Introduction 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. The Claims and Patient Business Services departments have made remarkable strides on getting back on track due to these changes, which has provided much needed relief to the MSD. However, MSD is still struggling, on the other hand, with a few issues such as high absenteeism and low morale which makes it difficult to balance available staff with incoming call load. There are also a few factions that are often found socializing in other people’s cubicles or going to the lobby to take personal phone calls. Lastly, there has also been difficulty within the management team as a result of both past and future management styles within the department. Data Collection/Observation Information and facts in relation to ‘Organizational Culture’ were gathered by a personal interview with Erica Mettert (a Team 15/85 member and Kaiser Permanente Membership Services Supervisor). Information and facts regarding potential concerns and/or issues within the department were attained through personal interviews with present and former Membership Services staff members. Ms. Mettert has six years tenure with Kaiser Permanente, four of which are with the MSD. 1. Interviews The interviewees varied in responsibility from supervisors, to call center representatives, to former employees, and were carried out via phone, email, and face-to-face.
Kaiser Permanente’s mission is to provide care assistance to those in need. As a health maintenance organization, Kaiser Permanente provides preventive care such as prenatal care, immunizations, diagnostics, hospital medical and pharmacy services. Also, they take responsibility and provide exceptional training for their future health professionals for better clinical performance and treatment for the patients. The organization is to ensure fair and proper treatment towards their employees for a pleasant working environment in hospital and to provide medical services especially in a growing population in suburban communities, such as Tracy and Stockton in California.
SGH has been plagued with patient quality issues, therefore SGH finds itself in a situation which is inherently antithetical to the mission of the hospital. The costs of healthcare continue to rise at an alarming rate, and hospital boards are experiencing increased scrutiny in their ability, and role, in ensuring patient quality (Millar, Freeman, & Mannion, 2015). Many internal actors are involved in patient quality, from the physicians, nurses, pharmacists and IT administrators, creating a complex internal system. When IT projects, such as the CPOE initiative fail, the project team members, and the organization as a whole, may experience negative emotions that impede the ability to learn from the experience (Shepherd, Patzelt, & Wolfe, 2011). The SGH executive management team must refocus the organization on the primary goal of patient
....S and overseas to supplement the care provided to the growing beneficiary population in the MTFs. The MTF is the primary health care facility for TRICARE. TRICARE PCP shortage is due to deployment to war zones, humanitarian missions and special combat skill training. Throughout the research, attempts will be made to respond to the primary question and then the other sub questions in relation to; TRICARE background history, epidemiology, physician types, administration, policies and law, finance, personnel, marketing, ethical issues, beneficiary complaints and satisfaction. Other areas include the role restructuring plays in resolving the beneficiary complaints and the impact the restructuring of TRICARE will have on health care delivery to beneficiaries. The summary, recommendations and conclusion will be addressed finally to complete this research paper.
The Crowded Clinic: Critical Analysis The Crowded Clinic Case Study (Colorado State University - Global, n.d.) discusses the issues of practice management as they apply to access to care. Access to care may be as inconvenient as lengthy patient wait times to issues far more serious that may have a profound effect on the health and well-being of a single patient or an entire cohort. In order to properly address the issue and look for a remedy, it is necessary to understand the underlying conditions that create the problem before creating the means to manage the change required to correct the problem. The Crowded Clinic has multiple issues, including social and operational, which are creating the associated inaccessibility to services.
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.
“KP is the largest non-profit health care delivery system in the United States, and operates in 8 states and the District of Columbia. KP is made up of 3 entities: the Kaiser Foundation Health Plan (KFHP), Kaiser Foundation Hospitals (KFH), and the regional Permanente Medical Groups,” (Selevan, Kindermann, Pines, and Fields (2015). Selevan al et (2015) state that the members of Kaiser Permanente can be compared to other insurance companies in regards to age, race, and employment status, although the members are known to have lower income levels. Additionally, they found that Kaiser Permanente’s model of care focuses on improving the health of patients, promoting population
University Medical has decided to create a new scheduling process within their organization. They are planning to centralize their scheduling calls so they come into a single, centralized call center. The call center will be responsible for all scheduling phone calls, as well as verifying registration and eligibility for those scheduling appointments. University Medical will be using their current resources and moving one secretary to the position of a full time operator, and the remaining secretaries and triage nurse will rotate between working in the call center and their current specialty cluster.
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
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 region’s labor market is already tightening, as a result of which competition for skilled healthcare professionals is increasing. Kaiser Permanente would have to compete with the existing hospitals in recruiting and retaining qualified management and staff personnel responsible for the day-to-day operations of each of its hospitals and physician practices, including nurses and other non-physician healthcare professionals. The scarcity of nurses and other medical support personnel in the region presents a significant operating issue. This shortage may require Kaiser Permanente to enhance wages and benefits to recruit and retain nurses and other medical support personnel, recruit personnel from foreign countries, and hire more expensive temporary personnel. Competition for skilled healthcare professionals may lead to a further increase in Kaiser Permanente’s wage
Thank you for providing me with the conditional offer for the Deputy Assessor position with the City of Southfield. I have reviewed the offer and have a couple of questions as follows:
•Under certain circumstances, yes, a life insurance policy may be taken by Medicaid to cover expenses following the death of the Medicaid recipient.
Barton, P.L. (2010). Understanding the U.S. health services system. (4th ed). Chicago, IL: Health Administration Press.
With regard to the healthcare organization, it is essential to develop a strategic plan and a clear vision so that the patient focused care will be at par with the organizational process that is conducted operationally and on a daily basis. SSM Health Care has its call letters for meetings standardized at all their sites as part of its protocol. Its values and missions are attached to its call letter for meetings as constant reminders for their staff. Indirectly, this approach helps in translating our vision on how people should behave at SSM Health Care.
Origin : It idea began 1964 by Hugh Chamberlen. It started with accident insurance which later covered disability insurance and gradually have taken the present form of medical and health Insurance. Under this apart from above medical cost are covered for illness including operations, bills for medicines.