Types Of Service Strategies In Integrated Healthcare Systems

Following an organization announcement in 2015, the healthcare system was divided into four divisions headed by a leadership team of 5 that oversee all the divisions. The second division consists of the 3 regional hospitals associated with the New York Presbyterian system. Often hospitals associated with a healthcare system are hospitals waiting on approval from the city and HCOs involved. The 3rd division consists of NY-Presbyterian physician services. Lastly, the fourth division consists of all the health services that make up the health care system’s community and population health. These services include ambulatory care network sites and healthcare initiatives. As a Highly Reliable Organization, New York Presbyterian keeps track of multiple trends to shift and shape it’s organization for today’s always changing and complex healthcare industry. Through the tracking of consumer healthcare decisions, New York-Presbyterian uses this data to adjust its practices and policies to help patients make the best medical decisions and provide the highest quality of care. Positioned in one of the biggest metropolitan areas in the world, New York-Presbyterian keeps track of it’s competition by monitoring the consolidations of healthcare organizations within their market share. Through this monetization, the healthcare system prioritize its marketing strategy that allows them to sell the unique

Porter’s five forces analysis provides a methodology to evaluate the external markets. Its consideration of substitutes, threats and power of buyer and supplier assists with the development of an integration strategy. A thorough analysis can isolate attractive opportunities in support of building a profitable business model. These strategies can leverage vertical and/or horizontal integration of new business entities. These entities are designed to help with growing market share, increase efficiencies and/or reduce costs. During the 1990’s many hospitals pursued a combination of both vertical and horizontal integration. The goal was to create an integrated delivery network (IDN) designed to improve their economic performance.

Growing through integration is concerned with mergers and takeovers of businesses. There are a number of different ways of integrating: Horizontal (same industry, same stage of production), backward vertical (same industry towards a supplier), forward vertical (same industry towards the customer) and Conglomerate (different industries).

Because each type of managed care organization has certain unique characteristics, network strategies must be chosen to fit these characteristics. An organization that offers more than one type of health plan may choose to coordinate provider networks through a network-within-a-network approach. This is done by including the providers from one product's panel in the network of another panel. Provider network strategies are also found to vary with the geographic scope and market focus of the plan. A growing number of managed care organizations are attempting to build national provider

The “Lewis Blackman Story” told by Helen Haskell, a person who continues to advocate for change and improved quality of care. Lewis Blackman the son of Helen Haskell died at age fifteen after developing complications after surgery that included incorrect administration of a medication and a nursing team who failed to see the changes in patient’s condition and effectively and sufficiently respond to the change in a timely manner ultimately resulting in failure to rescue and the patient’s death. More specifically, the staff failed to recognize the signs of shock that this patient. Likewise, no rescue plan was in place. Lastly, failed protocols and failed leadership

Vertically integrated health care system that I have chosen is the Veterans Administration (VA) it's accountable for a large patient population for military veterans. As stated, The Veterans Health Administration is America’s largest integrated health care system with over 1,700 sites of care, serving 8.76 million Veterans each year (VA.GOV). The services that's provided to veterans is health care, rehabilitation, employment, education, home loan guaranties, and life insurance coverage. VA control costs by buying in bulk and control costs by engaging in a deep, single-source relationship with each patient. The Assistant Secretary for Management oversees all resource requirements, development and implementation of agency performance measures,

Integrated Managed Care Organization- The organization is properly aligned for the primary driver being cost cutting services. Since all entities within the organization are responsible and affected by any expenses endured on any entity being unfavorable or favorable, the foundation serves as a primary motivator to reduce costs at all levels. This alignment eliminates any financial gains from driving high utilization of services or higher intensity services within the organization. Ultimately, this system allows the physician medical group to drive care, being responsible for the clinical care decisions as opposed to health plan making those decisions as designed in other organizations. This is the preferable model for Medicaid systems as

Mergers have become normal practice in the health care industry by creating a larger hospital system that provides broader services with the focus on lowering healthcare cost and being economically profitable with keeping in line with regulatory guidance. A merger happens when two or more organizations agree to join together and become one organization. One or more organizations essentially must dissolve for this to happen. Sometimes both organizations dissolve and take on a completely new name as in this case of the merging of the two competing hospitals. (McClure, n.d.) Hospitals along with health systems are following the same trend to merge with other hospitals, this movement has continue to gain momentum and appears to be the future trend in the health care industry due to high operating hospital cost. In a survey done in 2012 regarding hospital maintaining independence only 13% plan not to align with other hospitals or health care systems, while the other 87% plan some type of merger with another hospital or health care system. (Hospital Mergers and Acquisitions, 2013)

Horizontal integrations mean that all services, facilities, and other patient care needs are acquired and merged into the integrated system. An example would be a general hospital acquiring or partnering with other specialized sources of healthcare such as, outpatient facilities, pharmacies, specialty offices, oncology centers, and diagnostic labs and services. A vertical integration means to apply factors that do not directly affect patient care, such as medical supplies and drugs, insurance, financial services, emergency services such as ambulances, and administration responsibilities. A system that can implement both can afford to provide lower cost care while maintaining quality, if the system gets to large enough it can also help curb the availability of care. In the Dallas-Fort Worth area one can see a growth in Texas Health Resources or THR, they own several large general hospitals, along with free-standing ERs, sports medicine offices, a heart hospital, and many other facilities in the

According to Harrison (2016), “an integrated physician model is the result of a series of partnerships between hospitals and physicians developed over time.” The plan behind this model is to enhance joint efforts with medical specialists and associations. There are four strategies that need to be implemented for successful integration: “1) understand the forces affecting physicians; design strategic offerings to meet the needs of local physicians, 2) understand the hospital or health system’s specific capabilities and infrastructure in the context of the communities served, 3) ground physician-integration efforts on a well-defined strategic financial plan with sufficient resources and performance targets, and 4) ensure strong physician participation, leadership and governance.” (Cullen, S. J., Lambert III, M. J., & Pizzo, J. J. (2012)

Fourth, both health care organization are anticipated that during our organizational restructuring on the Care Select Health System would most likely affect job satisfaction levels and potentially compromise the quality of services provided, yet evidence on the impact of hospital mergers on staff satisfaction is surprisingly scarce. Therefore, Care Select Health System staff might perceive mergers as a breach of the psychological contract (implicit commitments and expectations between employers and employees) when they feel they are not listened to, when they have to ‘suffer’ from delays in service development and job uncertainties. For instance, cultures of merging organizations might also clash when they have opposing attitudes towards

In my opinion, I feel that every person should be given the best medical care available and the opportunity to live a long life expectancy. As an assistant, I must make sure that the hospital follows the proper ethical guidelines and ensure that the client is aware of her choices and what is available to her as well as her rights. I will also make sure that the patient knows what the health home offers her as an elderly woman who lives alone and is in need of some assistance. Health homes in today’s society have begun to take hold in several states via the integrated care delivery models. This has been occurring in the U.S. who continues to search for modern ways to control the costs of health care. Some states have progressively become labs

The demand for cost containment, the growth of purchaser influence, the decline trend in inpatient utilization, and the demands of managed care organizations for efficiency, cost containment, coordination of services, and accountability for service outcomes has changed hospitals strategic planning. Hospitals need to reconfigure and reorganize their health service delivery in order to meet the demands of managed care. To make their organization attractive to the managed care industry, system integration strategies began to emerge such as horizontal and vertical integration (Sultz & Young, 2009, p. 103).

But mostly the barriers to integrations are on the legal side. As mentioned in the article for this module, one obstacle would be the The Sherman Antitrust Act prohibits negotiations between providers that could result in excessive market power. Also, there is the issue of the anti-kickback law and Civil Monetary Penalties (CMP) Law where it mandates a penalty for payments from hospitals that directly or indirectly encourage physicians to reduce or limit services to Medicare or Medicaid patients. Finally, Stark Ethics in Patient Referral Act. According to Stark Law, it prohibits referrals of Medicare patients to institutions in which the physician has a financial interest.

Horizontal integration is the expanding of a company through increasing the service to create a stronger and more enhanced company that provides the same service. Vertical integration is when a company owned individual providers create or operates the distribution themselves. In order to provide the best healthcare service, healthcare facilities needs to offer a network of providers with a wide range of healthcare service. The term integration delivery system (IDC), “is a network of organizations that provides or arranges to provide a coordinated continuum of services to a defined population” (Shi& Singh, pg. 366). The goal for healthcare organization is to provide high quality and efficiency of care with cost reduction for healthcare aimed toward the patient population. This goal is not only a great benefit for an organization but for patient and also for healthcare services providers.