The Cost Dynamics Of Health Care Industry

As a managed care organization Kaiser Permanente has served as a model for informational healthcare systems and the recent demand for affordable care has prompted the organization to lower cost in services without hindering the quality of care. Kaiser Permanente has integrated a system in which the organization assumes all financial risk and a bundled enrollment fee for service strategy. What makes Kaiser Permanente unique from other HMOs is their accountability for quality, utilization management, financial risk, and business strategies (Kaiser Permanente, 2009).

The fact that there are broad spectrums of services available within the Kaiser Permanente network makes it easier to coordinate patient care. For example the Northern California site has implemented programs that focus on five “imperatives of personal care”, which are: patients have to have a primary care doctor, they need to be able to see that physician, patients that call have a short telephone wait, patients should receive timely appointments and have a great care experience (Commonwealth fund June 2009). Care management definitely plays a crucial role in health care. When the patients needs are met and quality care is received the result is patient satisfaction and potentially cost saving for the organization. Patients not only have to deal with health issues, many experience challenges within their environment and certain limitations depending on socioeconomic status. Therefore , coordination of patient care is key to the success of any health care delivery system.

Healthcare stakeholders know how to value what they have captured and they have come up with many ideas to help with their goal. “Big data could transform the healthcare sector, but the industry must undergo fundamental changes before stakeholders can capture its full value” (Kayyali, B., Knott, D., Van Kuiken, S., 2013). Since the affordable care act has been in place there has been an increase number of patients seeking preventative care or even seeking help for chronic illnesses that they weren’t seen for because of lack of insurance. Because of that, there has been a shortage of physicians, nurses and other healthcare providers. So the stakeholders have another challenge on their hands in trying to hire more doctors and nurses to help with the increase of patients.

A major change is occurring in the healthcare system as the United States continues to move toward enhancing patient care quality and access while also decreasing cost. This significant transformation is driven by a variety of forces, including changes in managed care, a shift from pay for service to pay for quality, and ever-evolving client characteristics. This paper aims to discuss each of these factors and the ways in which they make this major transformation a difficult one for the nation to undergo.

Worldwide use of computer technology in medicine began in the early 1950s with the rise of the computers. In 1949, Gustav Wagner established the first professional organization for informatics in Germany. Medical informatics research units began to appear during the 1970s in Poland and in the U.S. Since then the development of high-quality health informatics research, education and infrastructure has been a goal of the U.S. and the European Union. (NYU graduate training program, 2010) Changes in the healthcare environment produced fundamental shifts in the delivery of healthcare. The altering landscape of healthcare is creating a huge demand for health data analytics. The growth and maturity of healthcare informatics over the past decade has been a prime catalyst in positioning the healthcare industry for the changes posed by reform measures. By understanding the process of analytics, clinical informatics specialists say healthcare providers have the insight necessary to make the process adjustments in the future.(Riskin, 2013)

Changes in current health care practices, the aging baby-boomer population, and the higher acuity of patients has created a need for change and adaptability with the health care industry. Kaiser is an organization who has shown the ability to continuously change in order to reduce costs while improving efficient quality patient care. The investment on information technology (IT) advancements such as the implantation of electronic health records (EHRs) and use of a patient portal system is one way the organization has shown readiness to meet the health care needs of patients. KP in collaboration with five other healthcare organizations created a Care Connectivity Consortium, enabling secure electronic retrieval of current

The healthcare cost environment is moving from traditional fee-for-service to value-based payment, analytics can be used to look at the financial stability and direction of the industry. Specifically, as it relates to the integration of healthcare payers and providers. Payers and providers need to improve the way they interact with each other and how they share data. A Grant Thornton article summarizing the webcast “Provider/Payor Convergence: Regulatory, Governance and Operational Issues You Need to Consider,” notes that with shrinking bottom lines, we are seeing

With changes due to Healthcare Reform, healthcare organization’s are becoming more competitive in its market as they move towards finding the right effective fit through process improvements for their organization based on quality measurements, operational effectiveness, and financial performance in an effort to maximize their reimbursements in order to protect their margin and stay afloat in the healthcare industry to deliver the most profound care to the patient’s (Amerinet, n.d). Through new organizational architect and design, training, dashboards that helps to make matrix decisions, and big data analytics gathered from the electronic health record system, healthcare organization’s are driven to use the best fit resources and tools to improve their performance and be sustainable and successful in the healthcare market (Amerinet, n.d) (Stichler, 2017).

The driving force of any business is that of competition; the healthcare industry is no different. The presence of competition provides a need to grow and continually offer quality services or products; however, the competition in the healthcare industry can be a very daunting at times. The cost of medical care is rising and patients are expecting a certain level of high-quality care due to the vast amount of information available to them. Patients are now armed with knowledge; they are true consumers who look for the best quality care for the very best price. This paper will discuss the

In the new report releases on November 2013 of The Council of Economic Advisers, “Trends in Health Care Cost Growth and the Role of the Affordable Care Act”, shows the health care costs and prices are growing at their slowest rates in decades. The chart, “Real Per Enrollee Growth in Health Spending Per Payer,” in this report shows that the average annual growth rate of private insurance from 2010 to 2013 was just 1.3 percent, marking the lowest rate record and “less than one-third the long term historical average stretching back to 1965” (Trends in Health Care Cost Growth). This report also indicates that the ACA reduces the expenditure for health care and puts the inflation in the lowest rates (only one percent) in the recent fifty years (Trends

Obamacare program was developed to cover and provide health insurance to many people in the United States. It also was intended to decrease the health inflation that was affecting the country and reducing its outcomes including the rise in health insurance premiums. By looking at the facts and statistics after starting the ACA, we will see that the objective of reducing the health inflation and its outcomes has not been achieved completely.

At a CAGR of 37.9 pct. from 10 pct. adoption in 2011 to 50 pct. adoption by 2016, according to a recent freeze and Sullivan market analysis clinical data analytics are poised to grow. For data analytics report findings detail, however, that despite the strong market growing, it’s not all smooth sailing. Such complex and extensive data troves prove very much a daunting project for providers who already have a good deal on their plates first, bring offing. Pennies due to financial woes, clinical analytics may often be lay on the back burner such analytics solutions can also cost a pretty penny, and when provider organizations are currently nipping. Based analytics is still very much a reality furthermore, claims. Consequence, a market that creates significant challenges for those providers and healthcare organizations that seek to adopt analytics solutions in advance of payment reform driven in large component part by the affordable care act the end. From an ambit of payment perspectives, from those seeking p4p

The case is about current high cost of health care industry in US. There was not technology used in medical record keeping. But now some emerging software and applications are being used. The cost of traditional record keeping is higher compared to the facility it provides. The efficiency of traditional system is low. It also highlights the cost patients, hospital and government paying for not following efficient technology. It sheds light on some Electronic Medical Record systems viz. Veterans Affairs, Vista. The emerging EMR tries to solve the case to some extent but there have been issues with insurance company and the technical manpower needed for its implementation. More than 50% US hospitals

The field of analytics is the one of the most talked about topics in relation to any field around the world at the moment. Business Intelligence Analytics, Big Data Analytics have become indispensable to big businesses over the past couple of decades (Chen et al., 2012). Business Analytics was identified as the one of the for major technology trends for this decade by the IBM Tech Trends report which was based on a survey of thousands of IT professionals from countries all around the globe working in different industries(Ibm.com, 2013). Therefore, the growing importance of analytics was one of the rationales behind choosing QlikView for HealthCare as the technology tool for evaluation.

Healthcare is changing rapidly and so is the industry’s need for analytics and business intelligence. Many large healthcare organizations have been growing organically and through acquisitions. The rate of growth is so fast that it is nearly impossible to merge processes together. Due to the pressure of the external forces that are transforming healthcare and in the best interest to stay ahead, we have considered Business Intelligence as the forward strategy. Business intelligence technology promises to enable healthcare providers to