Joining An Integrated Health System (IHS)

Founded in 1946, Seattle’s Group Health Cooperative was created by doctors and community members who believed that there needed to be a health care program that was affordable, member centered, and held principles of social justice. This cooperative was one that had been successful for many years, but just recently was acquired by the not for profit Kaiser Permanente health-care company on February 1, 2017 for 1.8 billion dollars. Although Group Health is a cooperative and Kaiser Permanente is a nonprofit healthcare company, they have similar views on how they run their companies because both have missions to put their members and employees first. This is something that the articles stressed because this merge is going to affect thousands of members and employees. I plan on focusing on the process Kaiser Permanente had when wanting to take over Group Health Cooperative, the pros and cons of the final decision to merge the two healthcare programs, and ultimately how Group Health’s marketing and management strategies will be implemented in the merge. (12)

Growth and change in any organization can be a difficult time both for executives and for employees. When growth comes at an astounding rate, there are bound to be problems at all levels of the organization. Senior Health Plus (SHP) is a small, non-profit HMO based in Southern California. The company started as a grassroots organization that enjoyed a positive reputation for pioneering new ways to care for the elderly. This success has a price however, as the membership of SHP has grown exponentially in the past several years from 10,000 to 35,000 members. In response to this growth, management went on an expansion frenzy, moving all executives to a

In the nursing profession, provision of services to patients in long term care facilities is important for the overall quality of services provided. Such nursing services are a result of many individual systems that are distinct from the environment in which it exists. Nursing services might involve health promotion, disease prevention, and medical management. However, it cannot be denied that there are barriers encountered among the systems by the nurse practitioner during the provision of long term care. Using the GST in this thesis, barriers can be identified by means of a quantitative analysis. For example, participants involved will be nurse practitioners employed at various healthcare settings in Southwest Virginia (SWVA), and they

The organizational structure of a long term care facility is different from other health care agencies. First of all, all long term care facilities especially nursing homes are privately owned. The organizational structure will comprise of an owner or investors, the administrator and medical director. In the medical service department, there will be an attending physician, physician assistant, nurse practitioner, clinical nurse specialist and pharmacist. The nursing services department will have the director of nursing or DON, assistant

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

to the changing needs of patients regardless of their age, Sultz and Young, 2014. With the help of

Health care is a fascinating industry. So many types of care are included within the industry. Health care can be very broad or very specific. Health care is also comprised of different types of health care. One specific sector is long-term health care. Long-term care plays a huge role in the health care continuum. This paper will define long-term care and a continuum as well as discuss the services provided and how these services fit in the continuum of care, the resources that go along with long-term care and how it contributes to overall health care resources, and how long-term care services

The Continuum of Care is the variety of health care services provided to numerous individuals who are in need of it. All the various Long Term Care providers work as a unit, helping an individual handle their disability with various health care amenities accessible. The Continuum of Care, as stated in Long Term Care: Managing Across the Continuum (2010), is “comprehensive, integrated, and client-oriented”. All the services offered should be client-based and cater to the client’s needs and suitable care. The client’s should be able to obtain services when it is needed from the provider, making it comprehensive. All the different Long Term Care providers should be interconnected between one another, because their goal is all the same. Their goal is to care for the client’s needs. The Continuum of Care consists of: nursing facilities, sub acute care, assisted living, residential care, elderly housing, and a variety of community-based services (Pratt, 2010). All these different providers work together to care for the individuals within the health care industry, creating the continuum and making it integrated. The continuum has many positive attributes, along with many barriers. The range of barriers are: poor transitions from Long Term Care setting to setting for the clients, the continuum is reimbursement-driven, it is fragmented and uncoordinated, it is under staffed with medical professionals, and there are major language and literacy problems.

These agencies expect long-term care facilities to maintain an environment that will emphasize the importance of one’s quality of life and quality of care (Walsh, 2014).

Clinical integration is the overall purpose of an integrated physician model. Clinical integration provides an opportunity to coordinate services through centralized scheduling, electronic health records, clinical pathways, management of chronic diseases, and innovative quality improvement programs (Harrison, 2016). This needs to be a major factor in the planning process. When you have the capability and access to an patients care plan because of greater resources and having all of the necessary silos to provide such care, well then it becomes a much smoother process and as a result this can play a factor into timely care and quality of care, as well it can contribute to cost reducing factors such as outpatient care. The electronic health records allow each silo to have access to treatments and testing that has already been done, this further improves quality, timely, and costly care. The clinical pathways allow creating a standardized care plan for patients that over time become more effective and efficient. The management of chronic diseases before clinical integration could be very costly and painful, requiring the patient to see multiple facilities and doctors with limited communication between the different facilities. With success in clinical integration these patients can have easy access to their providers and information because it would all be tied together, it can reduce the stress of knowing everything themselves because the information would already be

The goal of this coordinated care is to provide the highest quality of care at the right time without duplication or medical errors. The premise is that doing this will reduce costs and the providers will share in that savings; the facilitation and coordination of this shared savings is outlined in the MSSP.

The realization of such services should be supported with adequate funding. Again, the stakeholders of the organization should be the major contributors towards the long term care service provision funding. The continuum care is crucial in the sense that it ensures that the care of the patients continues amid all the challenges and at all times. In case of financial challenges, the government ought to lend a helping hand to assist fund the important services (Pratt, 2010). Other private organizations with keen interest in healthcare provision

This paper will review the many aspects of long-term care problems and many challenges there are within Long-Term care. We will look at rising costs within long-Term Care, patient abuse, will look at the quality of life, shortages of nurses and demand that the elderly are putting on the medical field. The type of care that Long-Term Care had been giving to its patients and the changes within Long-Term Care.

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)

Brailer (2005) acknowledges that a sizeable number of citizens receive treatment from multiple providers at a time. Interoperability is a gateway for many business ventures in healthcare to accommodate for patients being admitted in multiple provider organizations. All healthcare professionals, especially managers, must communicate effectively. A good example of interoperability is transformation of electronic medical records, or recruiting physician specialists to operate on a specific procedure (Hellberg & Gronlund, 2013).