Perpetual Mercy Hospital Case

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

Say you’re a rural Midwestern farmer in bed recovering from a major illness at your local hospital. It’s time for nurse’s check in, but there’s no knock on the door.

#1 With no change in volume (utilization), is the clinic projected to make a profit?

Pate Memorial Hospital is a 600-bed, independent, not-for-profit, self-supporting hospitals. PHC, an ambulatory health care facility, was opened by PMH. Sherri Worth, a new assistant administrator of Pate Memorial Hospital in charge of the PHC, was told that a firm plan establishes a clinic five blocks north of PHC. It is a big competitor for PHC. On the other hand, financial problems, Short service hours, long waiting time and lacking of gynecological services are all be the problem faced by Worth. Therefore, Sherri was requested to analyze the PHC’s performance and take Medcenter, a possible competitor, into consideration which either did or not opens a clinic in north.

The individuals who utilize UPMC Mercy’s medical detoxification treatment represent a population of diverse educational attainment with chronic addiction and comorbid disorders. However, most of the patients’ socioeconomic status falls between the middle class or lower class. The age of participants ranged from 24 to 65 years. The bulk of admitted patients receives behavioral health care coverage through the Affordable Care Act health care marketplace or the private health care system.

There are different types of insurance plans that will meet the different needs of the consumer. The different plan types will provide various levels of coverage for care that consumers can get in and out of the plans network of doctors, hospitals, pharmacies, and other medical service providers. Prudential (my choice to discuss) sold its HMO, preferred-provider organization, indemnity health and dental line to Aetna, making Aetna that largest managed care company (managed care, 1999).

Some people may feel that HMOs have become more involved with insurance and less involved with health care assistance. The government attempt to decrease health care expenses has caused major regulatory changes of the market in health care. Managed care was seen as an effective way to support health care quality while maintaining costs here in the United States. When expectation for limited expenses faded away payors started looking in other directions. That’s when state government turned to managed care as a way of keeping down the cost with less resources available than the federal government. The growth of managed care in the U.S. was sparked by the interest in improving the organization of health care and their outcomes. Managed care will continue to face the everyday challenges of fulfilling the marketplace for less limited care while holding down the

The name of the CPO or designee. Briefly describe the individual’s background and formal training.

Medical Mercy Canada (MMC) is a non-religious, non-partisan registered Canadian volunteer organization. The organization provides support to impoverished persons and refugees along the Burmese borders, Nepal and Ukraine. Since 1991, MMC has extended its service to medical assistance, education, supplies and funds for local initiatives to facilitate self-sufficiency. MMC is established with a vision to create healthy communities by caring for and sharing with those in need. The mission is to improve the quality of life in impoverished areas through humanitarian projects with local participation. And, the purpose is to provide education, health care, knowledge and skills to refugees along the Burmese borders and impoverished villagers in Ukraine

From 1991 going forward, the health care environment again experienced fundamental changes as a result of the deregulation of hospitals which according to Ingols and Brem (as cited in Swayne, Duncan, and Ginter, 2006) was occurring for the first time in a decade. According to the authors, the impact of the move was immediate. Following the deregulation, the financial viability of most hospitals was

To start off this journey, you need a little background. Life didn’t make much sense when I was a kid. There was lots of abuse and not so much fun. This all led to a place called Mercy Ministries and that is where this journey begins.

Among hospital attributes from the AHA Annual Survey, this study controlled for hospital ownership, teaching status, and system/network affiliation. The AHA Annual Survey identifies four types of hospital ownership: 1) government, nonfederal; 2) nongovernment, not-for-profit; 3) investor-owned, for-profit; and 4) government, federal. This study defined hospital ownership types as private not-for-profit, private for-profit, and public hospitals. Teaching hospital was defined as an affiliated member hospital of the Council of Teaching Hospitals and Health Systems (COTH). As previously described, types of system affiliation are defined as centralized health physician insurance health system (CHPIHS), moderately centralized health system (MCHS), decentralized health system (DHS), and independent health system (IHS). The reference group of the health system/network variable is independent hospitals, which do not belong to any system or

Specifically, since opening DHC has found from the information gathered from surveys completed by the patient’s visiting, that their concerns lay in three areas related to service: service hours, services offered, and waiting time. In addition, patients consider whether the hospitals or clinics is convenience, has a good reputation, will accept their insurance coverage, and most importantly on the experiences of their family members and friends. (Seattle Times, Newsource)

The term Health Maintenance Organization (HMO) was developed in 1970 as part of the Nixon Administration to promote the growth of prepaid plans as a way to improve the nation’s health system. The Health Maintenance Organization has an appearance on the outside of being very appealing to those with little money to spend on insurance because it has a very low premium cost, but the truth be known that sometimes cheaper is not always better. In this paper I will discuss how HMO’s have influenced current healthcare systems.

The significance of community hospitals such as Community Hospital in Monmouth County, New Jersey, is greater than one may expect for primary and secondary care services provided to the local communities around the United States. Community Hospital’s mission is to provide exceptional primary care. However, with the declination of profitability in primary care, Community Hospital has had to compete with Shore University Medical Center (SUMC) and University Hospital (UH) for revenue restoration. The decline of Medicare and Medicaid reimbursements and the steady progression toward specialty care vs. primary care require a core alteration to the mission statement to adjust to the changes within the current healthcare system. A newly modified mission and vision statement will prove that Community Hospital has the ability to regain its relevance within the healthcare industry as a leading primary care provider in the community and increase its revenue. The implementation of the new mission and vision for Community Hospital is expected to be upheld without compromising the core values of compassion, advancement, reputation, efficiency, and physician integration. A few proposed strategies to help Community Hospital create a new and improved business model, may seem cumbersome and challenging, however could greatly improve the overall direction of Community Hospital.