Healthcare Consultant Research Paper

They have a wellness center that offers a broad range of preventative and wellness services to the community and we must find ways to work with them and see where there may be efficiencies that can be capitalized. For this action, I am recommending hiring a managed care contracts manager. Our managed care contracts are over two years old and in need of updating, revising, and renegotiations to secure our relationships with our managed care companies. Furthermore, this also will require investment in a new data management system to collect and report on our utilization and reimbursement information. This expense should be viewed as opportunity to excel and provide reliable data for forecasting future

The healthcare system in America started as a predominantly volunteer system where patients were required to pay little to nothing for treatment. Since it began, the healthcare industry has seen tremendous changes that have transformed it into a business entity which has operations like financial management, strategic planning and functional specialties to keep the industry viable. The industry is one of the largest in the country employing 15 million people with a projected increase of jobs with 3 million jobs annually. As the healthcare industry continues growing, services and personnel are changing, and various dynamics are coming into play to accommodate changes (Smith, Saunders, Stuckhardt, & McGinnis, 2013).

Managed care in the United States will constantly be changing or evolving. This is due to advances in technology, improvements made by the providers and deliverers of the services, new federal and state laws, and a shift towards a performance based system. Managed care will be delivered to the consumer in an affordable, innovative, and reliable manner with an emphasis on quality and accessibility.

Healthcare in the United States has reached a level of complexity which has perplexed Presidents, Congressional members and private industry for over a century (Palmer, 1999). While the healthcare system has evolved over the last century, policy decisions which have attempted to effectuate changes to cost, quality and access have been

The 53 RWHAP Part A recipients reported the total number of service categories funded. The services funded by recipients are divided into two categories: core medical services and supporting services. On average, 22.2 service categories are funded by recipients, including both core medical and supporting services.

|Expanded Coverage for young adults |Employers are required to cover dependents up to|Insured population will increase as well as |

"The California Endowment" founded the venture with a major focus in strategizing for healthcare within a specified framework to improve care for diversified populations. Nicole Reavis, M.Ed., coordinated the project. NICHQ structured a panel of professionals to create a range of potential strategies to improvise, and create community partnerships. Some of the strategies

Due to many changes in health service organizations’ internal and external environment, planning can be sometimes onerous (Longest & Darr, 2008, p. 366). Therefore, a well thought strategic plan will guide leaders and keep them focus on the organization’s mission. In health service organizations, strategic planning is emanated at the top level of the pyramid, then pass down to others in leadership positions (Longest & Darr, 2008, p. 366). A strategic planning process consists of many steps: a situational analysis, external environment analysis, internal environment analysis, strategy formulation, strategic implementation, and strategic control. As mentioned before, health service organization faced many challenges, a strategic planning not only helps with planning, controlling, and decision making, but it also allows management to analyze their strengths and weaknesses, as well as opportunities and threats. Again, the strategic planning process has proven to be effective when implemented by the entire organization.

A health care reform provides more people with health insurance coverage, set up ways consumers can shop for insurance, and provide legal protection for consumers. Health reform builds upon our current health insurance system. Currently, most Americans are required to have health insurance. Other steps include the expansion of Medicaid which allows more people at lowest incomes to qualify and Americans with moderate income who do not qualify for Medicaid gets provided with credits to purchase health insurance coverage. The health reform also, encourages employers that don’t provide health insurance to now provide it. Also, the health reform imposes protections to guard against unreasonable rate increase. If states want to provide protection

Medicare is administrated by the Centers for Medicare and Medicaid Services (CMS). It is divided by subdivisions which is the Center for Medicare Management who overseas development of payment policy and management of fee-for-service contractors. The Center for Beneficiary provides beneficences with information on Medicare programs, and research grievance and appeal functions. The Center for Medicaid and State Operations focuses on federal and state programs like Children’s Health Insurance Program and the Clinical Laboratory Improvement and CMS who enforces insurance portability and transaction and code set requirements of HIPAA.

In the case of the Patient Protection and Affordable Care Act, democrats had observed Bill Clinton’s effort at health care reform and they had also watched republican congress use their strong points of congressional leadership to pass reforms that had previously been put on hold (Beaussier, 2012). The Democratic Congressional Party learned through others that they could use their power of partisanship to vanquish those who opposed the healthcare reform and they did just that. What is meant by this is that at the time of this PPACA bill, the house and the senates was majority ruled by the Democratic Party and were able to vote in favor of the PPACA even with those opposing the bill it wouldn’t be enough to hold it

Manage a health care organization is not an easy task, the compromise with the community to provide an excellent service and the responsibility of keeping the profitability and viability of the organization makes health care management a complex and every day challenging profession. It require effective practices to avoid the failure of the business.

I am a registered architect and project manager with 18 years experience, and have been focused on healthcare projects for last 16 years. I have been involved in acute care general hospitals, outpatient surgery center and medical office building projects of various sizes. I have been responsible for delivering projects from planning to construction and close-out using various project delivery methods including Design Build and Integrated Project Delivery.

A measure of challenges are confronted by the health care service suppliers of the United States. Some of the key challenges are itemized and reviewed below:

In the Harvard Business School case study of Intermountain Health Care (IHC), we learned about the efforts made by IHC to adopt a new strategy for managing health care delivery that is focused on improving care quality while simultaneously saving money. Beginning in 1986 as a series of experiments tying cost outcomes to traditional clinical trials, IHC’s approach to delivering care became known as “Clinical Integration” which “referred to both an organizational structure and a set of tools” (Bohmer, 2002). The organizational structure required a departure from the traditional administrative management model to one that “involved administrative and medical