The Burke-Litwin Model: Medicaid Case Analysis

Policy analysis is an assessment of specific healthcare policy to determine its effectiveness in improving patient care outcomes. As an organization continues to grow in complexity; health status indicators provided gauges for process to be assessed and evaluated for restructuring. This provides new opportunities for evaluating policies, guidelines and procedures that enhances patient care to benefit all stakeholders. Transformational leaders are healthcare professionals whose knowledge and experience are required when policies analysis is needed that may require examination, designing, implementation, and evaluation for a practice change. In healthcare systems globally, transformational leaders are task with

Duke University Children's Hospital was facing a financial crisis in 1996 that required turnaround and transformation in order for the hospital to survive (Spector, 2013). On top of the financial crisis, caused by decreased Medicaid allowances and an increase in capitated reimbursement patients, patient and staff satisfaction had reached an all-time low (Spector, 2013). The hospital's chief medical director, Jon Meliones, understood that the hospital could only do so much to control their financial outcomes and a united front would be needed to bring about effective and impactful change (Spector, 2013).

In 1997 University of California, San Francisco (UCSF) merged its two public hospitals with Stanford’s two private hospitals. The two separate entities merged together to create a not-for-profit organization titled UCSF Stanford Health Care. The merger between the health systems at UCSF and Stanford seemed like a good idea due to the similar missions, proximity of institutions, increased financial pressure with cutbacks in Medicare reimbursements followed by a dramatic increase in managed care organizations. The first year UCSF Stanford Health Care produced a profit of $22 million, however three years later the health system had lost a total of $176 million (“UCSF-Stanford Merger,” n.d.). The first part of this paper will address reasons

The Affordable Care Act was put in place by President Obama in 2010, providing Americans access to affordable health insurance. But South Carolina’s governor, the republican Nikki Haley is still rejecting the Medicaid expansion. My paper has detailed information on why Governor Haley and republicans made their decision to opt out of the expansion. Also, alternate approaches to expanding access to care and implementing or reconsidering the state’s decision of opting out of the expansion. Finally, recommendations to the state legislature to convey opting out of Medicaid expansion.

The new law added to a per-existing hospital provider tax, which lawmakers love because it leverages federal matching funds that help pay for the state's Medicaid program. Critics objected to the increase because it added a new tax on health insurance.

In the state of Texas Medicaid is funded by state and federal programs. Those eligible to receive Medicare benefit is the low income individuals, families, children, pregnant women, elderly and individuals who suffer with disabilities (Hegar). The Texas Health and Human Service commission (HHSC) distributes the Medicaid (Hegar). Those receiving Medicaid benefits in the fiscal year of 2010 were found to be 55 percent female and 77 percent under the age of 21 (Hegar). Children accounted for 66 percent of all Texas Medicaid recipients in that year; however, 32 percent of those children actually received health care (Hegar).

Following the death of a Medicaid recipient, the program not only can but must attempt to recover costs from the estate of the deceased. Medicaid's official site says:

Texas ranks number one with the highest uninsured rate in the nation, accounting for nearly 6 million people (1). The federal government has nearly $100 billion for Medicaid expansion, out of which $15 billion is needed for expansion in Texas (1). Opting out of Medicaid expansion has left 1.5 million eligible Texans without health insurance (2). Consequently, a 300 percent increase in costs for primary care services, being provided in the emergency department, has been observed (1). Similarly, most hospitals are facing nearly $3-5 billion in losses due to uncompensated care (1).

Bill Haslam, the Tennessee state governor, announced that the state of Tennessee would accept the Medicaid expansion offer. The Medicaid expansion expands Medicaid eligibility to the region’s underserved populations living near or below the poverty line. The Medicaid expansion offer looked to be a major win for the state; however, others disagreed with this idea. Some of Tennessee’s lawmakers decided to deny the federal government’s Medicaid offer, even though many others wanted the offer to be accepted. The deal’s breakdown might be the result of “squabbling along party lines” which is a common theme at all levels of government. Although the deal was denied, it is still possible that the bill could still be passed with the help of the governor. The likelihood of Tennessee reviving its Medicaid expansion is a difficult one considering the state would have to fight. The Medicaid expansion could offer the state low-income citizens medical insurance, the state would come out of the deal with a net financial gain, and the state hospitals would come out on top.

On October 1, 2015, Ms. Booth was approved for Medicaid coverage through the BCC program. It was determined by the Mississippi State Department of Health that Ms. Heigle was eligible to receive Medicaid coverage for two (2) years or during the course of her treatment for breast cancer. The Office of Eligibility issued a Notice of Adverse Action on September 5, 2017, informing Ms. Booth that her eligibility would terminate on September 30, 2017, because her two (2) year treatment period was ending.

This model focuses on the overhang of an organizational profile: the environment, relationship, and strategic solution. Many different sectors of healthcare use the Baldrige model and criteria such as, though not limited to, ambulatory services, health maintenance, and long-term care. Baldrige focuses on a performance system and is composed of six categories. These six categories are designed to correlate between each other and influence the

The most critical asset any company has are its people and the knowledge they have, combined with the use of IT systems to streamline operations and stay focused on customers (Kroenke, 2013). The five component model is critically important from a synchronization standpoint, ensuring all aspects of a business function well together. Each of the components can't be viewed in isolation; rather they need to be viewed from the standpoint of how they create a unified strategy overall.

For several decades health care has been tied to the economy and with the current downturn we see continued efforts to control and reduce over-head costs. Health care organizations in their effort to become more efficient and address changes in the industry have altered their strategic business plans. Lee & Alexander (1999) researched organizational change in hospitals and their survival, in this paper I hope to discuss their findings and add other examples to validate their conclusions.

Week 3, the lecture on Managing Change describes organizational changes that occur when a company makes a shift from its current state to some preferred future state. Managing organizational change is the process of planning and implementing change in organizations in such a way as to decrease employee resistance and cost to the organization while concurrently expanding the effectiveness of the change effort. Today's business environment requires companies to undergo changes almost constantly if they are to remain competitive. Students of organizational change identify areas of change in order to analyze them. A manager trying to implement a change, no matter how small, should expect to encounter some resistance from within the organization.

For the purpose of industry analysis we have used the porters Five-force model, the result of analysis is attached in the appendix.