The accelerating costs of US healthcare, the economic downturn, and reform outcry have revitalize interest in integrated delivery systems (IDS). However, this is not a new concept. Shortell and McCurdy (2010) define IDS as a “network of organizations that directly provides or arranges to provide a coordinated continuum of services to a defined population and is able and willing to be held accountable for the cost, quality and outcomes of care and, the health status of the population served”(p.370). Today, many healthcare providers believe in the integrated delivery system; in fact, Strandberg-Larsen and Krasnik (2009) state that many think that it would lead to higher quality care, lower cost, and the maintenance or improvement the recipients’ health and satisfaction .Well- known Kaiser Permanente, Group Health Cooperative of Puget Sound, the Veterans Administration, the Geisinger Clinic, the Billings Clinic, the Mayo Clinic, the Cleveland Clinic, the Advocate Health System in Chicago, the Henry Ford Health System in Detroit, the Intermountain Health System in Salt Lake City, Utah, the Sharp Health System in San Diego ,and the Sutter Health system in Sacramento are all example of IDS (Shortell and McCurdy, 2010). However, there are many different model types of IDS. Although there are different models, Kongstvedt (2007) states that the common factor is the’ physician component’. However, the conditions under which a managed care plan would desire to contract with an integrated delivery system vary with each IDS model types.
A common IDS model type is the Independent Practice Association (IPA) model. IPA is legal entity consisting of independent physicians, who are contracted IPA members. Under this model, IPA would negotiate a...
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...or Medicare-risk contracts for medical services and as result eliminating the “middleman.” There are many different integrated delivery system models but the common factor is the’ physician component’. However, the conditions under which a managed care plan would contract with an integrated delivery system vary with each IDS model types.
Works Cited
Kongstvedt, P. R. (2007). Essentials of managed health care. (5th ed.). Sudbury, Massachusetts: Jones and Bartlett publishers.
Shortell, S. M., & McCurdy, R. K. (2010). Integrated health systems. Information Knowledge Systems Management, 8(1-4), 369-382. doi: 10.3233/IKS-2009-0147
Strandberg-Larsen, M., & Krasnik, A. (2009). Measurement of integrated healthcare delivery: a systematic review of methods and future research directions. International Journal Of Integrated Care (IJIC), 941-51. Retrieved from EBSCOhost.
According to Harry A. Sultz and Kristina M. Young, the authors of our textbook Health Care USA, medical care in the United States is a $2.5 Trillion industry (xvii). This industry is so large that “the U.S. health care system is the world’s eighth
To guarantee that its members receive appropriate, high level quality care in a cost-effective manner, each managed care organization (MCO) tailors its networks according to the characteristics of the providers, consumers, and competitors in a specific market. Other considerations for creating the network are the managed care organization's own goals for quality, accessibility, cost savings, and member satisfaction. Strategic planning for networks is a continuing process. In addition to an initial evaluation of its markets and goals, the managed care organization must periodically reevaluate its target markets and objectives. After reviewing the markets, then the organization must modify its network strategies accordingly to remain competitive in the rapidly changing healthcare industry. Coventry Health Care, Inc and its affiliated companies recognize the importance of developing and managing an adequate network of qualified providers to serve the need of customers and enrolled members (Coventry Health Care Intranet, Creasy and Spath, http://cvtynet/ ). "A central goal of managed care is containing the costs of delivering care, but the wide variety of organizations typically lumped together under the umbrella of managed care pursue this goal using combination of numerous strategies that vary from market to market and from organization to organization" (Baker , 2000, p.2).
113-117. Retrieved April 21st, 2011 from website: http://secure.cihi.ca/cihiweb/products/physicians_payment_aib_2010_f.pdf. D. Squires, The Commonwealth Fund, and others, International Profiles of Health Care Systems, The Commonwealth Fund, June 2010. Retrieved April 20th, 2011 from website: http://www.commonwealthfund.org//media/Files/Publications/Fund%20Report/2010/Jun/1417_Squires_Intl_Profiles_622.pdf. Johns, M. L. & Co. (2010). The 'Standard' of the 'Standard'.
It is enthralling to note that in spite of the advances in healthcare systems, such as our hospital’s ability to provide patients with lower cost, managed One being the Health Maintenance Organizations (HMO), which was first proposed in the 1960s by Dr. Paul Elwood in the "Health Maintenance Strategy”. The HMO concept was created to decrease increasing health care costs and was set in law as the Health Maintenance Organization Act of 1973, after promotion from the Nixon Administration. HMO would, in exchange for a fee, allow members access to employed physicians and facilities. In return, the HMO received market access and could earn federal development funds.
Niles, Nancy J. Basics of the U.S. Health Care System. Sudbury, MA: Jones and Bartlett, 2011. Print.
When one examines managed health care and the hospitals that provide the care, a degree of variation is found in the treatment and care of their patients. This variation can be between hospitals or even between physicians within a health care network. For managed care companies the variation may be beneficial. This may provide them with opportunities to save money when it comes to paying for their policy holder’s care, however this large variation may also be detrimental to the insurance company. This would fall into the category of management of utilization, if hospitals and managed care organizations can control treatment utilization, they can control premium costs for both themselves and their customers (Rodwin 1996). If health care organizations can implement prevention as a way to warrant good health with their consumers, insurance companies can also illuminate unnecessary health care. These are just a few examples of how the health care industry can help benefit their patients, but that does not mean every issue involving physician over utilization or quality of care is erased because there is a management mechanism set in place.
Kovner, A.R & Knickman, J.R (2011) Jonas & Kovner’s Health Care Delivery in the United States, 10th Edition. New York: Springer Publishing.
...f clinical information systems in health care quality improvement. The Health Care Manager. 25(3): 206-212.
Health Maintenance Organizations, or HMO’s, are a very important part of the American health care system. Also referred to as managed care programs, HMO's are combinations of doctors and insurance companies that are formed into one organization. This organization provides treatment to its members at fixed costs and decides on what treatment, if any, will be given based on the patient's or doctor's current health plan. Sometimes, no treatment is given at all. HMO's main concerns are to control costs and supposedly provide the best possible treatment to their patients. But it seems to the naked eye that instead their main goal is to get more people enrolled so that they can maintain or raise current premiums paid by consumers using their service. For HMO's, profit comes first- not patients' lives.
Formed in 1998, the Managed Care Executive Group (MCEG) is a national organization of U.S. senior health executives who provide an open exchange of shared resources by discussing issues which are currently faced by health care organizations. In the fall of 2011, 61 organizations, which represented 90 responders, ranked the top ten strategic issues for 2012. Although the issues were ranked according to their priority, this report discusses the top three issues which I believe to be the most significant due to the need for competitive and inter-related products, quality care and cost containment.
It is no secret that the current healthcare reform is a contentious matter that promises to transform the way Americans view an already complex healthcare system. The newly insured population is expected to increase by an estimated 32 million while facing an expected shortage of up to 44,000 primary care physicians within the next 12 years (Doherty, 2010). Amidst these already overwhelming challenges, healthcare systems are becoming increasingly scrutinized to identify ways to improve cost containment and patient access (Curits & Netten, 2007). “Growing awareness of the importance of health promotion and disease prevention, the increased complexity of community-based care, and the need to use scarce human healthcare resources, especially family physicians, far more efficiently and effectively, have resulted in increased emphasis on primary healthcare renewal.” (Bailey, Jones & Way, 2006, p. 381).
..., M., Thomas, E., Smolowitz, J., & Honig, J. (2007, Dec 07). Essential health care: affordable for all?. Retrieved from www.cinahl.com/cgi-bin/refsvc?jid=374&accno=2004209136
Shi, L., & Singh, D. (2012). Delivering health care in America: a system approach. Burlington: Jones & Bartlett Learning, LLC.
Niles, N. J. (2011). Basics of the U.S. health care system. Sudbury, MA: Jones and Bartlett.
Thrasher, E. H., & Revels, M. A. (2012). The Role of Information Technology as a Complementary Resource in Healthcare Integrated Delivery Systems. Hospital Topics, 90(2), 23-32. doi:10.1080/00185868.2012.679908