Integrated Managed Care Organization- The organization is properly aligned for the primary driver being cost cutting services. Since all entities within the organization are responsible and affected by any expenses endured on any entity being unfavorable or favorable, the foundation serves as a primary motivator to reduce costs at all levels. This alignment eliminates any financial gains from driving high utilization of services or higher intensity services within the organization. Ultimately, this system allows the physician medical group to drive patient care, being responsible for the clinical care decisions as opposed to health plan making those decisions as designed in other organizations. This is the preferable model for Medicaid …show more content…
The couple strengths above are some of the primary drivers of how Kaiser Permanente can provide a higher quality of care at a better price. One of the main trajectories being keeping health care costs low for all members. This focuses the awareness on reducing cost, minimizing utilization, keeping members healthy, and increasing member satisfaction. This alignment of all three entities has remained the backbone of the organization leading to a good amount of success that Kaiser Permanente has …show more content…
The strategic plan for 2015 led to a membership growth of 650,000 members. The main internal driver for the astounding growth, being managed care offered at 20% to 25% less than the surrounding competitors (Brooking Institution, 2015). The more membership growth the more profitable Kaiser becomes based managed care system. Kaiser Permanente’s growth can be related to high scores amongst CMS and it’s highly recommended operation structure amongst the healthcare industry. According to the CMS “2016 Star Ratings Fact Sheet,” Kaiser Permanente represents five of 12 medicare health plans (with Parts C and D) that earned 5 stars — and of the 1.6 million beneficiaries enrolled in those 5-star plans nationwide, 81 percent are Kaiser Permanente Medicare members (Kaiser press release). The Kaiser Permanente Medicare plans since 2009 have always been operating at a high performance
Kaiser Permanente (KP) started from manufacturing healthcare for construction, shipyard, and steel mill workers in the late 1930s and 1940s. The healthcare plan was available to the public in October 1945. The ideology behind prepayment healthcare started during the Great Depression with a surgeon and a twelve hospital bed in California. Kaiser Permanente is an integrated managed care group, founded in 1945 by Henry J. Kaiser and physician Sidney Garfield. KP is made up of three distinct groups of body: the Kaiser Health Plan; Kaiser Hospitals; and Permanente Medical Groups. As of 2014, Kaiser Permanente are in eight states and the District of Columbia, and is one of the largest healthcare organizations in the United States. According to the fast fact from its own web site, “Kaiser Permanente has 9.6 million health plan members, 174,415 employees, 17,425 physicians, 38 medical centers, and 618 medical offices. For 2011, the non-profit Kaiser Foundation Health Plan and Kaiser Foundation Hospitals entities reported a $56.4 billion in operating revenues” (Fast Facts about Kaiser
Membership Services (MSD) at Kaiser Permanente used to be a modest department of sixty staff. However, over the past few years the department has doubled in size, creating minor departmental reorganization. In addition the increase of departmental staffing, several challenges became apparent. The changes included primary job function, as well as the introduction of new network system software which slowed down the processes of other departments. These departments included Claims (who pay the bills for service providers outside of the Kaiser Permanente network), and Patient Business Services (who send invoices to members for services received within Kaiser Permanente). Due to the unforeseen challenges created by the system upgrade, it was decided that MSD would process the calls for both of the affected departments. Unfortunately, this created a catastrophic event of MSD receiving numerous phone calls from upset members—who had received bills a year after the service had been provided. The average Monday call volume had risen from 1,800 to 2,600 calls per day. The average handling time for each phone call had risen as well—from an acceptable standard of 5.6 minutes to an unfavorable 7.2 minutes. The department continued to be kept inundated with these types of calls for the two years that these changes have been effect.
Brand Name: Our strong brand name is a major strength of Kaiser Permanente. Although we have do not have many established markets throughout the Southeast, customers, consumers, providers, regulators, and insurers would still recognize the value of Kaiser Permanente. The value associated with our brand name is an easily defendable qualitative factor, so competing organization would have a difficult time overcoming it.
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).
Health Care workers are constantly faced with legal and ethical issues every day during the course of their work. It is important that the health care workers have a clear understanding of these legal and ethical issues that they will face (1). In the case study analysed key legal and ethical issues arise during the initial decision-making of the incident, when the second ambulance crew arrived, throughout the treatment and during the transfer of patient to the hospital. The ethical issues in this case can be described as what the paramedic believes is the right thing to do for the patient and the legal issues control what the law describes that the paramedic should do in this situation (2, 3). It is therefore important that paramedics also
The health care organization with which I am familiar and involved is Kaiser Permanente where I work as an Emergency Room Registered Nurse and later promoted to management. Kaiser Permanente was founded in 1945, is the nation’s largest not-for-profit health plan, serving 9.1 million members, with headquarters in Oakland, California. At Kaiser Permanente, physicians are responsible for medical decisions, continuously developing and refining medical practices to ensure that care is delivered in the most effective manner possible. Kaiser Permanente combines a nonprofit insurance plan with its own hospitals and clinics, is the kind of holistic health system that President Obama’s health care law encourages. It still operates in a half-dozen states from Maryland to Hawaii and is looking to expand...
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.
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.
Kaiser Permanente was founded in 1945. It is known as one of America’s top health care providers and not-for-profit health plans. Kaiser Permanente presently serves 11.8 million members in eight states and the District of Columbia. The Permanente Medical Groups, which deliver care to Kaiser Permanente members, constantly progress and improve medical practices to guarantee that care is rendered in the most competent and effective way possible. This is one of the many reasons why Kaiser’s hospitals and health programs are consistently considered as some of the finest in the nation with outstanding clinical, care and member gratification evaluation. Ultimately, Kaiser Permanente exists to provide high-quality, affordable health care services and to improve the health of its members and the communities they serve, as per the organization’s mission statement. This mission statement gives people an idea of Kaiser’s images of greater collaboration with people to help them prosper and create communities that are
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.
The concept of Health Insurance and managed health care the inventions of the twentieth century that were started as prepaid health care. The early insurance concept was merely a way for people to pay medical bills not a way of protecting individual financial assets as the case is today. Overall the health care industry has endured significant changes since its inception.
The Triple Aim Initiatives measures success by encouraging participants to adopt robust measures of outcome in achieving each three aims: population health, patient experience, and per capita cost of care (McCarthy & Klein, 2010). There is also five principles that organizations need to use when developing their new type of care: (1) Involve both individuals and families in the design of the new healthcare model; (2) Restructure primary care services to better serve the population; (3) Enhance both disease prevention and health promotion services; (4) Develop a cost-control program that helps saves money per capital for health care; and (5) Create a support system (McCarthy & Klein,
For patients, when ACOs are fully functional they represent an increase in patient experience in several ways. First ACOs allow open communication between physicians from different specialties coordinating together to determine solutions. Second, ACOs also establish a single point of contact for all questions concerning care. Finally, these organizations represent a centralized network of physicians for the patient, creating a team to deliver comprehensive care. In fact, there is mounting evidence that suggests the potential benefits of care coordination in ACOs for both patient experience and quality, including reduced hospital admissions, improved quality of chronic disease management, improved patient satisfaction, and better access to specialty care (Stille, 2005). For providers, ACOs provide an opportunity for better collaboration on the various modalities they use on their patients, as well as improved workflow and communication. There are several stakeholders in which the large scale implementation of ACOs would affect. Federal and state government health insurance programs like Medicaid and Medicare, one type of stakeholders. With the implementation of ACOs and the shared savings model, Medicaid and Medicare now have a financial incentive to partner with healthcare organizations to deliver better outcomes at lower costs. If done correctly, Medicaid and Medicare stand to save large
Competitive advantage matters greatly to those responsible for the management of healthcare institutions. Together with rapidly escalating healthcare costs, increasingly complex medical technologies, and growing regulatory and legal pressures, healthcare organizations face a critical need to improve the quality of care at reduced costs (Cu...
Managed health care actually combines health care delivery with the financing of services provided. This was intended to replace conventional fee-for service plans with much more affordable quality of care to the health consumers as well as the providers who was in agreement with the restrictions. However, managed care is becoming challenged due to the growth of consumer-directed health plans, which defines employer continuations and asking employees to be more responsible within their health care decisions and cost-sharing. The Americans health care system has been changing the way their health care services are organized and delivered. As seen by the movement from traditional fee-for-service systems to managed care networks. Ranging from structured staff model HMOs to the lesser structured preferred provider organizations (PPO). Statistics show that 60 million Americans are enrolled with some type of managed care program within the response to regulatory initiatives which affect health care cost and quality. Managed care organizations are responsible for the health of their enrollees, which can be administered by a physician’s group, health system, or even a hospital. Much of the managed care financing is through a method called capitation, and the enrollees are assigned to a select primary care provider, which serves as a gatekeeper.