’ understandings. I have demonstrated that I am capable and have the power to analyze and influence the world around me. In Communication Studies, theories, concepts, principles, and practices are all actively applied, allowing me to enhance my personal, professional, and political communication skills.


        In my Communication Studies major, I had the opportunity to apply course content in a Family Story Speech for my Family Communication course. After learning about different types of family stories, the purpose of the assignment was to give a speech that retells a particular family story to the class and analyze how that story is applied to our present perspective on life. With this assignment, I applied my knowledge of family story types and their functions to determine how my communication experience with a family story has influenced my current values and personal standards.


        In Family Communication, we discussed Narrative Theory, which describes humans as innate storytellers. According to this communication theory, implied rules are often the product of stories. In family stories, the family is the subject and communicating with each other through these narratives contributes to the creation of wholeness, roles, and behaviors within the family, as well as expectations and overall family history. There are three types of stories that were focused on in Family Communication: courtship stories, birth stories, and survival stories. Courtship stories are the parents’ attempt at telling the child how to behave in a romantic relationship. This story is told differently depending on age. A birth story is the child’s origin story that almost always matches their present-day personality. Lastly, a survival story tells stories of tragedy and hardship that promote behaviors for survival. These are stories that are meant to advise family members about what to do when bad things happen.


        The Family Story speech assignment in Family Communication required that we tell one of the three types of family stories and describe how it became relatable through Narrative Theory. In an effort to apply course content, I used a family survival story that my father has told me throughout my whole life as the focus of my speech. With knowledge of what family stories are capable of doing alongside the purpose of survival stories, in general, I evaluated my experience with my father’s survival story in order to determine why I still find it to be relevant today. After telling the story, I argued that this family narrative regarding education and work in America has influenced my personal and professional outlooks on life.


        Communicating messages of hardship, my father’s survival story details the experiences he faced as a Filipino immigrant in the United States. His story is mainly focused on the struggles of finding work in his field because of the discrimination he encountered as a person of color in an area that lacked diversity. Being the foreigner in his workplace, my father says that many people looked at him as not capable of doing the job. At the same time, those he worked with did not want to take the time to teach him what he needed to know. Despite having begun his engineering degree and acquiring relevant work experience in the Philippines, he learned that his coworkers were not going to take him seriously until he could truly prove himself, so he was advised to complete his degree. 


        Adding to the hardship my father was experiencing, he now had a family to care for. When I was born, that is when he decided to finish his degree. Being a working dad and student, he grew more frustrated because of how the extra school work was getting in the way of the job he needed to support his family. Struggling to balance work, school, and family, my father’s story explains how he wanted to give up and even considered dropping out of college with only one semester left. With regard to survival, he eventually ended up finishing his degree with encouragement from my mother and finally gained the respect in the workplace he deserved.


        Relative to Narrative Theory, there are values that have been produced by my communication experience with this survival story. By applying Narrative Theory to this family story, I can relate the communicated messages to my personal and professional life. In my family’s culture, this story is relevant because it is usually told to emphasize the importance of education. While I heard this story as a child, I hear it more often as a college student. When I talk about my own college struggles, this is usually the story that follows as it is a successful survival story that is used as encouragement while serving its function to promote endurance and hard work. To explain why I am pursuing a degree, my father’s survival story is also applicable to my professional life. In response to this story, it has become part of my nature to complete my education in order to avoid the kind of experiences my father faced before accomplishing his goals. Although our experiences greatly differ, the survival story communicates its functions: valuing education as a pathway to success in my professional endeavors.


        Every class I took for my Communication Studies major was focused on a topic and meant we were developing knowledge about that subject. In every class, I was able to go beyond learning about something to doing something with what I was learning. I had opportunities to apply theories, concepts, research, and ethical standards for communication to personal, professional, and political communication contexts. I am confident in my ability to apply what I have learned in my major to my personal, professional, and political life.

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Project

May 7, 2019/in Uncategorized /by admin

Project

you are asked to demonstrate your ability to conduct an abbreviated literature review on a forensic psychology topic of your choosing and report your findings from the literature review.

Your Final Project should include 12–15 research articles on your chosen topic and should be empirically based. The articles also should represent contemporary findings on your topic and come from peer-reviewed journals. Your Final Project should end with a summary of the major findings from your literature review and your recommendation of possible future directions that research on your chosen topic may cover.

A superior Final Project demonstrates breadth and depth of knowledge and critical thinking appropriate for graduate-level scholarship. The paper must follow APA Publication Manual guidelines and be free of typographical, spelling, and grammatical errors. The paper should be 10–12 pages, not counting the title page, abstract, or references. Please note that quantity does not always correspond to quality, and a well-written Final Project that includes all of the necessary information can be accomplished in fewer than the maximum number of pages. The Final Project for this course will be evaluated according to all four indicators in the Application Assignment and Final Project Writing Rubric located in the Course Information area.

References

Please note that you must use primary sources. Peer-reviewed journal articles should make up the bulk of your references (80% or more). In other words, you may use non-peer reviewed and non-empirically based material in addition to your 12–15 peer-reviewed, empirically-based journal articles. If referring to a book as one of your non-peer reviewed, non-empirically based sources, be sure to include all information in APA style, including specific page numbers. Note that an article referred to in a book is a secondary source and does not count as one of your peer-reviewed, empirically-based articles. You must go directly to the original source for your 12–15 peer-reviewed, empirically based articles. Additional information about secondary sources is available in the APA Publication Manual and in the Walden Writing Center http://inside.waldenu.edu/c/student_faculty/studentfaculty_562.htm)

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Ways To Address Barriers To The Implementation Of Evidence-Based Practice

May 7, 2019/in Uncategorized /by admin

Ways To Address Barriers To The Implementation Of Evidence-Based Practice

Please provide a 3-4 sentence reply to the below discussion question answer.

Answer: One of the identified barriers from last weeks discussion was a lack of understanding of the literature or research process. Nurses, in general, believe in the evidence-based process to improve clinical practice and patient outcomes but without knowing how to perform research or how to critique research studies this will continue to perpetuate the issue of implementation. One solution is to provide research workshops to provide foundational knowledge, research ethics, and literature review techniques (Black et al, 2015). Another solution would be employing the use of facilitators, those that can help guide nurses in the research process, framing precise questions, assisting in literature review, aid in the critical appraisal process of the literature. The facilitator would have had to have some training in evidence-based practice methods (Dalheim et al, 2012).

Original Question: Consider an obstacle or barrier to the implementation of evidence-based practice you identified in last week’s discussion. What are two ways to address this problem?

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Pay for Performance and the Healthcare Value Paradigm

May 7, 2019/in Uncategorized /by admin

Pay for Performance and the Healthcare Value Paradigm

Debra A. Harrison

Chapter 12

“Price is what you pay. Value is what you get.”

—Warren Buffett

“Knowing is not enough; we must apply. Willing is not enough; we must do.”

—Johann Wolfgang von Goethe

1

Learning Objectives

Analyze and discuss the evolution of quality in healthcare.

Discuss a range of approaches to the implementation of a total quality program in a healthcare organization, including Donabedian’s model of structure, process, and outcomes.

Articulate the concept of value and discuss performance measures that are important in healthcare organizations.

Define pay for performance and discuss some of the current initiatives in healthcare reimbursement.

Demonstrate the ability to link quality, efficiency, and financial decision making in an organization’s strategic plan.

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Key Terms and Concepts

Donabedian framework

Leapfrog Group

Nurse-sensitive patient outcomes

Pay-for-performance (P4P) programs

Quality

Therapeutic alliance

Value

Value-based purchasing

Value frontier

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Introduction

A paradigm shift from the efficiency frontier to a value frontier is occurring in healthcare.

The value frontier is a benchmark that takes into account not only efficiency but also quality.

A healthcare organization is efficient if it has achieved an optimal fit between its structural characteristics and its processes.

However, the healthcare environment is dynamic and requires organizations to make changes on a continuous basis.

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The Cost of Quality

US healthcare spending grew 3.6 percent in 2013, reaching $2.9 trillion, or $9,255 per person (CMS 2014c).

How to provide access to affordable healthcare is an ongoing philosophical discussion in modern medicine.

In healthy industries, competition is not based on cost but on value, which is the level of consumer benefit received per dollar spent.

To encourage quality improvement and more efficient delivery of healthcare services, the government, insurance companies, and other groups implement pay-for-performance (P4P) programs.

(V) = Q/C

Value (V): Level of consumer benefit received per dollar spent.

Q: Quality

C: Cost

Commonwealth Fund

The Commonwealth Fund is a private institution whose goal is to improve access to care, quality of care, and efficiency of care in the United States.

Reports from their studies in 2011 estimate that healthcare waste and medical errors account for $100 billion of US healthcare expenses and may cost 150,000 lives annually.

For more statistics and facts, visit:

www.commonwealthfund.org/

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Change in Rates for Hospital-Acquired Conditions, 2010–13

Source: Agency for Healthcare Research and Quality, Efforts to Improve Patient Safety Result in 1.3 Million Fewer Patient Harms: Interim Update on 2013 Annual Hospital-Acquired Condition Rate and Estimates of Cost Savings and Deaths Averted from 2010 to 2013, Dec. 2014.

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Column1
Adverse Drug Events Catheter-Associated UTIs Central Line-Associated Bloodstream Infections Falls Pressure Ulcers Surgical Site Infections Ventilator-Associated Pneumonias Venous Thromboembolisms Total -0.19 -0.28000000000000003 -0.49 -0.08 -0.2 -0.19 -0.03 -0.18 -0.17

GDP refers to gross domestic product.

Source: OECD Health Data 2014.

Healthcare Spending as a Percentage of GDP, 1980–2012

Percent

2011.

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At the same time, our quality is not higher than other countries spending less.

Medicare Pay-for-Performance Initiatives

Title III of the ACA mandated a financial reward to improve quality, safety, and the patient experience for Medicare patients, an initiative called value-based purchasing (VBP).

Began in 2013 with reimbursements for patient discharges on or after October 1, 2012. CMS automatically withholds a hospital’s Medicare payments by a specified percentage each year (see chart), and hospitals can earn back that percentage if they achieve certain quality and patient satisfaction scores

The intent of the law is that the program be budget neutral, meaning that organizations performing in the bottom 10 percent lose the Medicare payment reduction and the top 10 percent receive the Medicare payment incentive.

Medicare Pay-for-Performance Initiatives

CMS measures of efficiency now include a cost metric. This metric is called the Medicare Spending per Beneficiary (MSPB) and is defined as the average Medicare Part A and B spending per patient from 3 days prior to admission to 30 days after discharge (Chen and Ackerly 2014).

VBP also means efficient care, which will require physicians to limit the number of tests they order that do not improve morbidity or mortality.

The basis of CMS’s recent P4P initiatives is a collaboration with providers to ensure that valid measures are used to achieve improved quality.

CMS has explored P4P initiatives in nursing home care, home health care, dialysis, and coordination of care for patients with chronic illnesses.

Exhibit 12.2: Hospital Value-Based Purchasing Program Measures, 2016

Additional Initiatives in Pay For Performance

Commercial Payer Initiatives

CMS is not the only entity offering P4P incentives. US health plans and other payers are also developing P4P programs to improve the quality of care and minimize future cost increases.

In 2009, more than 250 private P4P programs existed across the nation, half of those programs targeting hospital care (Cauchi, King, and Yondorf 2010).

The California Pay for Performance Program is the largest and longest-running private sector P4P program.

It was founded in 2001 as a physician incentive program and has focused on measures related to improving quality performance by physician groups.

12

Additional Initiatives in Pay for Performance

Leapfrog Group

The Leapfrog Group is a purchaser that represents many of the nation’s largest corporations and public agencies that buy health benefits on behalf of their enrollees.

Their mission is to use employer purchasing power to improve the quality, efficiency, and affordability of US healthcare.

Leapfrog represents both the private and the public sector as well as more than 34 million Americans and tens of billions in healthcare expenditure (Leapfrog 2015a).

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Additional Initiatives in Pay for Performance

Leapfrog Group (cont.)

Leapfrog’s hospital reporting initiative assesses hospital performance on the basis of quality and safety measures developed by the National Quality Forum (NQF).

Leapfrog is focused on four major “leaps” to make healthcare safer: computerized physician order entry, evidence-based hospital referral, intensive care units staffed with physician specialists, and hospitals’ progress on eight NQF benchmarks (called Safe Practices).

www.leapfroggroup.org/

14

Physician’s Attitudes Regarding Pay for Performance

Lee, Lee, and Jo (2012) did a systematic review of provider attitudes and P4P. Their findings:

Healthcare providers still have a low level of awareness about P4P.

Providers are concerned that P4P may have unintended consequences.

They believe additional resources will be needed to provide adequate quality indicators and implementation of P4P.

To counteract the attitudes, healthcare organizations should:

Develop more accurate quality measures to minimize any unintended consequences.

Emphasize provider education.

Emphasize technical support to reduce provider burden.

15

Incorporating Pay for Performance into a Strategic Plan

Current and past P4P initiatives have focused on improving quality and reducing costs—two key factors in gaining a competitive advantage.

Strategic planners should routinely monitor their CMS Hospital Compare quality scores to raise them to the level of CMS’s P4P incentives.

If their scores are already at that level, they should focus on driving them up further to maximize rewards and reimbursement; the higher the quality, the greater the reward.

Planners need to allocate money to invest in programs and new technology that will help the hospital increase its quality scores.

In areas where quality is poor and unlikely to change, the strategic planner should consider closing the service so that patient safety is not jeopardized and the hospital is less likely to incur malpractice suits.

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Donabedian and Quality

Avedis Donabedian (1966), considered the father of quality assurance in healthcare, defined quality as a reflection of the goals and values currently adhered to in the medical care system and the society in which it exists.

The Donabedian framework is a model for evaluating the quality of medical care based on three criteria:

Structure

Includes the environment in which healthcare is delivered

The instruments and equipment providers use

Administrative processes and qualifications of the medical staff

The fiscal organization of the institution

Process

How care is delivered

Outcomes

Recovery

Restoration of function

Survival

Are We Achieving What We Hoped with VBP?

Spaulding, Zhao, and Haley (2014) reported that, while the VBP measures are covering process, structure, and outcomes, they do not correlate with an improvement in hospital-acquired conditions.

This result could mean that we are not measuring the correct processes, or that the outcome measurements do not reflect the quality we are trying to achieve.

Future healthcare leaders must answer this interesting question:

Which is more important—promoting an incentive system that lacks a clear indication of the outcomes that health systems should be measuring, or changing the process measures to ensure that the outcomes organizations care about are actually being measured?

Defining Quality

No single definition of healthcare quality exists, nor is there a single method of measuring quality in healthcare.

Access to healthcare for all Americans is paramount in the quality literature.

The ACA was more about access and insurance reform than healthcare reform.

The consumer’s ability to choose a physician or care setting is another focal point.

The rise of health maintenance organizations (HMOs) in the 1990s, with their limited network plans, left some consumers worried about choice.

The ACA insurance exchange program gives consumers choices along a range of plans, including the bronze, with a narrow network and lower premiums, and the platinum plan, with a broader network and higher premiums.

19

Comparative Outcomes

Dr. Ernest Codman researched healthcare quality by measuring quality outcomes. His end results theory advocated measuring patient care to assess hospital efficiency and to identify clinical errors or problems.

On the basis of this theory, the college created the Hospital Standardization Program, which later evolved into The Joint Commission on Accreditation of Healthcare Organizations (now simply “The Joint Commission”).

The initial purpose of measuring the quality of healthcare outcomes and processes was to help patients make informed healthcare decisions.

Research shows that Americans rate quality as the most important factor when choosing a health plan. Studies also show that most do not understand their options well enough to make an informed choice.

Public and private groups, such as the National Committee for Quality Assurance (NCQA), have developed tools for measuring and reporting healthcare quality.

20

Quality Metrics

Growing Demand for Quality-Related Data

Demand for quantitative data on healthcare quality is growing.

Quality measures should be based on peer-reviewed national standards of care.

Employers often find it difficult to determine what hospital quality measures are important, how to interpret and use quality information in a meaningful way, and how to present useful information to consumers (Carrier and Cross 2013).

The demand for data has pushed the implementation of electronic health records (EHRs), and meaningful use initiatives have furthered that effort.

To minimize the burden on clinicians, a combination of clinical knowledge and technological expertise is required to implement manually intensive steps so that hospitals can begin to use EHR-specific quality measures (Amster et al. 2014).

21

Quality Metrics

Growing Demand for Quality-Related Data

Hospital Compare allows the public to select up to three hospitals to compare quality measures related to heart attack, heart failure, pneumonia, surgery, and other conditions. These measures are organized by the following:

Patient survey results (HCAHPS)

Timely and effective care

Readmissions, complications, and deaths

Use of medical imaging

Linking quality to payment

Medicare volume

www.medicare.gov/hospitalcompare/search.html

Quality Metrics

Agency for Healthcare Research and Quality

AHRQ—whose mission is to produce evidence that helps make healthcare safer and higher quality, as well as more accessible, equitable, and affordable—is a division of the US Department of Health and Human Services (HHS).

AHRQ collects data on the following:

Inpatient mortality for certain procedures and medical conditions

Utilization of procedures for which there are questions of overuse, underuse, and misuse

Volume of procedures (some evidence suggests that a higher volume of procedures is associated with lower mortality)

23

For more information, go to http://www.ahrq.gov/research/data/state-snapshots/index.html

Quality Metrics

Patient Safety

The Institute of Medicine (IOM) report To Err Is Human: Building a Safer Health System, published in 1999, described the problems surrounding patient safety.

The report listed six aims designed to improve safety. Healthcare must be:

Safe

Effective

Patient- centered

Timely

Efficient

Equitable

The Joint Commission publishes National Patient Safety Goals that it expects hospitals to address when pursuing accreditation. www.jointcommission.org/assets/1/6/2015_hap_npsg_er.pdf

25

Other Quality Considerations

Workforce

An unintended consequence of an emphasis on quality is a rise in the cost of nursing services and ancillary staff.

Studies have shown that patient outcomes are influenced by patient-to-nurse ratios (Spaulding, Zhao, and Haley 2014).

Hospitals with poor nurse staffing (more than four patients per nurse) have higher rates of risk-adjusted 30-day mortality and failure to rescue in surgical patients (Wiltse Nicely, Sloane, and Aiken 2012).

Healthcare organizations require a well-designed infrastructure for supporting nurses and other staff to maximize quality outcomes.

Research on workforce issues can help organizations determine the number of staff members, mix of expertise, and level of experience necessary to providing optimal care.

Other Quality Considerations

Magnet Recognition

The American Nurses Credentialing Center (ANCC) is the sponsor of the Magnet Recognition Program, which recognizes healthcare organizations for quality patient care, nursing excellence, and innovations in professional nursing practice.

Studies have shown that organizations that pursue or achieve Magnet recognition have improved patient outcomes, patient satisfaction, and nurse satisfaction.

Organizations may consider achieving Magnet status to be a strategic goal in improving nurse-sensitive patient outcomes—patient outcomes that improve if there is a greater quantity or better quality of nursing care (e.g., pressure ulcers, falls, intravenous infiltrations).

27

Other Quality Considerations

Patient Engagement

Research suggests that empowering patients to actively process information, to decide how that information personally affects them, and then to act on those decisions is a key driver behind healthcare improvement and cost reduction (Hibbard, Greene, and Overton 2013).

A therapeutic alliance is a partnership between patient and providers that involves collaboration and negotiation to arrive at mutual goals.

Employee Satisfaction

Efforts to create higher employee satisfaction have very desirable outcomes for patients, including increased patient satisfaction, improved care quality, and increased patient loyalty.

28

Other Quality Considerations

Accreditation

Healthcare quality is also maintained through accreditation, which is a standardized method of ensuring that quality processes are consistent throughout healthcare.

For instance, the American Society of Clinical Pathology accredits laboratory systems on the basis of the Clinical Laboratory Improvement Amendments passed by Congress in 1988, and the American College of Surgeons accredits trauma centers.

Balanced Scorecards

Most organizations have established a dashboard or scorecard that reflects current quality measures along with financial performance.

Balancing the two (hence the balanced scorecard) can improve the value frontier of the organization.

29

Strategic Planning for Healthcare Value

Patients, employers, and the government want high-quality, low-cost healthcare. The degree to which organizations successfully coordinate high quality with low cost reflects the value of the care they are delivering.

While planning for healthcare value, strategists must consider all of the topics presented in this book:

Development of a mission, vision, and culture that support change

A transformational approach to leadership

Evaluation of strengths, weaknesses, opportunities, and threats (SWOT analysis)

The use of health information technology

Examination of financial data

Healthcare marketing

Opportunities in accountable care organizations

Opportunities for joint venture, merger, and affiliation (with physicians and other organizations)

Compliance with P4P initiatives

30

Summary

Federal healthcare policymakers and state regulators have concerns about the negative impact that reduced reimbursement for healthcare services, low hospital occupancy, and poor efficiency can have on the quality of healthcare.

They also recognize that the aging population, the ACA-induced increase in the number of insured patients, and investments in healthcare technology will continue to drive up healthcare costs.

By operating in a manner consistent with evolving healthcare policy and the quality standards set forth by value-based purchasing programs, hospitals can receive financial and other rewards (e.g., a reputation for excellence), all of which will place them in a stronger competitive position.

31

Questions

32

References

Agency for Healthcare Research and Quality (AHRQ). 2015. Inpatient Quality Indicators: A Tool to Help Assess the Quality of Care to Adults in the Hospital. Accessed October 11. www.qualityindicators.ahrq.gov/Downloads/Modules/IQI/V42/Inpatient_Broch_10_ Update.pdf.

AHC Media. 2014. “Look Ahead to Succeed Under VBP.” Hospital Case Management. Published July 1. www.ahcmedia.com/articles/117227-look-ahead-to-succeed-under-vbp.

Aiken, L. H., S. P. Clarke, D. M. Sloane, J. Sochalski, and J. H. Silber. 2002. “Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction.” Journal of the American Medical Association 288 (16): 1987–93.

American Nurses Credentialing Center (ANCC). 2015. “Magnet Model.” Accessed September 22. www.nursecredentialing.org/Magnet/ProgramOverview/New-Magnet-Model.

Amster, A., J. Jentzsch, H. Pasupuleti, and K. G. Subramanian. 2014. “Completeness, Accuracy, and Computability of National Quality Forum-Specified eMeasures.” Journal of the American Medical Informatics Association 22 (2): 1–6.

Blumenthal, D., and K. Stremikis. 2013. “Getting Real About Health Care Value.” Harvard Business Review. Published September 17. https://hbr.org/2013/09/getting-real-about-health-care-value.

Carrier, E., and D. Cross. 2013. Hospital Quality Reporting: Separating the Signal from the Noise. National Institute for Health Care Reform. Published April. www.nihcr.org/ Hospital-Quality-Reporting.

Casalino, L. P., G. C. Alexander, L. Jin, and R. T. Konetzka. 2007. “General Internists’ Views on Pay-for-Performance and Public Reporting of Quality Scores: A National Survey.” Health Affairs 26 (2): 492–99.

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References

Cauchi, R., M. King, and B. Yondorf. 2010. “Performance-Based Health Care Provider Payments.” National Conference of State Legislatures brief. Published May. www.ncsl.org/ portals/1/documents/health/perbenchformance-based_pay-2010.pdf.

Centers for Disease Control and Prevention (CDC). 2015. “Chronic Disease Prevention and Health Promotion.” Updated October 6. www.cdc.gov/chronicdisease/.

Centers for Medicare & Medicaid Services (CMS). 2014a. “Acute Inpatient PPS.” Modified August 4. www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html.

———. 2014b. “Medicare Program . . . .” Federal Register 79 (163): 49853–50536.

———. 2014c. “National Health Expenditures 2013 Highlights.” Accessed September 30. www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/ NationalHealthExpendData/Downloads/highlights.pdf.

Chen, C., and D. Ackerly. 2014. “Beyond ACOs and Bundled Payments: Medicare’s Shift Toward Accountability in Fee-for-Service.” Journal of the American Medical Association 311 (7): 673–74.

Donabedian, A. 1966. “Evaluating the Quality of Medical Care.” Milbank Quarterly 44 (3): 166–206.

Eisenberg, F., C. Lasome, A. Advani, R. Martins, P. A. Craig, and S. Sprenger. 2014. “A Study of the Impact of Meaningful Use Clinical Quality Measures.” Accessed September 29. www.aha.org/content/13/13ehrchallenges-report.pdf.

34

References

Emanuel, E. 2014. “In Health Care, Choice Is Overrated.” New York Times. Published March 5. www.nytimes.com/2014/03/06/opinion/in-health-care-choice-is-overrated.html.

Harrison, D., and C. Ledbetter. 2014. “Nurse Residency Programs: Outcome Comparisons to Best Practices.” Journal for Nurses in Professional Development 30 (2): 76–82.

Hibbard, J. H., J. Greene, and V. Overton. 2013. “Patients with Lower Activation Associated with Higher Costs; Delivery Systems Should Know Their Patients’ ‘Scores.’” Health Affairs 32 (2): 216–22.

Institute of Medicine (IOM). 1999. To Err Is Human: Building a Safer Health System. Washington, DC: National Academies Press.

James, J. 2012. “Health Policy Brief: Pay-for-Performance.” Health Affairs. Published October 11. www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=78.

The Joint Commission. 2014. “National Patient Safety Goals Effective January 1, 2015.” Published November 14. www.jointcommission.org/assets/1/6/2015_NPSG_HAP.pdf.

Kronick, R. 2015. “AHRQ: Making Health Care Safer and Higher Quality for Every American.” AHRQ Views (blog). Agency for Healthcare Research and Quality. Published October 2. www.ahrq.gov/news/blog/ahrqviews/100215.html.

Leapfrog Group. 2015a. “Explanation of Safety Score Grades.” Published April. www.hospitalsafetyscore.org/media/file/ExplanationofSafetyScoreGrades_April2015.pdf

Leapfrog. 2015b. “The Leapfrog Group Fact Sheet.” Revised April 1. www.leapfroggroup. org/about_leapfrog/leapfrog-factsheet.

References

Lee, J. Y., S. Lee, and M. Jo. 2012. “Lessons from Healthcare Providers’ Attitudes Toward Pay-for-Performance: What Should Purchasers Consider in Designing and Implementing a Successful Program?” Journal of Preventive Medicine and Public Health 45 (3): 137–47.

National Committee for Quality Assurance (NCQA). 2014. “HEDIS and Performance Measurement.” Accessed September 30. www.ncqa.org/HEDISQualityMeasurement.aspx.

Piper, L. E. 2013. “The Affordable Care Act: The Ethical Call for Value-Based Leadership to Transform Quality.” The Health Care Manager 32 (3): 227–32.

Spaulding, A., M. Zhao, and D. R. Haley. 2014. “Value-Based Purchasing and Hospital Acquired Conditions: Are We Seeing Improvement?” Health Policy 118 (3): 413–21.

Tozzi, J. 2015. “U.S. Health-Care Spending Is on the Rise Again.” Bloomberg Business. Published February 18. www.bloomberg.com/news/articles/2015-02-18/u-s-health-care-spending-is-on-the-rise-again.

Trivedi, A. N., W. Nsa, L. Hausmann, J. S. Lee, A. Ma, D. W. Bratzler, M. K. Mor, K. Baus, F. Larbi, and M. J. Fine. 2014. “Quality and Equity of Care in U. S. Hospitals.” New England Journal of Medicine 371 (24): 2298–308.

Wiltse Nicely, K. L., D. M. Sloane, and L. H. Aiken. 2012. “Lower Mortality for Abdominal Aortic Aneurysm Repair in High-Volume Hospitals Is Contingent upon Nurse Staffing.” Health Services Research 48 (3): 972–91.

Chart1
8.746 7.4212 7.0316 7.2224 8.423 8.9494 6.9084 6.3528 5.7896 8.7312 6.9543 5.5831 6.1494
9.064 7.5079 1981 7.2874 8.7037 9.1534 7.1021 6.4228 5.7155 8.8703 6.6841 5.869 6.0846
9.8258 7.8094 1982 7.4365 8.5785 9.1599 7.8839 6.5818 5.8698 8.9822 6.8029 5.7202 6.343
9.9624 7.6702 1983 7.8328 8.5542 8.8835 8.0416 6.6848 5.7132 8.8897 6.9968 5.9302 6.3235
9.8722 7.3731 1984 7.5715 8.632 8.4606 7.9398 6.4848 5.4257 8.6829 6.6631 5.8561 6.3403
10.0372 7.3049 7.9957 7.5748 8.7774 8.4848 7.9583 6.5483 4.9871 8.369 6.5632 5.766 6.4416
10.1935 7.4334 1986 7.7627 8.671 8.1562 8.2126 6.5009 5.0841 8.1374 7.0414 5.7749 6.6478
10.4532 7.5755 1987 7.9847 8.7727 8.4641 8.142 6.5106 5.6169 8.1718 7.5276 5.8619 6.4726
10.8682 7.627 1988 8.0372 8.9432 8.6157 8.0947 6.2189 6.1815 8.0759 7.7183 5.7865 6.4041
11.2365 7.9176 1989 8.0633 8.3422 8.4518 8.3098 5.9696 6.3284 8.1093 7.5467 5.8206 6.4673
11.9005 8.0136 8.3666 7.9977 8.2875 8.344 8.7284 5.8107 6.73 8.1123 7.6381 5.8456 6.8241
12.5965 8.1651 8.6079 8.6524 1991 8.2229 9.4027 5.8521 7.1693 7.9583 7.9974 6.2547 7.0998
12.8885 8.3562 8.8661 9.0543 9.6248 8.2781 9.6557 6.1125 7.2982 8.1179 8.0893 6.7041 7.2014
13.1568 8.4743 9.2884 9.1374 9.6119 8.646 9.5252 6.3878 6.9919 8.4331 7.9431 6.7074 7.2405
13.0656 8.3296 9.2598 9.2183 9.818 8.4357 9.1843 6.6608 6.9953 8.0257 7.8503 6.7661 7.2353
13.1624 8.3273 10.3559 9.3343 10.1137 8.1253 8.8613 6.8069 7.0011 7.9646 7.8777 6.6942 7.2567
13.136 8.2115 10.3753 9.7152 10.4202 8.2115 8.6367 6.9536 6.9476 8.2003 7.8272 6.7214 7.4398
13.045 7.9493 10.2503 9.6698 10.2668 8.1509 8.6041 6.8907 7.1633 8.0264 8.3994 6.4838 7.4955
13.0643 8.0618 10.146 9.8465 10.2941 8.1561 8.8274 7.1766 7.5926 8.1154 9.252 6.555 7.6592
13.0677 8.0882 10.1536 10.0029 10.362 8.9536 8.7299 7.4407 7.472 8.1976 9.3286 6.8179 7.7856
13.1366 7.9579 10.0848 9.9081 10.3952 8.6991 8.6686 7.6034 7.5578 8.1796 8.4213 6.9327 8.0679
13.7863 8.2974 10.2113 10.2817 10.5042 9.1002 9.0959 7.8061 7.6596 8.8595 8.8014 7.2263 8.1747
14.6258 8.8699 10.5603 10.6066 10.7243 9.3329 9.37 7.8575 7.9731 9.2282 9.7911 7.5441 8.3866
15.1418 9.7728 10.7536 10.9339 10.9191 9.5094 9.5403 7.9881 7.7933 9.31 10.0222 7.7736 8.3145
15.2092 9.9683 10.8859 10.9612 10.6689 9.6749 9.5559 7.9947 7.9715 9.088 9.5982 7.9114 8.5703
15.2348 10.882 10.9326 10.8629 10.8088 9.77 9.5726 8.1819 8.3411 9.0615 9.0304 8.1287 8.451
15.336 10.7468 10.8522 10.3877 10.6373 9.9243 9.7174 8.1986 8.7432 8.948 8.564 8.2879 8.4871
15.6108 10.7642 10.7751 10.2099 10.477 9.9873 9.7938 8.2295 8.4458 8.9172 8.746 8.3717 8.5268
16.0842 10.9909 10.9124 10.289 10.7041 10.183 9.9886 8.605 9.2546 9.2284 8.5513 8.7826 8.7207
17.0543 11.8823 11.5992 11.0005 11.7539 11.4722 11.1226 9.5258 9.8354 9.939 9.6743 9.7298 9.0143
17.047 12.1468 11.5543 10.913 11.5567 11.0818 11.1128 9.589 9.952 9.4688 9.4224 9.3739 8.9303
17.0152 12.0956 11.5235 11.054 11.2489 10.8655 10.9398 10.0764 10.0009 9.4911 9.2834 9.2302 9.0791
16.8995 2012 11.6108 11.4304 11.2675 10.9838 10.9285 10.2804 2012 9.5788 9.2836 9.2716 2012
US (16.9%)
NETH (12.1%)*
FR (11.6%)
SWIZ (11.4%)
GER (11.3%)
DEN (11.0%)
CAN (10.9%)
JPN (10.3%)
NZ (10.0%)*
SWE (9.6%)
NOR (9.3%)
UK (9.3%)
AUS (9.1%)*
Sheet1
1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
US (16.9%) 8.746 9.064 9.8258 9.9624 9.8722 10.0372 10.1935 10.4532 10.8682 11.2365 11.9005 12.5965 12.8885 13.1568 13.0656 13.1624 13.136 13.045 13.0643 13.0677 13.1366 13.7863 14.6258 15.1418 15.2092 15.2348 15.336 15.6108 16.0842 17.0543 17.047 17.0152 16.8995
NETH (12.1%)* 7.4212 7.5079 7.8094 7.6702 7.3731 7.3049 7.4334 7.5755 7.627 7.9176 8.0136 8.1651 8.3562 8.4743 8.3296 8.3273 8.2115 7.9493 8.0618 8.0882 7.9579 8.2974 8.8699 9.7728 9.9683 10.882 10.7468 10.7642 10.9909 11.8823 12.1468 12.0956
FR (11.6%) 7.0316 7.9957 8.3666 8.6079 8.8661 9.2884 9.2598 10.3559 10.3753 10.2503 10.146 10.1536 10.0848 10.2113 10.5603 10.7536 10.8859 10.9326 10.8522 10.7751 10.9124 11.5992 11.5543 11.5235 11.6108
SWIZ (11.4%) 7.2224 7.2874 7.4365 7.8328 7.5715 7.5748 7.7627 7.9847 8.0372 8.0633 7.9977 8.6524 9.0543 9.1374 9.2183 9.3343 9.7152 9.6698 9.8465 10.0029 9.9081 10.2817 10.6066 10.9339 10.9612 10.8629 10.3877 10.2099 10.289 11.0005 10.913 11.054 11.4304
GER (11.3%) 8.423 8.7037 8.5785 8.5542 8.632 8.7774 8.671 8.7727 8.9432 8.3422 8.2875 9.6248 9.6119 9.818 10.1137 10.4202 10.2668 10.2941 10.362 10.3952 10.5042 10.7243 10.9191 10.6689 10.8088 10.6373 10.477 10.7041 11.7539 11.5567 11.2489 11.2675
DEN (11.0%) 8.9494 9.1534 9.1599 8.8835 8.4606 8.4848 8.1562 8.4641 8.6157 8.4518 8.344 8.2229 8.2781 8.646 8.4357 8.1253 8.2115 8.1509 8.1561 8.9536 8.6991 9.1002 9.3329 9.5094 9.6749 9.77 9.9243 9.9873 10.183 11.4722 11.0818 10.8655 10.9838
CAN (10.9%) 6.9084 7.1021 7.8839 8.0416 7.9398 7.9583 8.2126 8.142 8.0947 8.3098 8.7284 9.4027 9.6557 9.5252 9.1843 8.8613 8.6367 8.6041 8.8274 8.7299 8.6686 9.0959 9.37 9.5403 9.5559 9.5726 9.7174 9.7938 9.9886 11.1226 11.1128 10.9398 10.9285
JPN (10.3%) 6.3528 6.4228 6.5818 6.6848 6.4848 6.5483 6.5009 6.5106 6.2189 5.9696 5.8107 5.8521 6.1125 6.3878 6.6608 6.8069 6.9536 6.8907 7.1766 7.4407 7.6034 7.8061 7.8575 7.9881 7.9947 8.1819 8.1986 8.2295 8.605 9.5258 9.589 10.0764 10.2804
NZ (10.0%)* 5.7896 5.7155 5.8698 5.7132 5.4257 4.9871 5.0841 5.6169 6.1815 6.3284 6.73 7.1693 7.2982 6.9919 6.9953 7.0011 6.9476 7.1633 7.5926 7.472 7.5578 7.6596 7.9731 7.7933 7.9715 8.3411 8.7432 8.4458 9.2546 9.8354 9.952 10.0009
SWE (9.6%) 8.7312 8.8703 8.9822 8.8897 8.6829 8.369 8.1374 8.1718 8.0759 8.1093 8.1123 7.9583 8.1179 8.4331 8.0257 7.9646 8.2003 8.0264 8.1154 8.1976 8.1796 8.8595 9.2282 9.31 9.088 9.0615 8.948 8.9172 9.2284 9.939 9.4688 9.4911 9.5788
NOR (9.3%) 6.9543 6.6841 6.8029 6.9968 6.6631 6.5632 7.0414 7.5276 7.7183 7.5467 7.6381 7.9974 8.0893 7.9431 7.8503 7.8777 7.8272 8.3994 9.252 9.3286 8.4213 8.8014 9.7911 10.0222 9.5982 9.0304 8.564 8.746 8.5513 9.6743 9.4224 9.2834 9.2836
UK (9.3%) 5.5831 5.869 5.7202 5.9302 5.8561 5.766 5.7749 5.8619 5.7865 5.8206 5.8456 6.2547 6.7041 6.7074 6.7661 6.6942 6.7214 6.4838 6.555 6.8179 6.9327 7.2263 7.5441 7.7736 7.9114 8.1287 8.2879 8.3717 8.7826 9.7298 9.3739 9.2302 9.2716
AUS (9.1%)* 6.1494 6.0846 6.343 6.3235 6.3403 6.4416 6.6478 6.4726 6.4041 6.4673 6.8241 7.0998 7.2014 7.2405 7.2353 7.2567 7.4398 7.4955 7.6592 7.7856 8.0679 8.1747 8.3866 8.3145 8.5703 8.451 8.4871 8.5268 8.7207 9.0143 8.9303 9.0791
The COMMONWEALTH FUND

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Discuss political, business, and ethical issues related to the growth in the US healthcare system.

May 7, 2019/in Uncategorized /by admin

Discuss political, business, and ethical issues related to the growth in the US healthcare system.

Strategic Planning in Health Systems

Jeffrey P. Harrison

Chapter 11

“By a wide margin, the biggest threat to our nation’s balance sheet is the skyrocketing cost of healthcare.”

—President Barack Obama

1

Learning Objectives

Discuss political, business, and ethical issues related to the growth in the US healthcare system.

Discuss the structures and governance of for-profit and not-for-profit healthcare systems.

Describe the key factors that affect organizational strategy and performance among healthcare systems.

Diagnose the differences in organizational culture between for-profit and not-for-profit healthcare systems.

Relate the concept of healthcare consolidation to the development, assessment, and redesign of healthcare systems.

2

Key Terms and Concepts

For-profit health system

Hospital acquisition

Hospital merger

Integrated delivery system (IDS)

Not-for-profit health system

Virtual health system

3

Introduction

The number of US hospitals operating as part of a health system grew from 2,542 in 2000 to 2,868 in 2008 and to 3,144 in 2014—a 24 percent increase since 2000 (AHA 2015).

55 percent of all US hospitals now are part of a health system.

Independently operated US hospitals, which are now in the minority, must consider future health system affiliation as part of their long-term survival plans.

Declining reimbursement and provider competition are driving this trend to form affiliations, confederations, or shared economic models such as integrated delivery systems (IDSs).

IDSs enable better use of staff and financial resources and can lead to greater operational efficiencies across the continuum of healthcare services.

4

Hospital Mergers and Acquisitions

A hospital acquisition is the purchase of a hospital by another facility or multihospital system.

The number of hospitals has only marginally increased since 1999—up less than 1%. However, the number of hospitals affiliated with a system has increased 16% (Yanci, Wolford, and Young 2013).

Not-for-profit health systems typically evaluate potential acquisitions on the basis of mission, outreach, services, and geographic location.

For-profit systems evaluate opportunities to maximize profits—for example, purchasing a hospital when its sale price is below the net present value of its cash flow stream.

Hospital Mergers and Acquisitions

A hospital merger is a combining of two or more hospitals, often through a pooling of interests.

Hospital mergers tend to be horizontal, meaning that the merging hospitals are competitors looking for increased operating efficiency and improved market share.

Additional reasons for merging are to eliminate unnecessary services, reduce overhead through consolidation, and provide a more rational mix of services designed to better meet the community’s needs.

In a merger, similarity of the mission, vision, and culture between the two organizations is important.

In an acquisition situation, organized fit is preferable, but similarity is not necessary because the acquiring organization will have dominance, and the acquired entity’s assets are transferred to the purchasing entity.

Integrated Delivery System (IDS)

In healthcare, mergers and acquisitions are a part of horizontal integration, in which a for-profit hospital system purchases other hospitals to increase its size (Harrison, Spaulding, and Mouhalis 2015).

Vertical integration results in IDSs designed to gain access to scarce resources across the continuum of care by acquiring an organization that controls those resources.

Many health policy experts have called for the country to reorganize healthcare providers and delivery systems through integration.

Integrated Delivery System

Mayo Clinic is an example of a large IDS, with a home base in Rochester, Minnesota; southern tertiary care sites in Florida and Arizona; and Mayo Clinic Health System in the Midwest.

Mayo Clinic is a not-for-profit, academic medical institution with a mission focused primarily on patient care supported by education and research.

It offers a full spectrum of healthcare options to local neighborhoods, ranging from primary to highly specialized, tertiary care. http://www.mayoclinic.org/

8

Integrated Delivery System

A not-for-profit health system is organized as a not-for-profit corporation. Based on charitable purpose and frequently affiliated with a religious denomination, not-for-profit systems are a traditional means of delivering medical care in the United States.

Geisinger Health System is a not-for-profit health system in Pennsylvania that consists of tertiary care hospitals, community hospitals, outpatient facilities, and 60 community practices.

The system also includes an insurance company, the Geisinger Health Plan, which provides comprehensive coverage for 290,000 members who receive care from 37,000 credentialed healthcare providers.

9

Integrated Delivery System

For-profit health systems are organizations that include hospitals that are owned by equity-based investors and that have a well-defined organizational goal of profit maximization, usually through efficiency measures.

As a result, the management team of for-profit hospitals answers to the shareholders of the company.

A sample for-profit health system organization chart is provided in Exhibit 11.2.

One of the largest for-profit health systems in the United States is Hospital Corporation of America (HCA), headquartered in Nashville, Tennessee.

As of 2013, an analysis of 749 large, for-profit hospitals found that they were 71% efficient on average (Harrison, Spaulding, and Mouhalis 2015).

10

Integrated Delivery System

Exhibit 11.2:

Sample For-Profit Health System Organization Chart

11

Strategic Planning at Health Systems

Strategic planning at the health system level is different from planning at an individual hospital.

Health systems routinely evaluate the acquisition of hospitals or other smaller health systems with values in excess of $1 billion.

Not all systems are created equal, and many small systems (as well as some larger systems) do not really operate as a consolidated entity.

These systems may comprise many facilities and have good public relations programs, but they are fragmented and do not integrate key services and functions.

Health systems are attempting to lower costs by increasing their economies of scale. In addition to spreading their costs over increasing volumes of services, healthcare organizations are able to negotiate for increased revenue when they negotiate with large insurers.

12

Integration Across the Continuum of Care

In the future, management of individual patients across the continuum of healthcare services will become increasingly important. US healthcare will continue to move toward further integration of clinical services and consolidation of payers and health systems (Moses et al. 2013).

Health systems are in a position to manage variation across their facilities in both administrative and clinical areas.

When protocols of care are standardized and implemented across a health system, quality scores improve, patient satisfaction increases, and fewer malpractice claims are filed.

Virtual Health Systems

Virtual health systems are networks of organizations created through the use of health information technology that allow independent healthcare providers to link together without having to merge with or acquire other facilities.

Participation in a virtual health system may appeal to some independent hospitals because they can gain many of the advantages of health system membership without giving up operational control to the health system.

These clinical affiliations allow organizations to access the clinical expertise and resources of much larger systems without giving up organizational control.

Virtual health systems can also link hospitals with physician groups or long-term care providers to enable smooth transitions for patients from facility to facility.

14

International Health Systems

In recognition of the global market, many health systems are considering international healthcare.

When considering expansion into an international market, strategic planners of health systems must ensure that a market for a new healthcare provider exists.

Once the market demand has been validated, the international strategic planner should determine whether a commercial health insurance program exists in the country to pay for services or if segments of the population have sufficient financial resources to pay for premium healthcare services.

For more information about international health, go to commonwealthfund.org/2013/International profiles.

15

Summary

IDSs and ACOs are able to gain a competitive advantage in the market by negotiating higher reimbursement rates, offering a wider array of clinical services, and delivering these services in a more coordinated manner.

Also contributing to the growth of IDSs is the development of virtual health systems, a new model that allows organizations, through health information technology, to participate in a loosely structured system without having to give up operational control or commit financial resources.

In addition, some US health systems are participating in international healthcare initiatives as a way to expand their market.

16

Questions

17

References

American Hospital Association (AHA). 2015. “Fast Facts on US Hospitals.” Updated January. www.aha.org/research/rc/stat-studies/fast-facts.shtml.

Ascension. 2014. 2014 Financial and Statistical Report. Accessed March 19, 2015. http://ascension.org/~/media/files/community_investor-relations-pdfs/annual-report-2014_financials.pdf.

———. 2009. “Consolidated Financial Statements.” Accessed October 1, 2015. www.ascensionhealth.org/assets/docs/AH_2009_AFS.pdf.

Cobb, A., and T. Wry. 2015. “Resource-Dependence Theory.” Oxford Bibliographies in Management. Last reviewed June 18. doi: 10.1093/obo/9780199846740-0072.

Cutler, D. M., and F. S. Morton. 2013. “Hospitals, Market Share, and Consolidation.” Journal of the American Medical Association 310 (18): 1964–70.

Harrison, J. P., A. Spaulding, and P. Mouhalis. 2015. “The Efficiency Frontier of For-Profit Hospitals.” Journal of Health Care Finance 41 (4): 1–23. HCA. 2015a. “HCA Facts.” Published July 7. http://hcahealthcare.com/util/documents/ HCA-presskit-fact-sheet.pdf.

18

References

———. 2015b. “HCA Reports Fourth Quarter 2014 Results.” Published February 15. http:// investor.hcahealthcare.com/press-release/hca-reports-fourth-quarter-2014-results.

———. 2011. “2011 Annual Report to Stockholders.” Accessed September 26, 2015. http://investor.hcahealthcare.com/sites/hcahealthcare.investorhq.businesswire.com/files/report/file/HCA_2011_Annual_Report.pdf.

———. 2008. “HCA Fact Sheet.” Accessed April 30, 2009. http://hcagulfcoast.com/util/documents/CurrentFactSheet1.pdf.

Hwang, W., J. Chang, M. LaClair, and H. Paz. 2013. “Effects of Integrated Delivery System on Cost and Quality.” The American Journal of Managed Care 19 (5): e175–e184.

Lee, T. H., A. Bothe, and G. D. Steele. 2012. “How Geisinger Structures Its Physicians’ Compensation to Support Improvements in Quality, Efficiency, and Volume.” Health Affairs 31 (9): 2068–73.

LeMaster, E., and J. Aygun. 2015. “Is Hospital M&A Waning?” Healthcare Financial Management Association. Published January. www.hfma.org/Content.aspx?id=27401&utmsource=Realpercentage20Magnet&utm medium=Email&utm campaign=64414373.

19

References

Mayo Clinic. 2014. “Mayo Clinic Facts.” Published December. www.mayoclinic.org/ about-mayo-clinic/facts-statistics.

Mayo Clinic Health System. 2015. “About Mayo Clinic Health System.” Accessed September 26. http://mayoclinichealthsystem.org/about-us.

Moses, H., D. H. M. Matheson, E. R. Dorsey, B. P. George, D. Sadoff, and S. Yoshimura. 2013. “The Anatomy of Health Care in the United States.” Journal of the American Medical Association 310 (18): 1947–64.

Page, L. 2010. “52 Not-for-Profit Hospital Systems to Know.” Becker’s Hospital Review. Published March 1. www.beckershospitalreview.com/lists-and-statistics/50-not-forprofit- hospital-systems-to-know.html.

Yanci, J., M. Wolford, and P. Young. 2013. What Hospital Executives Should Be Considering in Hospital Mergers and Acquisitions. Dixon Hughes Goodman LLP. Published January 1. www2.dhgllp.com/res_pubs/Hospital-Mergers-and-Acquisitions.pdf.

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Integration Across the Continuum of Care

May 7, 2019/in Uncategorized /by admin

Integration Across the Continuum of Care

Strategic Planning in Health Systems

Jeffrey P. Harrison

Chapter 11

“By a wide margin, the biggest threat to our nation’s balance sheet is the skyrocketing cost of healthcare.”

—President Barack Obama

1

Learning Objectives

Discuss political, business, and ethical issues related to the growth in the US healthcare system.

Discuss the structures and governance of for-profit and not-for-profit healthcare systems.

Describe the key factors that affect organizational strategy and performance among healthcare systems.

Diagnose the differences in organizational culture between for-profit and not-for-profit healthcare systems.

Relate the concept of healthcare consolidation to the development, assessment, and redesign of healthcare systems.

2

Key Terms and Concepts

For-profit health system

Hospital acquisition

Hospital merger

Integrated delivery system (IDS)

Not-for-profit health system

Virtual health system

3

Introduction

The number of US hospitals operating as part of a health system grew from 2,542 in 2000 to 2,868 in 2008 and to 3,144 in 2014—a 24 percent increase since 2000 (AHA 2015).

55 percent of all US hospitals now are part of a health system.

Independently operated US hospitals, which are now in the minority, must consider future health system affiliation as part of their long-term survival plans.

Declining reimbursement and provider competition are driving this trend to form affiliations, confederations, or shared economic models such as integrated delivery systems (IDSs).

IDSs enable better use of staff and financial resources and can lead to greater operational efficiencies across the continuum of healthcare services.

4

Hospital Mergers and Acquisitions

A hospital acquisition is the purchase of a hospital by another facility or multihospital system.

The number of hospitals has only marginally increased since 1999—up less than 1%. However, the number of hospitals affiliated with a system has increased 16% (Yanci, Wolford, and Young 2013).

Not-for-profit health systems typically evaluate potential acquisitions on the basis of mission, outreach, services, and geographic location.

For-profit systems evaluate opportunities to maximize profits—for example, purchasing a hospital when its sale price is below the net present value of its cash flow stream.

Hospital Mergers and Acquisitions

A hospital merger is a combining of two or more hospitals, often through a pooling of interests.

Hospital mergers tend to be horizontal, meaning that the merging hospitals are competitors looking for increased operating efficiency and improved market share.

Additional reasons for merging are to eliminate unnecessary services, reduce overhead through consolidation, and provide a more rational mix of services designed to better meet the community’s needs.

In a merger, similarity of the mission, vision, and culture between the two organizations is important.

In an acquisition situation, organized fit is preferable, but similarity is not necessary because the acquiring organization will have dominance, and the acquired entity’s assets are transferred to the purchasing entity.

Integrated Delivery System (IDS)

In healthcare, mergers and acquisitions are a part of horizontal integration, in which a for-profit hospital system purchases other hospitals to increase its size (Harrison, Spaulding, and Mouhalis 2015).

Vertical integration results in IDSs designed to gain access to scarce resources across the continuum of care by acquiring an organization that controls those resources.

Many health policy experts have called for the country to reorganize healthcare providers and delivery systems through integration.

Integrated Delivery System

Mayo Clinic is an example of a large IDS, with a home base in Rochester, Minnesota; southern tertiary care sites in Florida and Arizona; and Mayo Clinic Health System in the Midwest.

Mayo Clinic is a not-for-profit, academic medical institution with a mission focused primarily on patient care supported by education and research.

It offers a full spectrum of healthcare options to local neighborhoods, ranging from primary to highly specialized, tertiary care. http://www.mayoclinic.org/

8

Integrated Delivery System

A not-for-profit health system is organized as a not-for-profit corporation. Based on charitable purpose and frequently affiliated with a religious denomination, not-for-profit systems are a traditional means of delivering medical care in the United States.

Geisinger Health System is a not-for-profit health system in Pennsylvania that consists of tertiary care hospitals, community hospitals, outpatient facilities, and 60 community practices.

The system also includes an insurance company, the Geisinger Health Plan, which provides comprehensive coverage for 290,000 members who receive care from 37,000 credentialed healthcare providers.

9

Integrated Delivery System

For-profit health systems are organizations that include hospitals that are owned by equity-based investors and that have a well-defined organizational goal of profit maximization, usually through efficiency measures.

As a result, the management team of for-profit hospitals answers to the shareholders of the company.

A sample for-profit health system organization chart is provided in Exhibit 11.2.

One of the largest for-profit health systems in the United States is Hospital Corporation of America (HCA), headquartered in Nashville, Tennessee.

As of 2013, an analysis of 749 large, for-profit hospitals found that they were 71% efficient on average (Harrison, Spaulding, and Mouhalis 2015).

10

Integrated Delivery System

Exhibit 11.2:

Sample For-Profit Health System Organization Chart

11

Strategic Planning at Health Systems

Strategic planning at the health system level is different from planning at an individual hospital.

Health systems routinely evaluate the acquisition of hospitals or other smaller health systems with values in excess of $1 billion.

Not all systems are created equal, and many small systems (as well as some larger systems) do not really operate as a consolidated entity.

These systems may comprise many facilities and have good public relations programs, but they are fragmented and do not integrate key services and functions.

Health systems are attempting to lower costs by increasing their economies of scale. In addition to spreading their costs over increasing volumes of services, healthcare organizations are able to negotiate for increased revenue when they negotiate with large insurers.

12

Integration Across the Continuum of Care

In the future, management of individual patients across the continuum of healthcare services will become increasingly important. US healthcare will continue to move toward further integration of clinical services and consolidation of payers and health systems (Moses et al. 2013).

Health systems are in a position to manage variation across their facilities in both administrative and clinical areas.

When protocols of care are standardized and implemented across a health system, quality scores improve, patient satisfaction increases, and fewer malpractice claims are filed.

Virtual Health Systems

Virtual health systems are networks of organizations created through the use of health information technology that allow independent healthcare providers to link together without having to merge with or acquire other facilities.

Participation in a virtual health system may appeal to some independent hospitals because they can gain many of the advantages of health system membership without giving up operational control to the health system.

These clinical affiliations allow organizations to access the clinical expertise and resources of much larger systems without giving up organizational control.

Virtual health systems can also link hospitals with physician groups or long-term care providers to enable smooth transitions for patients from facility to facility.

14

International Health Systems

In recognition of the global market, many health systems are considering international healthcare.

When considering expansion into an international market, strategic planners of health systems must ensure that a market for a new healthcare provider exists.

Once the market demand has been validated, the international strategic planner should determine whether a commercial health insurance program exists in the country to pay for services or if segments of the population have sufficient financial resources to pay for premium healthcare services.

For more information about international health, go to commonwealthfund.org/2013/International profiles.

15

Summary

IDSs and ACOs are able to gain a competitive advantage in the market by negotiating higher reimbursement rates, offering a wider array of clinical services, and delivering these services in a more coordinated manner.

Also contributing to the growth of IDSs is the development of virtual health systems, a new model that allows organizations, through health information technology, to participate in a loosely structured system without having to give up operational control or commit financial resources.

In addition, some US health systems are participating in international healthcare initiatives as a way to expand their market.

16

Questions

17

References

American Hospital Association (AHA). 2015. “Fast Facts on US Hospitals.” Updated January. www.aha.org/research/rc/stat-studies/fast-facts.shtml.

Ascension. 2014. 2014 Financial and Statistical Report. Accessed March 19, 2015. http://ascension.org/~/media/files/community_investor-relations-pdfs/annual-report-2014_financials.pdf.

———. 2009. “Consolidated Financial Statements.” Accessed October 1, 2015. www.ascensionhealth.org/assets/docs/AH_2009_AFS.pdf.

Cobb, A., and T. Wry. 2015. “Resource-Dependence Theory.” Oxford Bibliographies in Management. Last reviewed June 18. doi: 10.1093/obo/9780199846740-0072.

Cutler, D. M., and F. S. Morton. 2013. “Hospitals, Market Share, and Consolidation.” Journal of the American Medical Association 310 (18): 1964–70.

Harrison, J. P., A. Spaulding, and P. Mouhalis. 2015. “The Efficiency Frontier of For-Profit Hospitals.” Journal of Health Care Finance 41 (4): 1–23. HCA. 2015a. “HCA Facts.” Published July 7. http://hcahealthcare.com/util/documents/ HCA-presskit-fact-sheet.pdf.

18

References

———. 2015b. “HCA Reports Fourth Quarter 2014 Results.” Published February 15. http:// investor.hcahealthcare.com/press-release/hca-reports-fourth-quarter-2014-results.

———. 2011. “2011 Annual Report to Stockholders.” Accessed September 26, 2015. http://investor.hcahealthcare.com/sites/hcahealthcare.investorhq.businesswire.com/files/report/file/HCA_2011_Annual_Report.pdf.

———. 2008. “HCA Fact Sheet.” Accessed April 30, 2009. http://hcagulfcoast.com/util/documents/CurrentFactSheet1.pdf.

Hwang, W., J. Chang, M. LaClair, and H. Paz. 2013. “Effects of Integrated Delivery System on Cost and Quality.” The American Journal of Managed Care 19 (5): e175–e184.

Lee, T. H., A. Bothe, and G. D. Steele. 2012. “How Geisinger Structures Its Physicians’ Compensation to Support Improvements in Quality, Efficiency, and Volume.” Health Affairs 31 (9): 2068–73.

LeMaster, E., and J. Aygun. 2015. “Is Hospital M&A Waning?” Healthcare Financial Management Association. Published January. www.hfma.org/Content.aspx?id=27401&utmsource=Realpercentage20Magnet&utm medium=Email&utm campaign=64414373.

19

References

Mayo Clinic. 2014. “Mayo Clinic Facts.” Published December. www.mayoclinic.org/ about-mayo-clinic/facts-statistics.

Mayo Clinic Health System. 2015. “About Mayo Clinic Health System.” Accessed September 26. http://mayoclinichealthsystem.org/about-us.

Moses, H., D. H. M. Matheson, E. R. Dorsey, B. P. George, D. Sadoff, and S. Yoshimura. 2013. “The Anatomy of Health Care in the United States.” Journal of the American Medical Association 310 (18): 1947–64.

Page, L. 2010. “52 Not-for-Profit Hospital Systems to Know.” Becker’s Hospital Review. Published March 1. www.beckershospitalreview.com/lists-and-statistics/50-not-forprofit- hospital-systems-to-know.html.

Yanci, J., M. Wolford, and P. Young. 2013. What Hospital Executives Should Be Considering in Hospital Mergers and Acquisitions. Dixon Hughes Goodman LLP. Published January 1. www2.dhgllp.com/res_pubs/Hospital-Mergers-and-Acquisitions.pdf.

The post Integration Across the Continuum of Care appeared first on graduatepaperhelp.

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Strategic Planning in Health Systems

May 7, 2019/in Uncategorized /by admin

Strategic Planning in Health Systems

Jeffrey P. Harrison

Chapter 11

“By a wide margin, the biggest threat to our nation’s balance sheet is the skyrocketing cost of healthcare.”

—President Barack Obama

1

Learning Objectives

Discuss political, business, and ethical issues related to the growth in the US healthcare system.

Discuss the structures and governance of for-profit and not-for-profit healthcare systems.

Describe the key factors that affect organizational strategy and performance among healthcare systems.

Diagnose the differences in organizational culture between for-profit and not-for-profit healthcare systems.

Relate the concept of healthcare consolidation to the development, assessment, and redesign of healthcare systems.

2

Key Terms and Concepts

For-profit health system

Hospital acquisition

Hospital merger

Integrated delivery system (IDS)

Not-for-profit health system

Virtual health system

3

Introduction

The number of US hospitals operating as part of a health system grew from 2,542 in 2000 to 2,868 in 2008 and to 3,144 in 2014—a 24 percent increase since 2000 (AHA 2015).

55 percent of all US hospitals now are part of a health system.

Independently operated US hospitals, which are now in the minority, must consider future health system affiliation as part of their long-term survival plans.

Declining reimbursement and provider competition are driving this trend to form affiliations, confederations, or shared economic models such as integrated delivery systems (IDSs).

IDSs enable better use of staff and financial resources and can lead to greater operational efficiencies across the continuum of healthcare services.

4

Hospital Mergers and Acquisitions

A hospital acquisition is the purchase of a hospital by another facility or multihospital system.

The number of hospitals has only marginally increased since 1999—up less than 1%. However, the number of hospitals affiliated with a system has increased 16% (Yanci, Wolford, and Young 2013).

Not-for-profit health systems typically evaluate potential acquisitions on the basis of mission, outreach, services, and geographic location.

For-profit systems evaluate opportunities to maximize profits—for example, purchasing a hospital when its sale price is below the net present value of its cash flow stream.

Hospital Mergers and Acquisitions

A hospital merger is a combining of two or more hospitals, often through a pooling of interests.

Hospital mergers tend to be horizontal, meaning that the merging hospitals are competitors looking for increased operating efficiency and improved market share.

Additional reasons for merging are to eliminate unnecessary services, reduce overhead through consolidation, and provide a more rational mix of services designed to better meet the community’s needs.

In a merger, similarity of the mission, vision, and culture between the two organizations is important.

In an acquisition situation, organized fit is preferable, but similarity is not necessary because the acquiring organization will have dominance, and the acquired entity’s assets are transferred to the purchasing entity.

Integrated Delivery System (IDS)

In healthcare, mergers and acquisitions are a part of horizontal integration, in which a for-profit hospital system purchases other hospitals to increase its size (Harrison, Spaulding, and Mouhalis 2015).

Vertical integration results in IDSs designed to gain access to scarce resources across the continuum of care by acquiring an organization that controls those resources.

Many health policy experts have called for the country to reorganize healthcare providers and delivery systems through integration.

Integrated Delivery System

Mayo Clinic is an example of a large IDS, with a home base in Rochester, Minnesota; southern tertiary care sites in Florida and Arizona; and Mayo Clinic Health System in the Midwest.

Mayo Clinic is a not-for-profit, academic medical institution with a mission focused primarily on patient care supported by education and research.

It offers a full spectrum of healthcare options to local neighborhoods, ranging from primary to highly specialized, tertiary care. http://www.mayoclinic.org/

8

Integrated Delivery System

A not-for-profit health system is organized as a not-for-profit corporation. Based on charitable purpose and frequently affiliated with a religious denomination, not-for-profit systems are a traditional means of delivering medical care in the United States.

Geisinger Health System is a not-for-profit health system in Pennsylvania that consists of tertiary care hospitals, community hospitals, outpatient facilities, and 60 community practices.

The system also includes an insurance company, the Geisinger Health Plan, which provides comprehensive coverage for 290,000 members who receive care from 37,000 credentialed healthcare providers.

9

Integrated Delivery System

For-profit health systems are organizations that include hospitals that are owned by equity-based investors and that have a well-defined organizational goal of profit maximization, usually through efficiency measures.

As a result, the management team of for-profit hospitals answers to the shareholders of the company.

A sample for-profit health system organization chart is provided in Exhibit 11.2.

One of the largest for-profit health systems in the United States is Hospital Corporation of America (HCA), headquartered in Nashville, Tennessee.

As of 2013, an analysis of 749 large, for-profit hospitals found that they were 71% efficient on average (Harrison, Spaulding, and Mouhalis 2015).

10

Integrated Delivery System

Exhibit 11.2:

Sample For-Profit Health System Organization Chart

11

Strategic Planning at Health Systems

Strategic planning at the health system level is different from planning at an individual hospital.

Health systems routinely evaluate the acquisition of hospitals or other smaller health systems with values in excess of $1 billion.

Not all systems are created equal, and many small systems (as well as some larger systems) do not really operate as a consolidated entity.

These systems may comprise many facilities and have good public relations programs, but they are fragmented and do not integrate key services and functions.

Health systems are attempting to lower costs by increasing their economies of scale. In addition to spreading their costs over increasing volumes of services, healthcare organizations are able to negotiate for increased revenue when they negotiate with large insurers.

12

Integration Across the Continuum of Care

In the future, management of individual patients across the continuum of healthcare services will become increasingly important. US healthcare will continue to move toward further integration of clinical services and consolidation of payers and health systems (Moses et al. 2013).

Health systems are in a position to manage variation across their facilities in both administrative and clinical areas.

When protocols of care are standardized and implemented across a health system, quality scores improve, patient satisfaction increases, and fewer malpractice claims are filed.

Virtual Health Systems

Virtual health systems are networks of organizations created through the use of health information technology that allow independent healthcare providers to link together without having to merge with or acquire other facilities.

Participation in a virtual health system may appeal to some independent hospitals because they can gain many of the advantages of health system membership without giving up operational control to the health system.

These clinical affiliations allow organizations to access the clinical expertise and resources of much larger systems without giving up organizational control.

Virtual health systems can also link hospitals with physician groups or long-term care providers to enable smooth transitions for patients from facility to facility.

14

International Health Systems

In recognition of the global market, many health systems are considering international healthcare.

When considering expansion into an international market, strategic planners of health systems must ensure that a market for a new healthcare provider exists.

Once the market demand has been validated, the international strategic planner should determine whether a commercial health insurance program exists in the country to pay for services or if segments of the population have sufficient financial resources to pay for premium healthcare services.

For more information about international health, go to commonwealthfund.org/2013/International profiles.

15

Summary

IDSs and ACOs are able to gain a competitive advantage in the market by negotiating higher reimbursement rates, offering a wider array of clinical services, and delivering these services in a more coordinated manner.

Also contributing to the growth of IDSs is the development of virtual health systems, a new model that allows organizations, through health information technology, to participate in a loosely structured system without having to give up operational control or commit financial resources.

In addition, some US health systems are participating in international healthcare initiatives as a way to expand their market.

16

Questions

17

References

American Hospital Association (AHA). 2015. “Fast Facts on US Hospitals.” Updated January. www.aha.org/research/rc/stat-studies/fast-facts.shtml.

Ascension. 2014. 2014 Financial and Statistical Report. Accessed March 19, 2015. http://ascension.org/~/media/files/community_investor-relations-pdfs/annual-report-2014_financials.pdf.

———. 2009. “Consolidated Financial Statements.” Accessed October 1, 2015. www.ascensionhealth.org/assets/docs/AH_2009_AFS.pdf.

Cobb, A., and T. Wry. 2015. “Resource-Dependence Theory.” Oxford Bibliographies in Management. Last reviewed June 18. doi: 10.1093/obo/9780199846740-0072.

Cutler, D. M., and F. S. Morton. 2013. “Hospitals, Market Share, and Consolidation.” Journal of the American Medical Association 310 (18): 1964–70.

Harrison, J. P., A. Spaulding, and P. Mouhalis. 2015. “The Efficiency Frontier of For-Profit Hospitals.” Journal of Health Care Finance 41 (4): 1–23. HCA. 2015a. “HCA Facts.” Published July 7. http://hcahealthcare.com/util/documents/ HCA-presskit-fact-sheet.pdf.

18

References

———. 2015b. “HCA Reports Fourth Quarter 2014 Results.” Published February 15. http:// investor.hcahealthcare.com/press-release/hca-reports-fourth-quarter-2014-results.

———. 2011. “2011 Annual Report to Stockholders.” Accessed September 26, 2015. http://investor.hcahealthcare.com/sites/hcahealthcare.investorhq.businesswire.com/files/report/file/HCA_2011_Annual_Report.pdf.

———. 2008. “HCA Fact Sheet.” Accessed April 30, 2009. http://hcagulfcoast.com/util/documents/CurrentFactSheet1.pdf.

Hwang, W., J. Chang, M. LaClair, and H. Paz. 2013. “Effects of Integrated Delivery System on Cost and Quality.” The American Journal of Managed Care 19 (5): e175–e184.

Lee, T. H., A. Bothe, and G. D. Steele. 2012. “How Geisinger Structures Its Physicians’ Compensation to Support Improvements in Quality, Efficiency, and Volume.” Health Affairs 31 (9): 2068–73.

LeMaster, E., and J. Aygun. 2015. “Is Hospital M&A Waning?” Healthcare Financial Management Association. Published January. www.hfma.org/Content.aspx?id=27401&utmsource=Realpercentage20Magnet&utm medium=Email&utm campaign=64414373.

19

References

Mayo Clinic. 2014. “Mayo Clinic Facts.” Published December. www.mayoclinic.org/ about-mayo-clinic/facts-statistics.

Mayo Clinic Health System. 2015. “About Mayo Clinic Health System.” Accessed September 26. http://mayoclinichealthsystem.org/about-us.

Moses, H., D. H. M. Matheson, E. R. Dorsey, B. P. George, D. Sadoff, and S. Yoshimura. 2013. “The Anatomy of Health Care in the United States.” Journal of the American Medical Association 310 (18): 1947–64.

Page, L. 2010. “52 Not-for-Profit Hospital Systems to Know.” Becker’s Hospital Review. Published March 1. www.beckershospitalreview.com/lists-and-statistics/50-not-forprofit- hospital-systems-to-know.html.

Yanci, J., M. Wolford, and P. Young. 2013. What Hospital Executives Should Be Considering in Hospital Mergers and Acquisitions. Dixon Hughes Goodman LLP. Published January 1. www2.dhgllp.com/res_pubs/Hospital-Mergers-and-Acquisitions.pdf.

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Who are the key stakeholders in a healthcare organization?

May 7, 2019/in Uncategorized /by admin

Who are the key stakeholders in a healthcare organization?

Question1

This is a major federal agency that provided health insurance to US citizens aged 65 or older. Thy also have the responsibility of maintaining extensive data on annual Medicare and Medicaid expenditures, as well as the Children’s Health Insurance Programs and national healthcare expenditures. What federal agency is this?

Question 2

A. The purchase of a hospital by another facility or multihospital system is called a ————————–

B. Organization whose ownership is divided between a hospital and physicians on the basis of their contributions to the enterprise is called —————————-

C. —————————-designed to keep senior citizens in the community as long as possible by providing a combination of social and medical services.

D. An organization’s ______, ______, and __ provide the foundation on which the strategic plan is built.

Question 3

What is an accountable care organization (ACO)?

Question 4

What arwhat are the roles of the following groups in the health care value improvement process: boards of directors, senior leaders, Physicians, employees, and payers?

Question 5

Many elderly patients are being discharged from acute care hospitals after undergoing procedures such as knee and hip replacement surgeries. They need extensive rehabilitation services. From a strategic planning perspective, investment in what type of PAC facility would be best to pursue, given these circumstances? Explain why

Question 6

In 1999, The Institute of Medicine (IOM) published To Err Is Human: Building a Safer Health System, to improve patient safety in health care; what are the six IOM aims for quality improvement?

Question 7

List 3 benefits of forming a joint venture?

Question 8

Why is diversity in the workplace so important? As a future healthcare professional, how will you make sure that diversity is part of your organization?

Question 9

Identify and discuss (a) one political issue and (b) one ethical issue related to the growth in the healthcare system of the USA and how might each of these issues impact the strategic planning of a healthcare organization. Give examples to help you explain your answer.

Question 10

Who are the key stakeholders in a healthcare organization? Provide an example of a motivating statement that might engage one of these groups.

The post Who are the key stakeholders in a healthcare organization? appeared first on graduatepaperhelp.

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