Blue Cross Blue Shield Essay

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

The healthcare industry consists of many strengths and weaknesses during the improvement of patient safety, efficient operations, reduction of medical errors, and ensuring that they provide timely access to all patient information. This will have to still comply with all legal guidelines as they control costs and protect patient privacy. The adoption of advanced information technology is a popular strategy being used in the healthcare industry because it allows their weaknesses to be progressively diminished as they gain and use the opportunities necessary as an analytical tool. This would allow their capabilities to be further developed with the new technologies and processes used as they unify the adoption of IT standards. In order to stay competitive within the healthcare industry, then there must be specific actions and measures that must be taken to ensure a positive outcome. This includes external opportunities to increase the capability of the IT infrastructure in a national environment as the growth of industry standards are met in order to decrease the pressured threats of legal compliance through patient trust and the high cost of IT. The growing recognition of strategic leadership often leads to both improved financial stability and contact accessibility of the system. Some challenges that may occur within the healthcare system may cause issues in a hospital setting because of the centralized society of an organization. This is because of the different visions and

Throughout the history of the United States, the economics of the health care system has experienced many changes. There are many factors to consider that has been the drive behind many of the changes within the health care system. Medical and surgical technologies are some factors that relate to the changes in health care. Besides these factors, allocating sources to fund health care services has always been the most critical factor. One might consider the economic term supply and demand when looking at the history of health care economics and the primary funding source. Health care funding

Each state has their own policies for Medicaid eligibility, services and payments. Medicaid plans have three eligibility groups such as categorically needy, medically needy and special groups. Children's Health Insurance Program (CHIP) is a program that offers health insurance coverage for uninsured children under Medicaid. If Medicaid does not cover a service, the patient may be billed if the following conditions have been met such as the physician informed the patient before the service was performed that the procedure was not covered by Medicaid and if the patient has signed an Advance beneficiary Notice form. However, there are also conditions where the patient cannot be billed if necessary preauthorization was not obtained or service

Health care costs are a longstanding concern to policymakers. For years, health care spending has been rising faster than the rate of economic growth, raising the question of what factors are responsible for rising health care costs. This paper explores published articles that report results from research conducted on technological innovations in health care and its relation to rising health care costs. The cost increases have a significant effect on households, businesses, and government programs. Health care experts indicates the development and diffusion of medical technology as primary factors in explaining the persistent

Texas has the largest uninsured population with an estimated 6.2 million uninsured citizens within its stateliness, approximately a quarter of the statewide population (Rapoport, 2012). In 2012, then governor, Rick Perry decided that Texas would not expand Medicaid under the Affordable Care Act (ACA). This decision led to much debate over whether or not Perry made the right decision to leave upwards of a million Texans, who did not receive insurance subsidies and did not qualify for Medicaid, uninsured. These Texans fell under what many politicians refer to as the “coverage gap.” Texas decided not to expand Medicaid under the Affordable Care Act because of the effects it would have on hospitals, financial reasons, and increased number of

In healthcare system the highest quality medical care means” the greatest benefit to patients at the lowest possible cost” (Burke & Ryan, 2014, p. 3). “The Agency for Healthcare Research and Quality (AHRQ) defines quality health care as doing the right thing for the right patient, at the right time, in the right way to achieve the best possible results” (NCQA, p. 3) According to American college of physicians, the single most reason for the health care cost is higher healthcare spending. There are several factors involved in the high health care cost such as inappropriate use of technologies, lack of patient centered care, overuse of the reimbursement, excessive price for health care facilities, increased organizational cost, and health accountability are some of the reasons for increased health care cost. In order to decrease the cost, the available health resources be used judiciously and equitably. Understanding these factors and identifying the potential factors of health care costs assists in providing quality and effective services and thus improves the health outcomes (ACP, 2009).

Competition between providers has caused physicians and hospitals to offer the most current healthcare technologies and modern, eye-catching settings has contributed to increasing healthcare costs, as well as providing unwarranted highly technical services (Shi & Singh, 2015). Renovations of the physical settings and the acquisition of expensive technologies elevated healthcare services prices to cover the additional costs of providing high technical services and attracting clients.

Blue Cross Blue Shield of Michigan prides itself on the company’s espoused values; Act Now, Reach Out, Own It, Let’s Talk, Be Radical, Embrace Lean & Be Aligned. These values are plastered around the company including the backs of our ID badges and are referred to as our company’s seven cultural beliefs. Act Now means I commit each day to act with urgency to beat the competition. Reach Out means I build partnerships across the enterprise to achieve outstanding corporate results. Own It mean I take accountability for our results and constantly ask “what else can I do”. Let’s Talk means I see, listen, and share to foster an open and honest exchange. Be Radical means I implement innovative solutions for stakeholders as part of my daily work. Embrace Lean means I beat the competition by maximizing efficiency – being leaner, faster, and better every day. Lastly Be Aligned means my daily actions align with, and focus on, achieving corporate results. These values are how the company see’s us succeeding in the future and most managers try to follow these values.

Trends indicate the administrative complexity in the U.S. health care system requires that American hospitals employ far larger staffs to handle billing requirements (Anderson & Squires, p. 1-2). Furthermore, despite enormous innovation and investments in technology, the U.S. is failing to achieve improvements in life expectancy. The return on investment has been low; therefore, examination into other methods to increase quality of care, and decrease costs has become compelling. The U.S. has known for quite some time that health care costs, and therefore spending have gotten out of control. There have been several Presidents who have unsuccessfully attempted to help alleviate the nation of this issue. However, with the implementation of the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, we have begun to notice a positive trend, in the said decline in spending. There have been methods implemented to begin helping providers and organizations monitor their progress, reward them for proper adherence, and now there are

Medical technology encompasses a wide range of healthcare products and is used to diagnose, monitor, and treat diseases or medical conditions that affect humans. This may included but not limited too, pharmaceuticals, vaccines, and medical equipment. Such technologies are intended to improve the quality of healthcare delivered through earlier diagnosis, less invasive treatment options and reductions in hospital stays and rehabilitation times. Recent advances in medical technology have also focused on cost reduction. Medical technology may include medical devices, information technology, biotech, and healthcare services. The impacts of medical technology may involve social and ethical issues. For example physicians may seek objective information from technology rather than listening to subjective patient reports. A major contributor of healthcare expenditure in America is the advancement of medical technology. According to several studies it is shown that there is a correlation between the nation’s gross domestic product (GDP) and money allocated to healthcare. One of the leading theories is that medical technology is growing faster than expected.

The health care industry is one of the most dynamic and delicate industries in the U.S. having experienced healthy and substantial changes for the last thirty years most of which have aimed to improve health care management and services delivery to the patients. The changes have enabled the integration of technology into the industry such as in the area of informatics, science and research and payment services and clinical treatments. The health care sector has introduced various changes to address disease and health care management such as the Modernization Act of 2003, the Patient Protection Act and Affordable Act, which aim at improving health provision and most

As it relates to the textbook, this describes some of the scope of the hospitals; which refers to the range of activities which the firm performs internally, the breadth of its product and service offerings, the extent of its geographic market and its mix of businesses. But unlike with the electric company, no regulator caps hospital profits. To the extent that author Steven Brill found any consistency among hospital charge-master practices, this is one of them: hospitals routinely seem to charge 2V2 times what expensive implantable devices cost them, which produces that 150% profit margin.

Information and communication technology has been adopted and implemented within various sectors of the economy. This is attributed to the benefits of technology in facilitating organizational activities and processes and its use in meeting the changes which characterize the modern society. The health sector is one of the industries which have significantly implemented technology. The health sector’s technological applications have been achieved within health information systems. The implementation of technology in this sector has resulted into both positive and negative implications on health

UnitedHealth Group is a diversified health care company, and a worldwide leader in helping people live healthier lives and taking the necessary steps in making the health system work better for everyone. The UnitedHealth group serves more than 85 million individuals worldwide with health benefits and services. In 2012, they produced revenues of $110.6 billion and were ranked number 17 in the Fortune 500. The economic and political segments would rank the highest in influencing the UnitedHealth Group.