Managed Healthcare Executive - Coursework Example

DRAFT Managed healthcare executive Lecturer’s Introduction As healthcare premiums and costs have risen in the recent past, health care centers are being forced to try to provide health care services on very tight budgets. As a result, in many instances, quality becomes compromised in an effort of managing the patients wait times and increased costs. Health care provision in the United States has become a very debated political hot topic as well as very profitable industry, but a very expensive avenue for nearly every hospital attributed to the increased cost of running the facilities. As a result, every healthcare facility is faced with dilemmas of running their own facility on whether to minimize their cost of spending or enhance their quality care provision. Quality and healthcare cost reduction initiatives are driving significant changes in the United States. In this regards, the paper takes a position on the case provided. As the chief clinical officer of a managed care company, I was asked by the company CEO and CFO to take a position. Whether to advise the managed care company should maintain quality care provision or the company’s profits margins should redirect the case management department’s efforts from cost containment emphasis to care coordination or they should leave the effort towards cost containment. Therefore, the paper presents my position towards the issue and support the stance that the managed care company should be involved in maintain and enhancing quality care provision, thus it should be involved in redirecting the case management efforts from cost containment to enhancing care coordination. Enhancing quality health care provision and benefits associated There is broad evidence that most individuals in many countries such as the united often do not get the health care that they need even though these nations spends greater sums of money per each individual on enhancing their healthcare needs. Often in a majority of instances, preventive and curative care provision is underutilized and as a result, there is an increased rate of the health care spending and advance in the patient’s diseases that increases the rate of spending even more. Patients that suffer from chronic conditions such as diabetes, heart conditions and hypertension often fail to receive effective treatment such as self-management services and good drug therapies to help in effective management of their conditions. Due to the poor quality care they receive, these patients often are affected by an increased relapse of their conditions and end up spending more on their health care needs as they are often readmitted in these healthcare facilities. Most of these healthcare facilities provide such care in an effort of minimizing on the healthcare spending but in the long run, they end up spending more with an increased number of patients hospital readmissions. Most of the health care problems facing the health sector are often exacerbated by a lack of coordination of appropriate heath care provision in their setting, thus quality health care provision is fundamental. According to statistics, many of the patients often never receive the necessary medical care as most of the patients receive care that is often unnecessarily or even harmful resulting in tremendous variation in the patient’s hospital lengths stay, procedures and cost involved. There is limited evidence available in regards to the treatment remedies and procedures that are most effective, insufficient evidence on the ways of informing the healthcare providers on the effectiveness of the different failures and treatments of detecting and reducing medical errors that further contributes to an increased gap in the quality and efficiency of health care provision. Thus, it is essential to reform the health delivery system in an effort of improving quality and value of care provision that is crucial in addressing the escalating poor quality health care provided as well as the associated escalating health care costs of providing the care. Healthcare facilities, organizations and company’s need to shift their focus towards provision of quality care of the patients. In achieving this, healthcare reforms are paramount in enhancing healthcare access in the right time in an effort of keeping people healthy and preventing common and avoidable health care complications in the largest extent possible. Therefore, these facilities need to be engaged in quality improvement reforms in construct of the current healthcare systems that encourages more hospital procedures, test and treatment that are often unnecessary resulting to an increase in the health care spending costs. According to……., in the health system, hospital facilities account for the greatest amount of spending. In, reducing the cost of spending, most facilities end up squeezing their health care budgets and as a result end up providing poor care to their patients. In the end, patients end up staying longer in such facilities and these hospitals spend more in the provision of care to the patients. Such facilities needs to find better ways of curbing their hospital spending that can be achieved better with enhancing the quality of health care provision. Aligning the healthcare systems means more than just assuring health care coverage to everyone. Rather in addressing the increased health care costs, health care facilities needs to improve on their mode of health care delivery to include enhancing and coordinating care provision better as well as improving the patient’s safety. According to the National Strategy for enhancing quality health improvement, poor quality of health care delivered results in medical and health care errors that harm millions of patients every year adding billions of dollars to the health care cost every year. According to the Center of Disease Control, more than a million health care associated infections and illnesses occur each year in the United States that cost approximately $30 billion annually. Adverse drug reactions result from medication errors and poor health care delivery are estimated to lead to more than a million emergency hospital visits and over 200,000 hospital readmissions resulting to approximately 2 million hospital patients stay each year. According to statistics, the cost that is involved in treating patients affected by adverse drug reactions is estimated to be more than five billions every year. Thus, enhancing quality care provision is essential in helping patients receive the best possible health care as well as protecting their safety and reducing the health care cost involved in caring for these patients. Quality care provision lowers health care cost containment It is crucial to maintain high quality care provision standards as it lower health care spending among health care facilities. According to……….. a lower quality care provided to the patients is assumed to be associated with a high prevalence of medical errors occurrence. It is important in this regards to be able to understand the impact of medical errors on the long and short-term hospital costs as well as the patients outcomes in the future. Minimizing and cutting the cost of spending over the expense of providing cheap health care may seem optimal on the short run but it is also essential to determine the long terms consequences. Many of the medical care company’s and facilities end up spending a lot of capital on medical expenditures associated with medical errors, increased readmissions rates, deaths and increased number of outpatients visiting these facilities. Therefore, as the chief clinical officer of the managed care company I will advocate for quality care enhancement by redirecting the case management departments efforts from cost containment to care coordination. Poor health care provision not only results in unnecessary medication errors, injuries and deaths to the patients, but it also adds quite significantly to the total cost of the patients and facilities that finance the care provided. According to a study by……………shows that approximately 30 percent of the total health care expenditure by both the private and public sector results from poor quality care provided to the patients. The provision of quality care across the health care setting provides the best opportunity of reducing the health care spending growth while at the same time enhancing the patient’s safety. The best care at lower cost has made it clear that health care delivery in the affected facilities to be often inefficient and uncoordinated resulting to wastage of private and public spending as well as an increased avoidable health problem to the patients affecting them negatively. Often, most of the health care providers tend to practice healthcare delivery in silos failing to coordinate care across the health care setting. The fragmented care delivery systems that are at times aimed at cutting down the health spending cost results to duplicative and avoidable services as well as health care complications especially among the patients with complex chronic ailments who account for the greatest percentage of the health care spending costs. As a result of this fragmented care, the patient’s receive many treatments that are often unnecessary for which alternative and less costly quality care exists. Amid these concerns on the quality and efficiency of the health care systems, there are several examples of high performing low cost facilities. Such facilities encourage integration that has enabled them to adopt common informational and technology as well as decision support tools enabling them to review better the patient’s comprehensive information and implement the appropriate team based approaches. In this regards, the Obama care or the Affordable and Care Act that has been put forward to reform the health care system has included steps of improving the quality of health care and by doing so, it has lowered greatly healthcare cost to the patients and providing facilities. This has been achieved through the avoidance of costly mistakes that results to increased patients readmissions, rewarding quality care rather than quantity, keeping patients healthy in the care setting as well as the creation and adoption of health information infrastructure that enhances the patient’s safety. According to the act, the adoption of the electronic health records (EHRs) is a crucial step in promoting better care, reducing the cost involved in the patients care as well as protecting the patients safety. The health information technological systems are expensive to install and adoption but have proven to be essential towards enhancing quality care delivery. Majority of the health care facilities are in the transitional phase of adoption process and as a result, the systems have made it easier for hospitals and physicians to be able to evaluate the patients’ medical status, eliminate redundant procedures, enhance care coordination and provide the best care possible to the patients. According to ………one of the primary reasons for introducing and implementing health information technology systems, into the health care system, is to minimize or prevent the occurrence of medication errors. However, current literature suggests that ‘medication errors occurrence’ is still a major problem and danger to patient safety in most of our health care settings. According to a study carried out by ………….. states that a Health Information Technological system provides five important benefits to a health care institution; decrease in expenses, eliminated redundancy, free space, reduction in workload, and prevention of medication errors. Consequently, the reduction of medication errors and patients adverse reactions resulting from poor care delivery is an important step towards cost containment in the health care settings. Moreover, enhancing the provision of quality care is essential in reducing the rate of hospital readmissions. Attest 20 percent of the patients that get admitted in the health care facilities get a repeat readmission within their 30th day of discharge due to fragmented poor quality care provided in a number of health care setting. As a result, this increases the care facilities rate of spending. Medicare has stipulated to spend over $15 billion yearly on these hospital readmissions a problem that is avoidable through quality health care provision. The increased rate of patients readmissions not only affects the care facilities but also increase the health care cost on the patient, results in distress as well as dissatisfaction on the patients who repeatedly will find themselves back to the care facilities. Although not a 100 percent of the hospital readmissions are avoidable, a whooping three quarters of them are avoidable through improved health care provision. In this regards, a new federal health care law has been passed under the centers of Medicaid and Medicare services that utilizes a 30-day cutoff of penalizing those health care facilities with higher rates of the hospital readmission rates. Conclusion The provision of high quality care is the best method available for enhancing hospital cost containment rather than redirecting the departmental resources towards cost containment. Through the provision of quality care in patients care, the rate of medical errors, patient’s adverse reaction, readmission and unnecessary procedures that are avoidable are reduced. As well quality care provision enhance integration and coordination in the care delivery process reducing unnecessary duplication of the patients care and in regards enhancing the patients safety. To be continued Read More