Case Study: The Unitedhealth Group

The mission of UnitedHealthcare Group is to “help people live healthier lives” with access, quality and affordability. They are committed to continual improvement and the delivery of quality care by investing approximately $3 billion in business process improvements, research development, and technology within the past five years. In addition to reinvesting the revenues in innovative technologies, research and other improvements to better serves its consumers, UnitedHealthcare Group is also committed to social responsibility through employee involvement,

Segmentation and positioning are two important concepts in marketing. While these terms are generally used in relationship to promotional activities, the term segmentation has relevance for market research as well. Segmentation involves dividing the larger universe of consumers or businesses into smaller units that represent more specific target audiences. Positioning is the next step whereby companies determine, based on the segments they have identified, how they can effectively promote what they have to offer compared to competitive offerings and positioning. Effective marketers know that the better they can segment audiences, the more they will be able to develop target messages and select specific

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!

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,

Kaiser Permanente Colorado is proud to offer a program that allows safety net primary care providers to electronically request advice from select Kaiser Permanente specialists. Currently eight speciality departments participate in this program that supports safety net primary care providers, the patients are uninsured and below the federal poverty level.

As we all know Managed Care Organizations (MCOs) have one major goal, and that is to save money. Whether it is by reducing care, incentivizing doctor s or advertising, they are pursuing their goal. In fact, we all know that back in the 70s the rise of healthcare cost pushed this initiative, and that although it has been criticized over the years, it has proven to some extent that it does reduce cost, to the point that Medicaid and Medicare have adopted their model. However, despite all the efforts, healthcare costs continued to rise, and skepticism arose. In fact, it wasn’t long until people were saying that managed care had failed. Furthermore, a new tool was developed

BlueCross BlueShield of Pennsylvania offers health insurance plans such as Medicare, dental, vision, and individual and family insurance. Individual and family plans are distinguished as platinum, gold, silver and bronze plans. Other plans include catastrophe and multi-state plans.

According to McConell (2012), the difference in a leader and a follower determines the success of a person regarding leadership. This chapter helps explain the content of qualities and proficiency for healthcare managers to be effective. Once again, effective management skills or certain qualifications enhance a healthcare organization environment. Healthcare managers and supervisors must have the capacity to handle challenges while the organization objectives and regulations may change over a period of time. Effective healthcare management governs the success of a healthcare organization. There are many different skill sets and leadership styles to be effective as a manager. People are interested in knowing what strategies are effective

1. Managed care plans (PPO/HMO) have had different successes in medicine and dentistry. Explain those differences and why you think they have occurred.

United Healthcare assesses that it services approximately 70 million Americans . Its entire system spans 676,287 physicians and health care professionals, 80,000 dentists and 5,190 hospitals, whilst their pharmaceutical management provides more affordable drugs to 13 million people.

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.

In all of the U.S, United Healthcare is the only health carrier that has been working towards improving the effectiveness as well as quality of healthcare for people belonging to all the various nations. This organization has been trying to make the medicines more accessible to the people who need them; they have been trying to implement the services that could be used by the masses not only in terms of cheaper costs but better accessibility as well.

Under this approach, as an example, United averages on any given day about 27,000 members in an inpatient setting and another 14,000 members receiving services in a skilled nursing facility. These members are managed by 2,000 clinical employees working with attending physicians to achieve optimal quality outcomes and having proper discharge plans in place when members leave the facilities in order to prevent unnecessary readmissions. United also expects to make one million house calls and home visits for its Medicare members aimed at enhancing adherence in care plans and closing care gaps.

As the healthcare industry continues to evolve, it requires people who attain great leadership qualities. The success of an organization depends on employees that can inspire people around them to achieve greatness and deliver quality care to the patients. Being in the healthcare industry, we have seen many changes recently. Therefore, by having a person with leadership qualities to guide others through these changes, while maintaining an organization that can deliver quality care is indispensable.

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.