Case Study : Partners Healthcare Systems

Name the four basic functional components of the US healthcare delivery system. What role does each play in the delivery of health care?

A powerful force for change can be created by embracing transparency. According to the Department of Health and Human Services, “transparency is a broad-scale initiative enabling consumers to compare quality and the price of health care services so they can make their own informative choices among doctors and hospitals. This initiative is laying the foundation for pooling and analyzing information about procedures, hospitals and physicians services. In order to create value driven health care, there are four steps to turn raw data into

To understand this process better, a case study will be referenced as a basis of the discussion of the paper. The study that will be utilized follows a multi-phase implementation of a program to change how to increase the Triple Aims within healthcare systems to deliver services within the community. The 2007 study was designed to evaluate how organizations could improve the quality, access, and reliability of care while being cost effective in providing healthcare services to the community (McCarthy & Klein, 2010). By identifying issues that impede providing these three elements, healthcare providers and organizations can utilize resources to address the issues and improve the patient’s health (McCarthy & Klein, 2010). Organizations can make a positive

The Basic Health program could be structure in several ways. It could expand programs such as Medicaid and CHIP and contract with managed care plans on behalf of its Medicaid and CHIP beneficiaries outside the private insurance market. These changes would allow both programs to continue as a "separate program with a separate financing mechanism and risk pool from that of Medicaid and CHIP, but would leverage the state's existing infrastructure for information technology, contracting, rate setting, and other function" (Angeles, 2012). Alternatively, a state could expand the Medicaid managed care by increasing the number and types of service through different network of providers, other than those that serve Medicaid and CHIP beneficiaries (Angeles,

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

Transitioning to this model is not as easy as it seems. Businesses such as hospitals will have to educate all health care workers on the foundations of a value based care system so that the highest quality of care is obtained for each patient and a satisfactory rate of patient outcomes are optimized. Health care providers may have trouble transitioning because there not used to being rewarded off patients outcomes, but rather off increasing revenue by preforming as many procedures as possible, some not even under the scope of evidenced based practice and medicine. Smaller

Partners is a little more than three years into a five year strategic plan of implementing an integrated, electronic health information system that will allow data sharing across the entire Partners network. It replaces disparate systems that are not sustainable and cannot support future healthcare goals (Partners eCare, n.d.b). Unofficially called eCare, the electronic system was designed through intense collaboration with Epic Systems. The design process finished one year ago. The first phase of the rollout is to replace the systems that support the revenue cycle, and then the clinical rollout follows (MGH Hotline, 2014). McLean Hospital is

As the industry continues to move away from some of the Medicare programs that were created during the Obama presidency,  the Centers for Medicare & Medicaid Services (CMS) is also pulling away from specific value-based initiatives, such as mandatory bundled payments. The CMS officially canceled two of the models that were included in the Bundled Payments for Care Improvement (BPCI) Initiative.

In healthcare settings, it often comes up when documentation and information on use of electronic health records are not communicated effectively. The organization and its investors decided to transfer over to a new electronic health record (EHR) system —connecting care across the New England area and the healthcare continuum through three services. This new EHR system would drive results with industry-leading services, from practice management and EHR to population health services. These three services were crucial to industry success and were designed with the following formula: Network+Knowledge+Work=Results. When presenting the new EHR system to physicians, the project team requested the clinical providers ask themselves a few questions as they assessed the transition. A few of the questions that physicians asked themselves include:

Many individual providers are beginning to recognize the benefits of partnering with other organizations to create economies of scale in revenue cycle management and administrative supports for expenses in IT, data collection, quality management, utilization management and back office operational supports (HR, contracting, etc.). Additionally, partnerships are necessary to support clinical integration, performance management and population health management.

As healthcare organizations adapt to the changes due to Healthcare Reform, many organizations are faced challenges with decreasing revenues in relation to the transforming from volume to value-based purchasing that have deteriorated reimbursement payment rates and preventive care that keeps patients healthier while reducing inpatient revenues along with escalating cost to do business due to more compliance cost, and the encouraging of integration through the accountable care organization model. (Brown, Werling, Walker, Burgdorfer & Shields, March 2012). As a result of Healthcare Reform, many organizations have been driven by environmental forces and ongoing trends to consolidate with other healthcare systems to deter the effect of these changes due to the new healthcare laws through the desire of gaining more capital, opportunities for future investments, and to better compete in the healthcare market (Healthcare Financial Management Association, Dec 2016.).

It was in 1977 that the United Healthcare United Health group was founded by Richard Burke. The headquarters of the company are in Minnetonka, Minnesota. This organization works towards the betterment of people's health, it help them in living a healthy life by providing them with the kind of health care that would be best for them. The main focus of United Healthcare which is a major division of the United Health group is to provide the people with better health benefits and coverage.

The best health care systems in the world offer integrated care. Systems like the Mayo Clinic and Geisinger Health System own hospitals and labs and employ all the physicians and nurses a patient is likely to see, so they can easily integrate a patient’s care. In contrast, patients in North Carolina and throughout America typically obtain their care from a variety of independent providers. Health care expenses are paid by a variety of sources including private insurers, employers, the government and patients themselves. But unlike any other state, or even any large geographic area, North Carolina has the capacity to create a “virtually” integrated system, one that can provide the same integrated care but across an entire state. When patients’ transition between providers and health care settings, the result is often poor health outcomes, medical errors and costly duplication of tests and procedures. Through partnerships with other organizations and providers, NCHQA is seeking ways to better coordinate care and address systemic problems that cause dangerous and costly gaps in care. (NCHQA, 2014)

The Fortune 500 company I chose is CVS Health. I chose this for a few different reasons. First, I recently had to visit the Minute Clinic in the CVS store twice within the last month. Secondly, I chose CVS because it is part of the health care initiative and I work for a healthcare company.

Hospitals and health systems in the U.S. are experiencing a remarkable transformation in their business models directed from numerous influences that are projected to ultimately turn the industry around. Pressures include providers troubled with the quantity of services they are responsible for, to providers who concentrate on presenting high-cost services that give emphasis to sustaining healthy populations (Dunn & Becker, 2013).