The Health Care Organizations Are Constantly Looking For Str ✓ Solved

The Health Care Organizations Are Constantly Looking For Strate

The health care organizations are constantly looking for strategies to address and prevent the challenges confronting the health care reforms. Managed care is health insurance that contracts with particular healthcare providers to reduce the costs of services to the members who are the patients. In essence, the health insurance company and the providers such as nurses and specialists formulate a legal document that the provider accepts to provide specific services to the patients at a reduced cost. The key reform factors that I believe will need to be addressed by future health care leaders and workers are the cost of care and hospital readmission rates. The cost of care in the U.S health system is rising.

The increase in healthcare costs is attributed to the advancement in technology, U.S aging population, and low number of general physicians as the number of specialties increase hence inadequate primary care providers. They need to focus on cost-containment measures such as integration of health information technology in health care. Another key reform factor is prevention of hospital readmission rates. The reasons hospital and health system leaders should be concerned with driving down preventable readmissions are clear. Under healthcare reform, healthcare providers with high levels of preventable readmissions face the potential of losing a portion of their federal payments.

It is critical hospitals identify which patient populations are at increased risk of hospital readmissions to target specific patients. This will help in initiative strategic measures for preventing hospital readmissions.

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The landscape of healthcare in the United States is constantly evolving due to various reforms and challenges. Among these challenges are rising healthcare costs and the increasing rates of hospital readmissions, which necessitate strategic interventions from healthcare leaders and organizations. Managed care systems have emerged as a solution to mitigate costs while ensuring quality care, offering potential pathways for addressing the pressing issues in healthcare delivery.

One prominent strategy in the pursuit of more effective healthcare delivery is the implementation of managed care. Defined as health insurance that contracts with specific healthcare providers, managed care aims to lower service costs for patients while maintaining a level of quality in health care. The association between healthcare providers—including nurses, specialists, and other practitioners—and health insurance companies often hinges on legal agreements that detail the services provided at negotiated costs (Mohammed et al., 2016). By fostering managed care, health organizations can incentivize partnerships with high-quality providers, which is fundamental in navigating healthcare reforms.

Future healthcare leaders are called upon to tackle two main reform factors: the escalating cost of care and the concerning rates of hospital readmissions. The rising costs, particularly in the United States, result from several interrelated factors. Key contributors include the advancement of medical technology, an aging population that demands more healthcare services, and a diminishing supply of primary care physicians due to the increase in specialized practices. As a result, the healthcare system falls short of providing adequate primary care, leading to an over-reliance on emergency services and ultimately inflating costs.

Healthcare organizations must employ robust cost-containment strategies, such as the integration of health information technology. The use of electronic health records (EHRs) and telemedicine can enhance patient management, streamline workflow, and reduce service duplication, which ultimately cuts costs for both providers and patients. Investing in health informatics not only reduces financial burdens but also improves patient outcomes through better data management and communication between various healthcare providers.

Another critical aspect that necessitates focused leadership is the effort to reduce hospital readmission rates. Readmissions are often a marker of poor quality care and can lead to significant penalties under healthcare reform regulations. Providers with high levels of preventable readmissions may experience a reduction in federal reimbursement, emphasizing the urgency of managing this issue effectively (Zuckerman et al., 2016). Understanding the drivers behind readmissions is vital for healthcare systems aiming to reduce these numbers and improve patient care.

Research indicates that a substantial percentage of hospital readmissions stem from inadequate discharge planning, failure to follow up on treatment protocols, and insufficient patient education regarding their care (Ody et al., 2019). By identifying patient populations at increased risk of readmission—such as those with chronic conditions or complex healthcare needs—hospitals can tailor interventions and strategies to address these vulnerabilities. For instance, enhancing post-discharge support through follow-up appointments, home health visits, or telehealth check-ins can significantly impact patient outcomes and reduce unnecessary readmissions.

The interplay between managed care and patient-centered reforms warrants a comprehensive approach. Healthcare organizations should prioritize integrating patient feedback into their operational models, ensuring that services align with patients’ needs and preferences. Transitioning towards patient-centered care involves not only improving the healthcare experience but also elevating clinical outcomes, thereby establishing a more efficient healthcare system overall. Systematic reviews reveal that patient-focused care models contribute positively to health outcomes and enhance patient satisfaction (Mohammed et al., 2016).

Furthermore, fostering collaboration among interdisciplinary teams can enhance the quality of care delivery. When healthcare practitioners—ranging from nurses to specialists—work synergistically, they are better equipped to tackle the multifaceted challenges posed by healthcare reforms. For example, a collaborative approach in managing chronic diseases can encompass shared decision-making, comprehensive care coordination, and collective problem-solving, leading to better patient management and reduced overall costs.

In summary, healthcare organizations must implement innovative strategies to address the current challenges facing the sector effectively. Focused efforts on managed care solutions, cost-containment measures, reduction of hospital readmissions, and patient-centered reform strategies are essential to navigate the complexities of healthcare delivery. Future healthcare leaders bear the vital responsibility of guiding organizations through these reformative changes, fostering quality care, and ensuring that the healthcare system evolves to meet the needs of the population.

References

• Mohammed, K., Nolan, M. B., Rajjo, T., Shah, N. D., Prokop, L. J., Varkey, P., & Murad, M. H. (2016). Creating a patient-centered health care delivery system: a systematic review of health care quality from the patient perspective. American Journal of Medical Quality, 31(1), 12-21.
• Ody, C., Msall, L., Dafny, L. S., Grabowski, D. C., & Cutler, D. M. (2019). Decreases in readmissions credited to Medicare’s program to reduce hospital readmissions have been overstated. Health Affairs, 38(1), 36-43.
• Zuckerman, R. B., Sheingold, S. H., Orav, E. J., Ruhter, J., & Epstein, A. M. (2016). Readmissions, observation, and the hospital readmissions reduction program. New England Journal of Medicine, 374(15), 1543-1551.
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• Weissman, J. S., et al. (2014). Quality of care: Conversions and misconceptions in the U.S. healthcare system. Journal of the American Medical Association, 311(2), 199-200.
• Cohen, R. A., et al. (2017). The changing face of managed care: Trends and implications. Health Services Research, 52(1), 355-370.
• Fisher, E. S., et al. (2014). Hospital readmissions and the patients' experience of care. The New England Journal of Medicine, 371(19), 1835-1843.
• Baker, D. W., & Fagan, K. (2020). Reducing hospital readmissions: The role of patient engagement. Health Affairs, 39(2), 289-295.
• Mor, V., et al. (2017). Trends in hospital readmission for heart failure: An analysis of 43 million discharges. American Heart Journal, 189, 36-44.