Health Care Delivery System Analysis

“An Integrated Physician Model is the result of a series of partnership between hospitals and physician develop overtime” (Harrison, 2016). Primarily, it is a joint venture that has become many joint ventures. In addition, all of this joint ventures are connected through congruent goals, and that is to provide different level of care to all the patients. Integrated physician model also organizing themselves to improve the cost and quality by operating under a clinical guideline. This could include acute care hospital, home care, nursing homes, affiliated medical group, primary care clinics, employed physician and any independent medical groups.

Yale-new Haven Health System is affiliated with Yale University is one of the Connecticut leading healthcare system; it consists of Bridgeport, Greenwich in addition Yale-New Haven Hospitals along with Northeast Medical Group, a physician foundation of primary care plus medical specialists. It provides care in 100 medical specialties along with supporting by over 6,300 university along with community physicians also advanced practitioners. It’s the third largest employer in Connecticut with 20,396 employees.

Preferred provider organizations offer flexibility in benefit design and allow patients flexibility to choose from a list of in-network providers for their care. Care provided in-network typically is discounted with out of network services resulting in higher out of pocket expenses to the patient (Hirth, Grazier, Chernew and Okeke, 2007). Clinically integrated networks are a more recently developed managed care structure. In this model, independent practitioners form a virtual network as a means of increasing capacity for contracting with payers of healthcare whether commercial insurance or for self-insured organizations. Physicians recognize advantages to collaborative contracting and the increase in coordinating care of patients through the network (Kaplan and Guest, 2012). Commercial insurance companies are looking to clinically integrated networks as another mechanism to control the costs of healthcare delivery. Accountable care organizations, as with clinically integrated networks, are fairly recent phenomenon with similar but more formalized characteristics. An accountable care organization is a structured network of healthcare entities which have united and are responsible for the health of an identified population. The accountable care organization shares the risk of meeting the health needs of

More and more integrated hospitals and other providers are becoming prevalent in our community; two large systems in the Dallas Fort Worth area are Texas Health Resources and the Baylor Scott White systems. What exactly are these integrated hospital systems? An integrated healthcare system is one that through official agreements or ownership sets up a horizontal and vertical line of healthcare facilities and services to better deliver seamless healthcare to patients. An example to use is Texas Health Resources since its found in most corners of the Metroplex. With any large corporation and system comes confusion and other problems: such as regulatory obstacles, the complexity of operations, and unclear financial ownerships. Integrated healthcare systems appear at face value to be the solution to curbing the

Cardiac diseases alone have been estimated, direct and indirect costs, for the overall American population are “approximately $165.4 billion for 2009” (CDC, 2013). A survey found that heart disease accounted for 4.2 million of the hospitalizations in 2006. In 62% of these cases were short stay hospitalizations and occurred amount peoples ages 65 and older. These hospitalization rates also vary by gender, racial, and ethnic groups.

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

There are various levels and types of integration, such as hospitals merging with hospitals and physicians aligning with physicians and hospitals and physicians affiliating. Additional services such as home health care, long-term care facilities, pharmacies, and more can be added to result in a continuum of care. A fully integrated delivery system is one that unites a financing group with all providers. The system is built on a foundation of primary care, and all facets of it operate under capitation, so everyone involved shares risk. The strategy of integrated delivery systems is to coordinate the seamless delivery of high-quality healthcare services over the continuum of care. There are the benefits of having information systems integrated

Benoff, M. a. (1997). Risk Sharing in an Integrated Delivery System. Healthcare Financial Management, pp

-There are four functional components of health care delivery system. 1-Financing: to purchase insurance or to pay for health care services consumed. 2-Insurance: to protect against catastrophic risk

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,

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 first improvement in health care made by Affordable Health Act of 2009 is it has reshaped the health care system in terms of access by making it easier for those who couldn’t afford it, were out of the age range, or had preexisting conditions by making new rules to include them. It has also reshaped the health care system in terms of quality be ensuring that the payment to health care providers does not out way patient care. “To ensure premium dollars are spent primarily on health care, the new law generally requires that at least 85% of all premium dollars collected by insurance companies for large employer plans are spent on health care services and health care quality improvement” (Lopez, 2013). Another improvement made by the Affordable

In the past, managed care in the United States took the form of voluntary programs. Such programs date from about 1850, when managed care was provided chiefly by cooperative mutual benefit and fraternal beneficiary associations. Limited coverage by commercial companies was also introduced during that period, and subsequently many plans were established by industries and labor unions.

Roemer’s model of a health care delivery system shows the different necessary elements for a system to be successful. As health needs are the input; the system needs resources, organization of programs, economic support mechanisms, and delivery of services to provide the health needs output (Roemer, p 33). Able 2 is an organization that provides services to people with disabilities. They have many resources, but perhaps not enough to meet the health needs of every consumer. They have well organized programs, have economic support, and can deliver services completely and holistically to produce health as the output of the client. The most important implication that was found in analyzing Able 2 was the need for increased resources as they are not able to meet the needs for every client in need of its services. Ultimately though, Able 2 is an excellent organization that provides an array of services for those people with disabilities.

The best health care systems in the world offer integrated care. Systems like the Mayo Clinic and Geisinger Health System own hospitals and labs and employ all the physicians and nurses a patient is likely to see, so they can easily integrate a patient’s care. In contrast, patients in North Carolina and throughout America typically obtain their care from a variety of independent providers. Health care expenses are paid by a variety of sources including private insurers, employers, the government and patients themselves. But unlike any other state, or even any large geographic area, North Carolina has the capacity to create a “virtually” integrated system, one that can provide the same integrated care but across an entire state. When patients’ transition between providers and health care settings, the result is often poor health outcomes, medical errors and costly duplication of tests and procedures. Through partnerships with other organizations and providers, NCHQA is seeking ways to better coordinate care and address systemic problems that cause dangerous and costly gaps in care. (NCHQA, 2014)