Benefits Of Integrated Managed Care

Managed care dominates health care in the United States. It is any health care delivery system that combines the functions of health insurance and the actual delivery of care, where costs and utilization of services are controlled by methods such as gatekeeping, case management, and utilization review. Different types of managed care plans came into development by three major factors. These factors include choice of providers, different ways of arranging the delivery of services, and payment and risk sharing. Types of managed care organizations include Health Maintenance Organizations (HMOs) which consist of five common models that differ according to how the HMO is related to the participating physicians, Preferred Provider Organizations

As a managed care organization Kaiser Permanente has served as a model for informational healthcare systems and the recent demand for affordable care has prompted the organization to lower cost in services without hindering the quality of care. Kaiser Permanente has integrated a system in which the organization assumes all financial risk and a bundled enrollment fee for service strategy. What makes Kaiser Permanente unique from other HMOs is their accountability for quality, utilization management, financial risk, and business strategies (Kaiser Permanente, 2009).

Kaiser Permanente is a large health care delivery system that serves over eight million individuals across nine states, and the District of Columbia. In 1990 Kaiser Permanente developed a internet patient portal, KP Online. KP Online enabled members to make appointments, request prescription refills, seek clinical advice, obtain health care information, and interact with patients in forums.

Vertically integrated health care system that I have chosen is the Veterans Administration (VA) it's accountable for a large patient population for military veterans. As stated, The Veterans Health Administration is America’s largest integrated health care system with over 1,700 sites of care, serving 8.76 million Veterans each year (VA.GOV). The services that's provided to veterans is health care, rehabilitation, employment, education, home loan guaranties, and life insurance coverage. VA control costs by buying in bulk and control costs by engaging in a deep, single-source relationship with each patient. The Assistant Secretary for Management oversees all resource requirements, development and implementation of agency performance measures,

“An Integrated Physician Model is the result of a series of partnership between hospitals and physician develop overtime” (Harrison, 2016). Primarily, it is a joint venture that has become many joint ventures. In addition, all of this joint ventures are connected through congruent goals, and that is to provide different level of care to all the patients. Integrated physician model also organizing themselves to improve the cost and quality by operating under a clinical guideline. This could include acute care hospital, home care, nursing homes, affiliated medical group, primary care clinics, employed physician and any independent medical groups.

The integrated physician model plays a key role in healthcare. This paper will explore what the integrated physician model is, as well as why clinical integration is important in the strategic planning process. Accountable care organizations will be assessed based on their dynamics and controversies. Finally, an in-depth look at one of the integrated physician models (the hospitalist model) will be assessed for its advantages and disadvantages.

Managed care in simple can be defined as an organized approach to delivering healthcare services in an efficient way to enrolled members by negotiation of prices and payments with the providers. Managed care is one of the dominant influence that as transformed the healthcare delivery system in the United States since the 1990s. Managed care has two different contexts to it.

In the article “Ten Strategies To Lower Costs, Improve Quality, And Engage Patients: The View From Leading Health System CEOs” discusses the results following the implantation of strategies that aim to decrease the cost of care and increase its quality to satisfy both patients and health care organizations. The authors in order- as listed in article- are: Delos M. Cosgrove, Michael Fisher, Patricia Gabow, Gary Gottlieb, George C. Halvorson, Brent C. James, Gary S. Kaplan, Jonathan B. Perlin, Robert Petzel, Glenn D. Steele and John S. Toussaint. The authors are executives of several leading health care delivery institutions which include: Cleveland Clinic, Cincinnati Children’s Hospital Medical Center, Denver Health and Hospital Authority, Partners HealthCare, Kaiser Permanente (which is the

This article is about today’s healthcare marketplace have broad demand for greater value in healthcare face two obligations according to HFMA survey. Those obligations consist of reducing costs for existing services, optimizing the efficiency with which those services are delivered and develop the infrastructure and capabilities required to thrive in the emerging value-based payment and care delivery environment (HFMA 2015). HFMA research seeks to understand the challenge organizations face today is not simply to contain costs, but rather to reconfigure cost structure so that spending reductions in one area can free up resources needed for new investments in another (HFMA 2015). Dan Piro, president of MedAssets Advisory Solutions, notes:

Thus, Kaiser Permanente is working in a rapidly changing health care environment that requires constant change. Their mission is to provide high quality, affordable health care services and to improve the health of their members and the communities they serve (KP, 2016a). Their vision states they are trusted partners in total health, collaborating with people to help them thrive, and creating communities that are among the healthiest in the nation (KP, 2016a). Therefore, advancing the mission on affordability will help them achieve their main goals, to perform, grow, and lead while keeping affordability at the center (Kaiser Permanente, personal communication, February 2015). First, drive performance in care, quality, and service at a lower cost, enabled by their people, places, and technology. Second, pursue core and new growth with an increasing focus on consumers. Third, lead national health care change through expertise, trust, and

To form and operate integrated health care delivery systems successfully requires a great deal of commitment, leadership, and business savvy and can pose major challenges to even the most experienced health care executives. Health care providers integrate for many reasons. From the insurance and liability perspective, risk financing for these entities has also been integrated.

One of the goals in managed care in relation to the triple aim is the development of care for individuals that will allow them to expand and thrive. “In the aggregate, we call those goals the “Triple Aim”: improving the individual experience of care; improving the health of populations; and reducing the per capita costs of care for populations,” (Berwick, Nolan, & Wittington, 2008, p. 759). By balancing this form of an advanced system the society would see a continual improve the cost impact of managed care.

The rapid growth of managed care is the response to limited financial resources and the demand for healthcare services to be affordable. Economic viability is a crucial aspect of health care. Managed care plans were developed to provided health care services, but also to be a method to collect payment for services. There are different types of managed care plans. For example, health maintenance organization (HMO), preferred provider organization (PPO), and point-of-service (POS) plans. For brevity of this paper the HMO managed care system will be discussed along with the relevance of the role of the advance practitioner practicing in HMO setting.

With the implementation of the EHRs, patients in the community can have access to their personal health records (PHR). They can have direct access to functions such as secure messaging with health care providers, medication refills, and appointment scheduling. The patient controls their PHR and has the discretion to permit numerous people to have access and data adding privileges. Access to patient’s medical record takes seconds compare to taking days with having paper records. Another thing is that patients do not have to carry a list of the medications they take. Once entered into the system, the record is there.

integrated health care systems and group purchasing organizations. It takes on the financial risk of owning and