Case Study: Heart-Healthy Insurance

This week I began my 6-week internship at Blue Cross Blue Shield of Nebraska (BCBSNE). The first day was a common orientation for all new employees, internally denoted to as the “onboarding process” where all employees are told they matter. This full-day session communicates the core mission, vision and goals of BCBSNE, organizational structure, operating objectives, and workplace culture. BCBSNE is a not-for-profit health insurance company that is focused on collaboration to find the best solution for their customers; in other words, they are customer-focused. Since the implementation of the Affordable Care Act (ACA), many changes to the health insurance market required a change in the organizational structure and culture of BCBSNE. Through partnerships with providers, the goals of BCBSNE are to be responsive, accountable, minimize errors, and decrease costs – all components of the ACA. BCBSNE has strategically aligned their goals to those of the government-mandated goals, and implemented them at all levels of the organization, making them competitive in the health insurance market. I found this very fascinating: I was very excited after day one!

Due to personnel, policy and system changes, and audits, Heart Healthy has voluntarily updated their information security policy to be in-line with the current information security laws and regulations. Currently Heart-Healthy Insurance, a large insurance company, plans to review and provide recommendations for an updated information security policy in the area ‘s of:

Data show that the number of uninsured Americans has greatly reduced over the past 2-3 years. However, prior to the adoption of various provisions of the Affordable Care Act (ACA), there were over 41 million people uninsured in 2013 (Kaiser Family Foundation, 2014). The number of people without health insurance, especially children, has steadily increased throughout most of the past decade. Children without health insurance are more likely to suffer from preventable and treatable illnesses, including their long lasting related effects, than their insured peers (Majerol et al, 2014). Majerol et al. also demonstrate that the uninsured are less likely than those with insurance to receive preventive care and services for major health conditions and chronic diseases.

As Health information system continues to evolve and innovate the healthcare industries, one should be conscious of information security and safety. Kaiser Permanente experiences this dilemma first hand. On August 2000, Kaiser Permanente had a serious security breach that sends out email messages to their patients with another patient’s information. This integrated health delivery system serves over eight million members with appointments, prescription refills, health information, clinical advice and patient forums was breath and nineteen of the member received email messages with private information.

The perspective I have about the recent efforts to help the uninsured in the U.S is it has come a long way towards positive change since the 1950’s till now. The Patient Protection and Affordable Care Act of 2010 (ACA)/ Obama Care, has provided the uninsured with medical insurance and access to reduce the risk of health issue through prevention. The law expands eligibility for public insurance, use of federal subsidies to make private coverage more affordable, new rules on insurers and employers to make coverage more accessible, and require all Americans to have some form of health insurance (Knickman and Kovner, 2015). The outcome of this enactment; 5 million Americans enrolled in state Medicaid programs, 8 million received public subsidies,

On this date worker received a message from Misty Jenkins, social worker for HealthSprings Insurance. She stated Mr. Duncan was not doing well and someone needed to do a safety check on him. Worker returned Ms. Jenkins call, learned Mr. Duncan went to the ER on Friday 2/12/16, and was diagnosed with a UTI. HIs doctor Dr. Brassfield refused to admit Mr. Duncan to the hospital and sent him back to Laurel Gardens (Mr. Duncan was discharged from the hospital on 2/9/16 and returned three days later with a UTI.) Ms. Jenkins believes Mr. Duncan's discharge to Laurel Gardens was a bad discharge from the hospital. Worker explained to Ms. Jenkins that Dr. Brassfield refused to state Mr. Duncan was mentally or physically unable to care for himself. Therefore,

The launch of the Affordable Care Act (ACA) website was a disaster but not surprising at all. Ethics is certainly involved with the development and launch of this new system. ACA aimed to fill gap and provide insurance to the uninsured population. The number of uninsured expected to enroll in health care coverage was understood. The technology was certainly not designed or tested to support the volume and complexities. As a result, the uninsured was bewildered by the faulty website and perhaps lost the confidence of many that the commitment to help the uninsured was simply not well done. The big website technology failure significant hampered the enrollment process and highlighted the need for a thorough analysis prior to implementation

Regence Blue Shield of Washington is a subsidiary of Cambia Health Solutions (formerly the Regence Group) a nonprofit health insurance company founded in 1917. Regence Blue Shield is one of the largest health insurance carriers in the Washington state. Regence offers Employer, Individual and Managed Medicare coverage. In the 2014 Regence Year in Review, they insure over 1 million consumers, have 1,800 employees, and contract with over 34,700 providers in 748 in network facilities. In 2014 Regence Blue Shield was the number 3 Accident and Health Line of Business of the Top 40 Authorized Companies in State of Washington according to the annual report.

Our nation’s current health care expenditures have continuously risen over the past years. This issue has escalated because many Americans do not have health care coverage.

Pharmaceutical companies, insurance agencies, research hospitals, and countless medical practices must take safeguards to secure health information. It’s vital to surviving in our competitive marketplace.

The first task I will be creating a check-list for the numerous procedures that will help secure the network secure, one policy I will be entering in the check-list is password policy. This type of authentication is used in most websites and many organization that requires a password like Facebook, eBay, and websites that as secure data. It can be secure depending on how decent the password is, usually the user-name is the most secure part as its just specific for that user, also for the user to make his or her password secure is by using capital letter, spaces, number and not something the hacker can guess like the same as your user-name or birthdays and your name, also the user can change and updated any time they want, and if you get either

With no health insurance or being underinsured, individuals struggle to afford necessary health care. The Commonwealth Fund, an organization aimed at improving the quality and access to health care, publishes the stories of many uninsured Americans. One story that caught my eye was the experience of Toni; an uninsured 30-year-old woman suffering from fibrocystic breast disease and prediabetes. Toni is a divorced mom raising her two teenage children on a salary of $850/month from her bakery job in the rural Mississippi Delta. Toni was diagnosed with fibrocystic breast disease when she noticed large lumps on her breast, which continue to accumulate. The tumors lead to frequent, painful infections that require a $1,000 antibiotic treatment, which ends up being more than one month’s pay. Additionally, the tumors lead to other uncomfortable symptoms that tend to interfere with her job, such as fluid leak from her breasts and extreme pain. She can have surgery to remove the tumors and reduce her pain, but she cannot afford the surgery without insurance. Also, Toni frequently skips her necessary bi-yearly mammograms and routine care checkups due to the cost. These appointments are important because fibrocystic breast disease puts her at an increased risk for breast cancer. Lastly, Toni has prediabetes,

Health Choice Insurance Co. is a managed care organization which provides health plans beneficial for you, your family or your company. Although the company is based out of Arizona, it is affiliated to IASIS which has its presence in Utah, Texas, Nevada, Louisiana, Colorado, Florida, Arkansas and Arizona. Being a subsidiary of IASIS, Health Choice Insurance Co. provides Medicare as well as Medicaid services in Utah and Arizona area. Being relatively new in this industry, from 1998 Health Choice Insurance Co. have been successful in expanding their network to 19 acute care units and one behavioral hospital in 8 different states such as

previously. My father was severely sick and i wanted to the pharmacy to get his prescription but they refused me because he's healthcare did not coverage for this particular prescription which was way expensive at around$ 450. I spoke to the pharmacist about my father condition.She insisted to give the prescribed and i did not know what to do called several time his healthcare coverage and did not helped me. At the present time i used to lived in Saint Paul Minnesota and one of City council by the name Dai Thao was happend to be there at time. He saw my frustration and Asked me that happened and told him that my father is sever sick and his healthcare is not covering the prescription. He immediately called Healthcare Coverage and told

The Lawrence’s should look for a good health insurance plan that consists of basic coverage for hospital and doctor bills. For example, the plan should offer at least 120 days' hospital room and board in full, provide at least a $1 million lifetime limit for each family member, pay at least 80 percent for out-of-hospital expenses after a yearly deductible of $1,000 per person, or $2,000 per family has been met, it should require no excessive exclusions, and finally the plan should restrain your out-of-pocket expenses to no more than $4,000 to $6,000 per year, apart from dental, optical, and prescription