Activity of United Healthcare Organization in America - Case Study Example

United Healthcare Case Study al Affiliation United Healthcare Case Study United Healthcare is a subsidiary American healthcare entity that is headquartered in Minnetonka, the State of Minnesota. As a subsidiary of the larger UnitedHealth Group Inc., it is one of two operating entities, which provide access to the range of services and offered by the diversified managed health care firm. Its partner entity is Optum, with the two subsidiaries, and divisions present, enabling UnitedHealth Group serve an approximated 70 million Americans nationwide. The UnitedHealth Group Inc. is ranked at position 17 of American top 500 firms, as portrayed on Fortune magazine best represented through its 2011 net earnings of $5.142 billion. The above portrays the national focus of the Group, as will be discussed below. UnitedHealth Group Inc., was created in 1977, and is currently the single largest health care in America having initially started with the introduction of the first seniors’ health plan that was network-based. By the year 1984, it was ready to join the securities exchange, becoming a publicly traded entity. J.D. Power and Associates’ recent rating of the entity, as having the highest employer satisfaction in terms of self-insured health plans, is one of its many accreditations, which continue to portray its positive presence in American society. Adding to this was its 2011 accreditation by the American Medical Association (UnitedHealth Group, 2014). Evaluation of Insurance Claims Processing According to the Fourth Annual Report Card, as portrayed by UnitedHealth Group (2014) out of the seven national health insurance firms evaluated; in terms of the accuracy and timeliness of claims processing, United Healthcare was placed in pole position. This is concerning metrics such as approval, processing and payment, where the firm led its industry peers in – Electronic Remittance Advice (ERA) Accuracy and Contracted Fee Schedule Match Rate. The latter, is an indicator of how often insurance claim payments match the contracted fee schedules. The former pertains to measurements of the rate at which the physician practices’ projected allowed amount equals that of the insurer’s permitted amount. Thus, accordingly, the Business Insurance Magazine named the firm as the overall ‘readers last choice’ winner (2010) for its great role as the most excellent health plan provider. On the converse, the entity rated last, concerning the metric, which covers the required medications and procedures. Further still is the fact that a survey in the same year, of hospital executives who had interacted with the firm, resulted in the firm receiving a 65% favorable rating. This was indicative of a 33% improvement from the former year’s survey thereby resulting in its last place ranking concerning all firms listed (UnitedHealth Group, 2014). Contributing to overall legislation and policy enactment in the U.S. is the policy research and consulting firm The Lewin Group, which is under the greater UnitedHealth Group. It is fundamental to the economic analysis of America’s human service and policies, as well as health care. Through its non-partisan reputation, abate the numerous ownership changes to have taken place, attests to its formidable place in American legislation and policymaking. This important role is vividly exemplified in both the Republican and Democratic parties’ frequent citation of the firm’s studies; concerning U.S. healthcare reform proposals. This portrays the kind of inclination that the American public may embrace in terms of healthcare policy issues affecting them, in not only the present, but also future impacts and effects (UHC News, 2010). Health Care Needs: Future Projection To best understand the influence and effects of the firm-entity in question is the need to delve into a little bit of its historical evolution. As Irwin, Jack & Ashish (2013) portray, though founded as Charter Med Incorporated, it has through time gained greater national success and recognition because of various aspects and actions taken. Through acquisitions of entities such as The MentraHealth Companies Inc., AmericChoice, Oxford Health Plans, PacifiCare Health Systems, and the recent move on Sierra Health Services Inc., all attest to its continued diversification of products and services offers. As the Group’s Health Benefits platform, it offers varying health benefit services and products both to benefit sponsors and consumers. In this regard, it serves individuals enrolled in both Medicaid and Medicare, those with purchased personal health plans, and those engaged in employer-sponsored health plans. Generally, the aforementioned covers a wide range of sectors, concerning health insurance cover. Strategic Plan As a nation-wide entity, it has and continues engaging more, with not only the prevailing administrations of governance, but also the American public at large (Irwin, Jack & Ashish, 2013). This is evident from its continued lobbying activities, where it spends millions of dollars. An example would be its 2010 attempt at gaining favorable legislation, through seven varying lobby firms. Additionally, has been the input of its PAC (Political Action Committee), known as the United for Health Reform, in further lobbying measures. This is towards the whole group-entity’s interpretation and future effects of greater health care reform. The opposition to such reform is factored on a number of key issues, all which informed the management’s decisions. Through its recent (September 2013) approval of a new 3-year strategic plan, the firm entails to focus on its efforts, concerning the most beneficial activities targeted at its members. The above will be fundamentally aimed at enhancing their national delivery of high-quality health care services. This is through “making a difference in how the health care systems work, and to collaborate with large employers to help their employees live healthier lives” (UnitedHealthcare CEO Message, 2014). Through continued utility of existing innovative ideas i.e. the UnitedHealth Premium hospital and physician designation programs and the Care and Coordination Management, it endeavors at further enhancing itself through novel initiatives. The former pertains to health care cost plans and tools, which support transparency by way of enabling members access both affordable and quality care. As McCann (2013) alludes, this is through the inclusion of new programs and products i.e. mobile application for easier access, video-on-demand capacity in delivering in-home wellness and health programs, and gamification that is aimed at enhancing video-playing as a healthy activity. In reference to the aforementioned, these are targeted at enabling individuals have an active role in their personal health care, as well as participation in wellness, chronic care and prevention programs (McCann, 2013). This is for the betterment of their lives, by way of innovation that works. Nurse staffing is an essential variable in the wake of increased medical and health care provision in the U.S. Comprising the largest grouping of healthcare professionals, this is fundamentally influenced by the growth of their roles; through expanded medical and health care service provision. Through their different role-play, influenced by the changing dynamics of the American health care requirements, the parent firm – UnitedHealth Group founded the Center for Nursing Advancement (2008). The center will function as a conduit for the Group’s focus on strategies regarding nurse engagement, as well as their mentoring, training and coaching. This will enable its large nursing fraternity, to be better positioned in meeting and supporting the evolving consumer demands for health care. Additionally, its nursing fraternity will also be part of a larger team responsible for formulating novel care-delivery models. Such models are requisite in solving various challenges that face the nursing profession as a whole, in addition to enabling better achievement of health care modernization (UHC, 2014). In regard to resource management, the firm-entity engages in its Primary Care and Emergency Room (ER) Care Management Program. It is essential towards the overall improvement of both the affordability and quality of primary care. In addition is the development of tools, initiatives and programs aimed at catering to chronic, urgent and emergent care. Above all, is the working collaboration present, which focuses more on patient satisfaction and wellbeing. This is through its offer of various tools/ avenues of better service provision such as: - evidence-based medicine (EBM) guidelines, disease management programs, and electronic registries, in addition to other benefits aimed at value addition. Through partnerships with key organizations such as: - the American Academy of Family Physicians, the American Academy of Pediatrics (AAP) and the American College of Physicians (ACP), further enables better management of prevailing resources, as well as enhanced service provision. Recently, was the establishment of a Primary Care Scientific Advisory Board, which aids in enabling management get a better understanding of the firm’s physician needs, in addition to ensuring effectiveness of their initiatives. Further still, is the presence of Disease Management Programs that are focused on diabetes and asthma amongst others (UHC Online, 2014). Patient satisfaction is core to enhanced social health and wellbeing, which is the driving force behind the prevailing healthcare provision. Excellent health care organizations result in excellent patient experiences, which are based on the quality of healthcare provided. The firm, through its steering committee for the UHC Patient Experience 2008 Benchmarking project, there is continuous definition and refining of what excellent patient experience pertains to. As a benchmarking project, it enables the identification of successful practices, which are essential in sustaining improved overall patient experience, in addition to aiding participants identify their strengths, as well as existing opportunities for improvement. It provides incentives towards organizational improvement, in addition to aiding in the overcoming of prevailing barriers to success. This thus enables the effective tackling of a blame-oriented culture, the lack of individual accountability, and competing priorities, as well as challenges that are inherent in such contexts as medical and healthcare provision. The above is achievable through various measures such as the implementation of staff rounding, through performing regular, efficient and thorough patient rounds, which involves not only the nursing and medical practitioners’ fraternity, but also the leadership present as well. In addition, is the necessary need of enhancing the leadership’s role in ensuring service excellence, and the development of staff competencies amongst other measures (UHC. 2009). Conclusion With focus being placed on future endeavors, the entity aims at enhancing its strategy by way of different goals. These include driving better results in terms of execution, innovation and affordability, sustaining and improving the lifetime health and wellbeing of members and the delivery of information and technology. Other include essential in enhancing healthier decision-making, and lastly, the provision of better insight, regarding daily decisions made by members in terms of the reduction and awareness of health costs and risks (UHC News, 2010). Through groundbreaking approaches as well as consultative support, the firm aims at aiding large-scale employers understand the benefits of employee cover. This is in addition to the design of plans, which aim at maximizing investment returns, as well as satisfying the wellness and health needs of entire workforces. The overall aim is in driving upward productivity, bottom-line results and satisfaction of populations for a greater and healthier American society. References CEO Message. (2014). UnitedHealthcare [Home], retrieved from http://www.uhcnational.com/about/message.html McCann, E. (2013, July 12). UnitedHealthcare to double ACO contracts: The Five-year plan is part of the insurer’s overall business strategy. Healthcare Finance News, retrieved from: http://www.healthcarefinancenews.com/news/unitedhealthcare-double-aco-contracts Irwin, G., Jack, T. & Ashish, K. (2013, May 28). Putting an I in Healthcare. Harvard Business School [Healthcare Executive Education]: Strategy + Business, retrieved from: http://www.strategy-business.com/article/00167?pg=all UHC. (2014). Center for Nursing Advancement. UnitedHealthcare [Physicians], retrieved from: http://www.uhc.com/physicians/center_for_nursing_advancement.htm UHC. (2009). Improvement Collaborative Patient Experience 2009 Field Brief: Benchmarking and Improvement Services. University HealthSystem Consortium, retrieved from: http://www.slideshare.net/ljmansfield/uhc-patient-satisfaction-collaborative UHC News. (2010, November). New Strategic Plan Sets Direction for the Future. UHC NEWS [University Health System Consortium], retrieved from: https://www.uhc.edu/37474.htm UHC Online (2014). Primary Care and ER Care Management. UnitedHealthcare Online [Clinician Resources], retrieved from: http://www.welcometounitedhealthcareonline.com/tour/demo/b2c/pcercm.html UnitedHealth Group. (2014). UnitedHealthcare. UnitedHealth Group [Homepage], retrieved from: http://www.unitedhealthgroup.com/Businesses/UnitedHealthcare.aspx Read More