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HEALTHCARE MANGEMENT BUSINESS MODELING

In Health, Healthcare, Medicine on September 20, 2012 at 8:00 am

 

Current Healthcare situation is changing. Performance is awarded, not value.

HEALTHCARE MANAGEMENT ISSUES

1. Cost

One of the biggest issues in healthcare management is the cost of medical care services and insurance. Health insurance rates often increase faster than inflation, which means they consume a larger portion of an employer’s money or an individual buyer’s income. Some employers cut their health benefits to employees as costs rise or during a period of financial distress, forcing more people to pay for their own healthcare. Those who can’t afford to do so add to the number of uninsured Americans or receive benefits from a government-subsidized program such as Medicare or Medicaid.

2. Litigation

Litigation is a significant issue for medical practices and healthcare providers alike. The threat of malpractice suits forces doctors to spend a great deal on malpractice insurance, and practitioners must pass some of this cost on to patients. Legal disputes between patients, insurance providers and healthcare providers take time and money away from medical research and treating patients.

3. Access

Access to affordable, high-quality healthcare is far from a given for millions of people. Programs such as Medicare and Medicaid are only available to elderly and low-income individuals and families that qualify. Group insurance is only an option for members of groups that receive reduced rates, such as employees of a company or members of a social club.

4. Staffing

Staffing is an ongoing issue in hospitals, doctors’ offices, nursing homes and other facilities that needs trained specialists on hand to assist patients. The broad shortage of nurses means that many duties fall to untrained or inexperienced assistants, thereby driving up the likelihood of error. Discrepancies in pay draw medical students away from certain fields and into others, resulting in a lopsided distribution of doctors and a lack, or surplus, of options for patients.

5. Types of Care

Healthcare management seeks to offer different types of care to patients. For example, terminally ill patients may elect to receive end-of-life palliative care, which focuses on alleviating symptoms instead of aggressively combating disease. Preventative care takes place before symptoms appear and saves time and money in the long-term, but requires an early awareness and up-front spending by insurance providers or patients. Electing between different types of care requires healthcare providers to educate patients and also demands that individuals take control of their own healthcare needs.
Do we have the Right Models?

Health care is the country’s economic black hole, rising from about 13% of U.S. GDP in 1999 to 18% in 2009. By 2025, it is projected to soar to 25%. Legislation and regulation can only go so far in fixing the system, and new technology can’t do much on its own. To truly combat health care’s cost challenge, the focus must shift to disruptive business models–innovative ways of delivering existing treatments at a much lower cost.

While new business models are needed across the spectrum of healthcare, many impediments prevent new ideas from taking root. Barriers stem from the fact that health care in America doesn’t function like the free market. For instance, consumers rarely pay directly for their own care, so there is little incentive for making trade-offs such as choosing something cheaper that costs less. The regulatory environment often doesn’t allow inexpensive solutions to make it to market. Finally, there are mismatched incentives: hospitals want patients to get that operation, but insurance companies don’t.

Health care in America doesn’t function like the free market. Given all that’s standing in the way of enabling new business models, we must take note when promising ones appear ready to take off.

The lesson isn’t that healthcare companies should accept charging less and making lower profits. Instead, through business model innovation, companies need to examine their value chains and throw away assumptions about the way things are done. By reinventing business models we can dramatically reduce costs and greatly improve care.

 

What does this all mean?

Successful healthcare organizations have to excel in:

  • Forging Trusted Relationships: Between Management, Providers and Patients
  • Building Networked Business Models: Connecting value-exchanging entities
  • Realizing Sustainable Economies of Scale: On both a discrete and networked basis
  • Focusing on Core Competencies: Borrowing skills and assets where required

To perform well, a healthcare organization needs,

1. Strong Management

2. Healthcare Information Technology

3. Employee Satisfaction and Retention

4. Patient Satisfaction

5. Quality Improvement

6. Training

7. Data Tracking

Q: How can changes be made?    

 A:  BY INNOVATION

Innovation of Management tools

1. Setting Goals

2. Value of Organizational Behavior

3. Develop workable business and IT infrastructure models.

4. Extending the patient-physician interaction beyond the office visit using telemedicine tools, as well as using health information exchange (HIE) to aggregate data from multiple sources.

5. Meaningful Use Guidelines:

  • Patients View, Download and Transmit Their Health Information
  • HIE Crossing Vendor and Organizational Boundaries
  • Secure Electronic Messaging
  • Summary of Care Documents
  • eMAR
  • Medication Reconciliation
  • CPOE
  •  Clinical Quality Measures

6. Applying Lean and Six sigma to current Management and workforce.

7. TELE-HEALTH: Being able to communicate using IT tools to help patients stay healthy and get rewarded well.

8. Transparency: Everyone should know what is happening in the organization.

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Seeking treatment for Eating Disorders

In Health, Healthcare, Medicine on September 18, 2012 at 8:00 am

Questions to Ask When Considering Treatment Options

 

There are various approaches to eating disorders treatment. It is important to find an option that is most effective for your needs.

Questions to Ask Your Treatment Provider
Once you have chosen a treatment provider, you may want to consider asking these questions in your first meeting.

Eating Disorders Survival Guide
Eating disorders can lead to significant physiological changes that require medical treatment in addition to psychiatric treatment and the reimbursement system does not allow for a holistic approach. For this reason, patients and families frequently have to fight to get the appropriate and necessary treatment.

Securing Eating Disorders Treatment: Ammunition for Arguments with Third Parties
Unfortunately, some patients and families frequently have to fight to get the appropriate and necessary treatment for eating disorders. Here are some arguments to use when trying to secure treatment from an insurance provider or another third party.

Substance Abuse and Eating Disorders
Research suggests that nearly 50% of individuals with an eating disorder (ED) are also abusing drugs and/or alcohol, a rate 5 times greater than what is seen in the general population according to the National Center on Addiction and Substance Abuse.

Suggested Medical Tests
A complete medical assessment is important when diagnosing eating disorders. Talk with your doctor about performing specific laboratory tests.

Sharing with EEEase
When you begin to notice that disordered eating habits are affecting your life, your happiness, and your ability to concentrate, it is important that you talk to somebody about what you’re going through.

Treatment of Eating Disorders
The most effective and long-lasting treatment for an eating disorder is some form of psychotherapy or counseling, coupled with careful attention to medical and nutritional needs. Ideally, this treatment should be tailored to the individual and will vary according to both the severity of the disorder and the patient’s individual problems, needs, and strengths.

What Should I Say? Tips for Talking to a Friend Who May Be Struggling with an Eating Disorder
If you are worried about your friend’s eating behaviors or attitudes, it is important to express your concerns in a loving and supportive way. It is also necessary to discuss your worries early on, rather than waiting until your friend has endured many of the damaging physical and emotional effects of eating disorders

Twelve Ideas for Negotiating the Holidays
The Holidays can be a time to spend with loved ones and a time to celebrate. They can also be a time when food and family can provoke anxiety and present triggers. This guide suggests a few ideas that may help you plan ahead and get your supports in place.

Source: http://www.nationaleatingdisorders.org/information-resources/general-information.php

 

Economic Costs Related to Overweight and Obesity

In Health, Healthcare, Medicine on September 14, 2012 at 8:00 am

As the prevalence of overweight and obesity has increased in the United States, so have related health care costs. The statistics presented below represent the economic cost of obesity in the United States in 2006, updated to 2008 dollars.

 

Q: What is the cost of obesity?

A: On average, people who are considered obese pay $1,429 (42 percent) more in health care costs than normal-weight individuals.

What is the cost of obesity by insurance status?

A: For each obese beneficiary:

  • Medicare pays $1,723 more than it pays for normal-weight beneficiaries.
  • Medicaid pays $1,021 more than it pays for normal-weight beneficiaries.
  • Private insurers pay $1,140 more than they pay for normal-weight beneficiaries.

What is the cost of obesity by the type of service provided?

A: For each obese patient:

  • Medicare pays $95 more for an inpatient service, $693 more for a non-inpatient service, and $608 more for prescription drugs in comparison with normal-weight patients.
  • Medicaid pays $213 more for an inpatient service,$175 more for a non-inpatient service, and $230 more for prescription drugs in comparison with normal-weight patients.
  • Private insurers pay $443 more for an inpatient service, $398 more for a non-inpatient service, and $284 more for prescription drugs in comparison with normal-weight patients.

 

Weight-loss and Nutrition Myths: Day 4

In Health, Healthcare, Medicine on July 20, 2012 at 8:00 am

 

Myth: Natural or herbal weight-loss products are safe and effective.

Fact: A weight-loss product that claims to be “natural” or “herbal” is not necessarily safe. These products are not usually scientifically tested to prove that they are safe or that they work. For example, herbal products containing ephedra (now banned by the U.S. Government) have caused serious health problems and even death. Newer products that claim to be ephedra-free are not necessarily danger-free, because they may contain ingredients similar to ephedra.

Tip: Talk with your health care provider before using any weight-loss product. Some natural or herbal weight-loss products can be harmful.

 

20 DAYS TOWARDS HAPPINESS AND HEALTH: DAY 19

In Health, Healthcare, Medicine on July 11, 2012 at 9:24 am

19. BUY A PLANT

Fact: A NASA study found that common house plants could improve air quality. In fact, they reported that houseplants were able to remove up to 87 percent of air toxins in 24 hours. The recommendation? Use 15 to 18 “good-sized” house plants in 6- to 8-inch diameter containers for a 1,800 square-foot house.

Plants are a great asset to any home or office. They depict Life and Growth. Green color has a very deep meaning to it. It is the color of nature. It relates to growth, peace, freshness, fertility and safety. Green color has wonderful healing powers. It is the restful color for the human eye; it can improve vision. Having a plant also increase oxygen content in air giving your more freshness and vitality.

If you already have one or many plants, rearrange them. Change their position. Or add a new plant to your existing collection.

20 DAYS TOWARDS HAPPINESS AND HEALTH: DAY 10

In Health, Healthcare, Medicine on July 2, 2012 at 9:23 am

10. EAT A HEALTHY BREAKFAST

 

Fact: Researchers from the National Weight Control Registry, a database of more than 3,000 people who have lost at least 60 pounds and kept it off for an average of 6 years, found that eating breakfast every day was a weight control strategy for 78% of the people in the registry.

Eggs, juice, milk, wheat bread, whole grain cereal and oatmeal are the best choices for a healthy breakfast. According to research, skipping meals, especially breakfast, can actually make weight control more difficult. Breakfast skippers tend to eat more food than usual at the next meal or nibble on high-calorie snacks to stave off hunger. Several studies suggest that people tend to accumulate more body fat when they eat fewer, larger meals than when they eat the same number of calories in smaller, more frequent meals. You do not have to have the same thing everyday. Change creates spice in life.

20 DAYS TOWARDS HAPPINESS AND HEALTH: DAY 7

In Health, Healthcare, Medicine on June 29, 2012 at 8:00 am

7. DRINK MORE WATER

 

Fact: 75% of Americans are chronically dehydrated. Drinking 5 glasses of water daily decreases the risk of colon cancer by 45%, plus it can slash the risk of breast cancer by 79%, and one is 50% less likely to develop bladder cancer.

Over 70% of human body is made of water, making it the most valuable energy source.

Benefits include

*Clears all body toxins

*Improves colon and bladder health

*Improves circulation

*Improves muscle strength

*Improves skin texture

*Promotes muscle growth.

*Reduces weight

*Better mood

*Better exercise

*Increased productivity

*Reduces fatigue and tiredness

20 DAYS TOWARDS HAPPINESS AND HEALTH: DAY 5

In Health, Healthcare, Medicine on June 27, 2012 at 8:00 am

5. FORGIVE 

Fact: “Judge nothing, you will be happy. Forgive everything, you will be happier. Love everything, you will be happiest.” ~Sri Chinmoy

 

To err is Human. We all make mistakes knowingly or unknowingly on a daily basis. Mistakes are our best teachers. They always teach us something. We get wiser with each mistake. It’s hard for people to forgive others and sometimes own self for things that happened. Whether someone has done it deliberately or undeliberately, it has happened already. There is not point holding it on for long. When we keep things unsolved for too long, it settles in the subconscious and creates waves of unpleasant neurochemical reactions which are harmful for mind and body. So forgive self or others for what they have done so that you can settle your subconscious.

HEALTHCARE PAYMENT SYSTEMS

In Health, Healthcare, Medicine on June 15, 2012 at 8:00 am

GOALS FOR IMPROVED HEALTHCARE PAYMENT SYSTEMS

In order to address the current problems with healthcare payment systems and to avoid the concerns about existing Pay-for-Performance systems, the following are twelve goals that revised payment systems should seek to achieve:

  • Payment systems should enable and encourage providers to deliver accepted procedures of care to patients in a high-quality, efficient, and patient centered manner.
  • Payment systems should support and encourage investments, innovations, and other actions by providers that lead to improvements in efficiency, quality, and patient outcomes and/or reduced costs.
  • Payment systems should not encourage or reward over-treatment, use of unnecessarily expensive services, unnecessary hospitalization or re-hospitalization, provision of services with poor patient outcomes, inefficient service delivery, or choices about preference-sensitive services that are not compatible with patient desires.
  • Payment systems should not reward providers for under-treatment of patients or for the exclusion of patients with serious conditions or multiple risk factors. Payment systems should not reward provider errors or adverse events.
  • Payment systems should make providers responsible for quality and costs within their control, but not for quality or costs outside of their control.
  • Payment systems should support and encourage coordination of care among multiple providers, and should discourage providers from shifting costs to other providers without explicit agreements to do so.
  • Payment systems should encourage involvement of patients in decision making, and encourage patient choices that improve adherence to recommended care processes, improve outcomes, and reduce the costs of care.
  • Payment systems should not reward short-term cost reductions at the expense of long-term cost reductions, and should not increase indirect costs in order to reduce direct costs.
  • Payment systems should not encourage providers to reduce costs for one payer by increasing costs for other payers, unless the changes bring payments more in line with costs for both payers.
  • Payment systems should minimize the administrative costs for providers in complying with payment system requirements. Different payers should align their standards and methods of payment in order to avoid unnecessary differences in incentives for providers.

In addition, an overarching goal is to have improved payment systems maintain or reduce healthcare costs, rather than increase them.

Measuring Success in Current Healthcare Times: Very Important

In Health, Healthcare, Medicine on June 14, 2012 at 8:00 am

An implicit goal of an improved Healthcare structure is to create an improved system of care for patients. So in addition to measuring patient-level outcomes, it will be important to measure whether the system itself is improving in ways that are believed to result in better patient care and better outcomes in the future. Some of the questions to be answered and measures to be developed include:

Are we strengthening primary care?

• Do more patients report that they have a primary care physician or team?

• Do more patients report that they can find a primary care team easily?

• Are patients able to communicate with their primary care team more readily?

• Do more primary care physicians report “joy in work” and being “fairly paid?”

• Has access to specialists, as reported by patients and primary care physicians, improved?

• Is primary care becoming more patient-centered?

• Do more patients report that they are getting exactly the care they need, exactly when and as they need it?

• Do more patients report that they fully understand their care, understand what they need to do to stay healthy, and that the care fully reflects their preferences?

Are decisions about payment and other issues more oriented toward patients’ interests than providers’ interests?

• Do patients report that their providers coordinate services effectively?

• Is care of patients with chronic illness becoming more efficient?

• Have expenditures for specific patients and conditions met the target levels?

• Has the percentage of care managed without face-to-face contact and in single visits increased?

• Have hospitalizations been reduced?

• Has there been a decrease in the frequency of procedures that had been performed previously at a rate above the national average?

• Has the rate of test repetition decreased?

• Have patients reported any greater problems in accessing care?

Are outcomes for chronically ill patients improving?

• Have blood pressure levels improved?

• Have Hemoglobin A1c levels improved?

• Do patients experience fewer limitations affecting their quality of life?

Are data being used for management and continuous improvement?

• How many quality/outcome/cost measures are available?

• How promptly are the measures available?

• Does the managing board of the provider review the measures regularly?

• Is the CEO compensation/performance plan tied to the measures?

Ref: nrhi.org

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