American Well Case Study

HMOs are usually the least expensive health plans, offer predictable costs for health care, the least administrative paperwork, and cover preventive care (Barsukiewicz, Raffel, & Raffel, 2010). However, HMOs also restrict direct access to specialists by requiring referrals by a PCP, requiring patients to see a provider in the HMO network, and often not covering more costly procedures or care options, because care is managed to control excessive or unnecessary care. Providers gain if they provide less care (Austin & Wetle, 2012). This incentive could affect patient-provider trust.

Rural Americans face the struggle of accessing healthcare, both preventative services and also specialty care, here in America. What is the cause most often? Distance. According to a study conducted by Buzza et al (2011), those surveyed believed that distance was perhaps the most important reason for lack of access to healthcare on a variety of the spectrum to include: routine healthcare, emergency care, specialty care, and in some cases diagnostic services. What the study found was that among other things, improved means of getting to said services would in turn, improve access to healthcare services for rural Americans.

Instead of using the traditional messenger model, the network opted to set up their own fee schedule based on their own analysis without any negotiation between the payers and the physicians. Thus, caused an increase in the cost for the payers and had the consumers believe that this was the way the messenger model worked. Nevertheless, the physicians of the network either did not notice or chose not to question the higher reimbursement rates they received over the years. By withholding information about the process and avoiding negotiations between the physicians and harming the consumers, the network not only harmed the consumers but also used deceiving methods to eliminate competition

Patients in the United States are receiving an elevated level of care that places their needs at the core of each health care visit. As the US adopts the new, patient-centered medical home model (PCMH), the health care system transforms into a community-focused on holistic wellbeing. While making use of existing resources, the addition of technology that enables timely file sharing between practitioners and outreach programs, decreases duplicated processes and creates sustainable improvements to system efficiency (Cliff, 2012). Standardization of data formats and billing practices enables health care providers and insurance companies to make informed decisions that maximize profits (Harbrecht & Latts, 2012), or excess revenues over expenses in nonprofit HCOs. The PCMH establishes an effective, trustful, and

The real problem as pertains to the reimbursement of managed care organizations is that these managed care has had an effect on slowing the rates of growth concerning the costs of hospitals and specialist physicians. For both the hospitals and practitioners, the sources of revenue have been shifted with over 20 percent of the charges being paid from the pocket, others coming from third parties who demand for complex accounting of the charges, lack a pre-authorization process and they can review in a retrospective manner and deny the reimbursement (Furrow et al., 2013). The

PPOs management style has advantages over HMOs as they less restrictive and affords the consumers opportunity to use out of network facilities with prior approval at a cost. PPOs are located in more geographical areas and makes access easier. Subscribers are not stuck with a PCP nor require referrals to see providers outside the network. Consumers file for claims for reimbursement when visit is made to out of network health provider

WellPoint Company is an independent licensee of the Blue Cross and Blue Shield Association (BCBSA) and the association of independent health benefit plans. WellPoint is headquartered in Indianapolis, Indiana and employs 48,200 people (Market Line, 2014). WellPoint’s total revenue was $71,023.5 million in 2013, operating profit was $4,588.2 million and net profit was $2,489.7 million. According to the Market Line (2014) research analysis, WellPoint’s strength is having a broad membership via affiliate medical plans and individual subsidiary plans. Through WellPoint’s deal making legacy in merger and acquisitions and has the potential to increase its portfolio and attract new markets.

Restrictions on originating sites, geographic limitations, constraints on store-and-forward technologies and issues with Medicare reimbursements are just a few of the challenges. In the 114th Congress, Zipnosis was one of 98 organizations to publicly endorse the CONNECT for Health Act (H.R. 4442). With bipartisan support, CONNECT would have facilitated the full integration of telemedicine by removing geographical limitations, providing a federal definition of telemedicine, creating a level playing field for virtual care technologies and expanding Medicare’s telehealth and remote patient monitoring services.

CMS intends to work with BPCI participants to assess the effectiveness of the payment models on improvement of patient care and reduction of the healthcare costs. “All models include provider-led care redesign and enhancements, such as reengineered care pathways using evidence-based medicine, standardized operating protocols, improved care transitions, and care coordination. Awardee Agreements may also include proposals for gainsharing among provider partners.” (Center for Medicare and Medicaid Services,

The conference offers workshops that will clarify changes in the new Medicare policies as well as provide information detailing the supplemental insurance policies available to patients. This training offers a wonderful benefit to North Shore because when all care coordinators are educated about the new Medicare policies and can calculate the correct supplemental insurance plans for each patient, coordinators can recover treatment costs for the clinic. While the total cost to attend this conference is $18,000, this amount pales in comparison to the treatment costs that will be recovered due to the education of the clinic’s patient coordinators. Knowledge of the Medicare changes can help coordinators recover, for the clinic, up to or exceeding $50,000, per patient, in some cases. Therefore this one time cost will reap large returns down the

While the internet and modern EHR technology has undeniably transformed healthcare in the past two decades, the Interstate Medical Licensure Compact will accelerate telemedicine adoption, providing even more opportunities to enhance chronic disease management and improve patient safety. Patients will have access to their specialists without the physical and financial burdens of travel across town, and to other states, when clinically appropriate.

One of these vendors is a company named InterSystems. InterSystems recently launched their next-generation platform, Personal Community, for advanced care coordination. Their vision is to transform healthcare by sharing health information and connecting communities on a single platform (Intersystem, 2015). While similarities exist between the Personal Community system and a patient portal, what makes the Personal Community system unique is that the application can be placed across several different healthcare systems. Another vendor in the community platform market is a company called HealthyCircles. HealthyCircles created a product called Engage that can also be placed across multiple healthcare systems and can help organizations drive patient engagement by organizing communications and information more effectively than a traditional patient portal and provides the ability to measure health outcomes. They do this by using tools and equipment that transmit information to the portal, sometimes from the patient’s house, to monitor conditions and spot trends. This connected solution can offer recommended solutions to the patient’s case manager and help coordinate the patient’s new care plan to the entire care team (HealthyCircles,

A patient centered medical home (PCMH) could integrate patient care. A patient centered medial home is a team of healthcare providers coming together to improve the health of a specific population. A PCMH is designed to integrate primary care and specialists into improve care coordination, safety and quality.(Stange, et al 2010) A PCMH would also improve physician training and development to provide a commitment to treat the whole patient, rather than just one part.(Stange, et al 2010) Healthcare fragmentation can also be limited through improved communication between providers using e-mail and social media tools such as facebook and twitter.

Often the biggest barriers to accessing healthcare are cost and location. Lower income individuals just do not have the resources to have optimal healthcare, or cannot take the time away from employment to deal with health issues. One potential solution to help with these problems could be “telehealth.” Telehealth allows a lower level healthcare practitioner to communicate with a physician or specialists when necessary. Remote rural areas use a Physician Assistant or a Nurse Practitioner on location in remote areas.

AMERICAN WELL NEW MARKET OPPORTUNITIES The various market opportunities for American well are listed as per the priority  Online Kiosk: The patients can enter their preliminary information on the Hospitals Kiosks instead of waiting idle. The information that shared can be useful to the doctors on narrowing down the symptoms and treatment. There by increasing the efficiency of the physician and better treatment for patients  International Expansion: American well can expand the concept of E care over the horizon there by providing healthcare facilities to remote destinations and catering to international markets. Since healthcare industry is most prominent throughout the world Expanding would better investments  Online Pharmacy: The digitalizing pharmacy is trivial as many will have questions on how to take medicines its side effects due to the social stigma associated most of them just keep quiet to take the prescribed medicine and then come