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Sunnyside HMO: Servicing Ethical Dilemmas

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Introduction Southside HMO serves 495,000 members throughout the eastern region of the United States. Servicing this amount of members means that the company is providing quality health care. Given this amount of volume it is understandable that there will be concerns at times raised from both our providers and the membership. It is essential that all issues and concerns be addressed in a professional, ethical and timely fashion while maintaining the standard of care that our company has built its reputation on.
It has been brought my attention that some of our Sunnyside Hospital affiliated members have filed complaints that their primary care physician issued referrals to designated specialists are not being approved. There are also complaints
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It is also key that we identify if the cause for the issues are a result of a localized facility issue or if it is actually system wide. This task will be accomplished with a client survey or phone call at which time our staff will assure our membership that their health and concerns are our top priority. Going forward it is my recommendation that all future incoming complaints be acknowledged within 24 hours with a statement informing the complainant that their concern will be reviewed and investigated with a formal response or resolution completed within 30 days. It is also understood that depending on the complexity of the complaint an additional 30 days may be required or expedited. In this instance this can only occur with supervisor review and approval.
The providers of Sunnyside Hospital will be contacted next in the form of a series of town hall meetings if hospital space is available or mailers. It is essential that we reassure our participating providers that their service is invaluable and patient care is our priority. We need to be sure that the providers have confidence in the service that our company supplies. We will also reassure the providers that we value their expertise in providing comprehensive patient care and it is our role at Southside HMO to coordinate that care while maintaining costs at an affordable level for
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This educational plan will also be shared with our members and providers by the use of mailers, posters, and inserts.
It is my recommendation that performance measures be instituted as a means to know how to better service both the members and providers. These measures will maintain and ensure the following (Kongstvedt, 2013): Transparency and accountability Quality improvement Education and engagement of consumers Patient safety Research

Summary
With the implementation of the above guidelines, initiatives and protocols we will continue to provide quality health care for our members and assist our providers with the tools needed to give their patients the care required. Our company will continue to be in compliance with all quality management initiatives. Ultimately, our members and providers need to feel our company is not about the bottom line but the people it serves by providing quality
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