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Future of Managed Health Care Delivery Systems

You will select a topic for your Final Paper related to the Future of Managed Health Care Delivery Systems, which will be submitted to your instructor for approval during Week Two.  The 10-15 page paper (excluding title and reference pages) must follow APA guidelines for written assignments and contain eight to ten scholarly and/ or peer-reviewed sources, excluding the course textbook.  

Your paper must address the following bolded topics, which should be titled appropriately in your paper:

  1. Include an Abstract which is a synopsis of the overall paper.  
  2. Managed Health Care Quality should address such factors as whether or not patient health care needs and even preferences are being met; the care is right for the illness, care is timely, and unnecessary test and procedures are not ordered.
  3. Provider Contracting is when doctors and health care practitioners have a contract agreement through a third party payer to accept a specified payment for services provided to patients.
  4. Cost Containment deals with managing the costs of doing business within a specified budget while restraining expenditures to meet a specified financial target.
  5. Effects on Medicare and Medicaid in managed health care appear to be moving in a direction where both types of recipients will be enrolled in some type of managed health care plan in the near future.  
  6. The Future Role of Government Regulations, to include ERISA and HIPAA health care policies.
  7. Include Three Recommendations each, related to quality and change in Medicare and Medicaid managed health care plans.


Writing the Final Paper

  1. Must be ten- to fifteen double-spaced pages in length and formatted according to APA style as outlined in the Ashford Writing Center.
  2. Must have a cover page that includes: 
    1. Title of paper
    2. Student’s name
    3. Course name and number
    4. Instructor’s name
    5. Date submitted
  3. Must include an introductory paragraph with a succinct thesis statement.
  4. Must address the topic of the paper with critical thought.
  5. Must end with a conclusion that reaffirms your thesis.
  6. Must use at least eight scholarly and /or peer-reviewed sources, published within the last five years, including a minimum of three from the Ashford University Online Library.
  7. Must document all sources in APA style, as outlined in the Ashford Writing Center.
  8. Must include a separate reference page, formatted according to APA style as outlined in the Ashford Writing Center.

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Abstract

            This thesis present the achievement of the managed health care delivery systems, lessons for policy makers from different parts of the world and the reforms needed to improve the quality of service delivery, reduce the cost of health care provision, increase efficiency of Medicare and Medicaid as well as the future role of government in enactment of policies and regulations. Due to dynamics in health care industry related to backlash by providers and consumers, the future of the managed health care delivery systems is uncertain in United States of America. However, proper policies and regulations in place have proved to contain the increasing health care spending without affecting the quality of service delivery.

            Some innovative technologies applied in other parts of the world that does not necessarily relied on the US market environment have shown to be more appropriate when applied in private and public health care system. For instance, placement of incentives between health care providers and acquirers, use of performance measurement report cards and continuous acquisition of equipment that integrate disease management programs address the key challenges affecting the future of the managed health care delivery systems in most parts of the world. This paper recommends for selective adoption of voluntary US insurance market and single payer systems which allows for precise monitoring of their effects and systematic lower transaction costs. In addition, pharmaceutical and………………………………………………………………………………………………………………………………………………………………………………………………………………………………….

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Financial management of home health care

Unit VII Course Project
The course project must include at least the following sections; you may want to include others if you deem them appropriate:

  1. Introduction
  2. Challenges and Problems (associated with your topic)
  3. Review of the Literature
  4. Critical Analysis of Challenges/Problems
  5. Recommended Solutions
  6. Implementation of Solutions
  7. Justification of Solutions
  8. Conclusion
  9. References

Course project topic below:

Financial management of home health care

The course project must be seven to ten pages, double-spaced, not counting the cover page and the references pages. You must use at least five outside sources for your course project beyond the course textbook. At least one reference must come directly from the CSU Online Library. Web resources and professional journal articles will be key sources in researching your topic.
All sources used, including the textbook, must be referenced; paraphrased and quoted material must have accompanying APA citations.

Course Textbook
Berger, S. (2014). Fundamentals of health care financial management: A practical guide to fiscal issues and activities (4th ed.). San Francisco, CA: Jossey-Bass

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Financial management of healthcare is a rewarding and fascinating undertaking because the many concepts that involves have implication on both personal and professional behavior. In the professional perspective, today’s healthcare environment requires the managers to put more emphasis on financial management during decision making process in relations to carrying operations effectively(Speizman, 2009). In the foreseeable future, home health care and other health care organization will force the managers to effectively manage the financial resource in order to improve service delivery and attracts funding from donors such as philanthropy, financial institutions, charitable institutions and government. Financial management in home health care and any other health care institution involves two processes: strategizing the home health care’s financial direction and performance of daily financial operations.

            The process of strategizing the financial direction of the home health care is vested at the executive level such as chief financial officer (CFO). The main function involves the preparation and presentation of the home health care’s strategic financial plan for endorsement and approval by board of directors(Sandrick, 2008). Since most……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………..

 

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Developing a Health Advocacy Campaign


To be an effective advocate and to develop a successful health advocacy campaign, you must have a clear idea of the goals of your campaign program and be able to communicate those goals to others Developing a Health Advocacy Campaign. In addition, it is the nature of nurses to want to help, but it is important to make sure that the vision you develop is manageable in size and scope. By researching what others have done, you will better appreciate what can realistically be accomplished. It is also wise to determine if others have similar goals and to work with these people to form strategic partnerships. If you begin your planning with a strong idea of your resources, assets, and capabilities, you will be much more likely to succeed and truly make a difference with those you hope to help.
Over the next 3 weeks, you will develop a 9- to 12-page paper that outlines a health advocacy campaign designed to promote policies to improve the health of a population of your choice. This week, you will establish the framework for your campaign by identifying a population health concern of interest to you. You will then provide an overview of how you would approach advocating for this issue. In Week 9, you will consider legal and regulatory factors that have an impact on the issue and finally, in Week 10, you will identify ethical concerns that you could face as an advocate. Specific details for each aspect of this paper are provided each week. The Final Paper will be due in Week 10. This paper will serve as the Portfolio Application for the course.
Before you begin, review the complete Assignment. 
This week, begin developing your health advocacy campaign by focusing on the following:
Identifying a Problem
 To prepare:•Select a population health issue of interest to you and identify the population affected by the issue.•Locate two scholarly articles, each of which provides a description of an effective health advocacy program that addresses your issue. •Analyze the attributes of the programs to determine what made them effective.•Reflect on a policy you could propose or a change to a current policy to further improve the health of the population you selected with regard to the issue.•Consider how you could develop an advocacy program, applying the attributes identified in similar, effective programs.
To complete: 
For this section of your paper (approximately 3–4 pages in length) address the following:
•Describe your selected population health issue and the population affected by this issue.•Summarize the advocacy programs you researched in this area.•Explain the attributes that made those programs effective.•Develop a plan for a health advocacy campaign that seeks to create a new policy or change an existing policy with regard to the issue and population you selected. Be sure to include in your plan: ?A description of the public health issue and proposed policy solution ?Specific objectives for the policy you want to be implemented?The means by which you will convey information to various stakeholders on the need for this policy change ?Be sure your proposed need is substantiated by data and evidence.?Methods of establishing support for the policy, including how to influence policymakers 
•Explain how the attributes of the effective advocacy programs you researched could be applied to your proposed advocacy campaign.

Legal Considerations
 To prepare:•Review Chapter 3 of Health Policy and Politics: A Nurse’s Guide (3rd ed.) to determine methods of influencing the political process. •Reflect on whether the policy you would like to promote could best be achieved through the development of new legislation, or a change in an existing law or regulation.•Contemplate in what ways existing laws or regulations may impact how you proceed in advocating for your proposed policy. •Consider how you could influence legislators or other policymakers to enact the policy you would like to propose.•Think about the obstacles of the legislative process that may prevent your proposed policy from being implemented as intended. 
To complete:
For this section of your paper (approximately 3–4 pages in length) address the following: •Explain whether your proposed policy could be enacted through a modification of existing law or regulation or the creation of new legislation/regulation.•Explain how existing laws or regulations could impact your advocacy efforts.•Provide an analysis of the methods you could use to influence legislators or other policymakers to support your policy. In particular, explain how you would use the “three legs” of lobbying in your advocacy efforts. •Summarize the obstacles you anticipate arising in the legislative process and how you could overcome these hurdles.

To prepare for this final portion of your paper:•Review provisions 7, 8, and 9 of the ANA Code of Ethics in relation to advocacy for population health.•Reflect on the ethical considerations you may need to take into account in your advocacy campaign.•Research the ethical considerations, laws, and reporting requirements (with respect to lobbying) that are relevant to the location where your advocacy campaign will occur.•Consider potential ethical dilemmas you might face in your campaign.
To complete:
For this section of your paper (approximately 3–4 pages in length), address the following: •Explain any ethical dilemmas that could arise during your advocacy campaign, and how you would resolve them.•Describe the ethics laws and reporting requirements that are applicable to your advocacy campaign.•Evaluate the special ethical challenges that are unique to the population you are addressing.
Reminder: You will combine the sections of your paper developed in Weeks 8, 9, and 10 into one cogent paper

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Introduction

Mental health advocacy in the rural area involves the process of creating awareness, breaking attitudinal and structural barriers associated with mental illness in order to achieve positive results. The concept of advocacy is not a new phenomenon since similar actions have been implemented in urban. The main objective of developing health advocacy campaign for mental people in the rural area is overcome discrimination and stigma as well as promoting the rights of people with mental disorder (Druss, &Bornemann, 2010). In the United States, rights and the needs of people suffering from severe mental disorder became more visible in the past three decades. The Civil organization, consumers and families developed a platform in which the voices of these persons were heard. In the last decade, non-governmental organizations, their associates, and many mental health workers have tried to make general population and the society that person with mental illness have their human rights and should be supported to overcome the conditions.

Initially, advocacy was concentrated in urban areas where more mental health facilities were accessible. However, recently the services………………………………………………………………………………………………………………………………………………………………………………………………………………………………….

………………………………………………………………………………………………………………………………………………………………………Developing a Health Advocacy Campaign ………………………………………………………….

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Value of branding in health care.

Your assignment is to write a 4 page scholarly position essay in which you assess the value of branding in health care.
Specifically, under what circumstances do you feel that it is beneficial for health care organizations to use branding?
Can the use of branding have unexpected negative consequences? Explain in detail

Will be expected to:

  1. Provide a scholarly basis for your response.
  2. Justify your opinions with evidence from the literature.
  3. Cite several scholarly references in your essay.
  4. Properly cite all references in the text of your essay (either in parentheses or in footnotes), as well as at the end.

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Specifically, under what circumstances do you feel that it is beneficial for health care organizations to use branding?

            Branding is described as process in which the service or a product is differentiated from that of the competitors by the use of a symbol before the consumers. However, branding in health care is different from the other industries because it involves the provision of high quality products and services in order to ensure that the needs of the consumers are fulfilled while observing the ethical, legal and economic responsibilities of the organization(Chinomana, 2013). This shows that health care organization has the responsibility of ensuring that the interest of the stakeholders such as consumers, workforce and investors are preserved.

According to Smith (2010), the health care providers owes the investors the economic responsibility of ensuring that earnings are maximized. In addition, health care providers has the prerogative of ensuring that its operations complies with the requirements as established in the law(Fellows, 2013). This include the ethical responsibility of making sure that its operations abides to the ethical and social norms as established in the society. All these aspects may present challenges when a health care provider wants to promote or establish a brand.This paper discussed the circumstance in which branding is beneficial to health care organizations and how it can lead to unexpected negative consequences.

Health care providers play crucial role in the society since it serve as the platform for patients to access wellness and health. Recent studies………………………………………………………………………………………………………………………………………………………………………………………………………………………………….

……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………Value of branding in health care…………………………………………………………………………………………………………………………………………………………………………

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Pros and cons of Health Care Reform

What are the pros and cons of Health Care Reform? Present arguments from both sides, then tell me WHICH side you agree with, and WHY. Important issues to address are

Scarcity of resources,and the current market for health care
Elasticity of health care demand, and health care supply,
Is government intervention required ie is there market failure and/or public good scenario? Does economics indicate that this change will help Americans achieve higher living standards?
Government spending, and resource allocation- what role should the government play and how can government fund health care?
Could we make the health care “market’ more efficient?
Theory to Remember-

Price Elasticity: Elasticity means responsiveness- the extent to which a change in price will cause quantity demanded to change, other things held constant.
Elasticity and Total Revenues: There are three relationships among the types of price elasticity and total revenue.
Elastic demand: A negative relationship exists between changes in price and changes in total revenues.
Unit-elastic demand: Changes in price do not change total revenues.
Inelastic demand: A positive relationship exists between changes in price and total revenues.
Market Failures and Externalities: In a pure market system, competition generates economic efficiency only when individuals know and must bear the true opportunity costs of their actions.
Externalities: A consequence of an economic activity that spills over to affect third parties,i.e., parties who are not directly involved in a given activity or transaction
Public Goods: Public goods are goods to which the principle of rival consumption does not apply and that are jointly consumed by many individuals simultaneously.
Paying for the Public Sector: Systems of Taxation: The three sources of funding for governments are user charges, taxes, and borrowing.
Tax Rates and Tax Revenues: The two fundamental issues that governments face when they try to fund their operations by taxing market activities are how tax rates can be set to maximize tax revenues for the government.
Taxation from the Point of View of Producers and Consumers: Taxes on goods and services are levied by all levels of government. These taxes affect market prices and quantities.
When governments levy taxes on producers and require them to charge these taxes when they sell their output, the effect is to cause a decrease in supply.
The decrease in supply caused by the imposition of a tax causes equilibrium price to increase and equilibrium quantity to decrease.
Who Pays the Tax? Both producers and consumers end up paying the tax. The amount paid by consumers is the difference between the (higher) equilibrium price after the tax is imposed and the initial equilibrium price. The amount paid by the producers is the difference between the initial equilibrium price and (lower) price net of tax after the tax is imposed.

Remember that this can be controversial because denial of health care can result in permanent disability or death, So BE NICE TO EACH OTHER.

Here are some articles that you may want to read- Please dont read all 🙂

Health Care Reform Timeline (Links to an external site.)Links to an external site.
Obama’s healthcare reforms: your guide to the key provisions (Links to an external site.)Links to an external site.
ObamaCare: Pros and Cons of ObamaCare (Links to an external site.)Links to an external site.
Obamacare: Is it good or bad for Americans? (Links to an external site.)Links to an external site.
Is Obamacare Good or Bad? It’s All a Matter of Perspective (Links to an external site.)Links to an external site.
U.S. Healthcare Ranked Dead Last Compared To 10 Other Countries (Links to an external site.)Links to an external site.

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What are the pros and cons of Health Care Reform?

            The introduction of the Obamacare commonly referred to as Affordable Care Act (ACA) received equal support and criticism. Analysis indicated that proposers of Affordable Care Act was a ‘landmark legislation’ and ‘historic victory’ that reforms the US health care system by significantly reducing the health care costs, thus allowing millions of American citizens to afford health care(Roland, 2015). The health care reforms also protected the American citizens from exploitation by unfair insurance practices. According to Congressional Budget Office, this health care reforms will reduce the deficit by approximately $210 billion by 2021.

            On the other hand, the criticizers of this health care reforms termed it as ‘unconstitutional’ and ‘socialist’ because they believe it was a way the government was interfering with health care system(Cho, & Partridge, 2013………………………………………………………………………………………………………………………………………………………………………………………………………………………………….

 

References

Cho, C. & Partridge, M. D. (2013, December). The Affordable Care Act: Effects of the Healthcare Reforms. Retrieved from aede: https://aede.osu.edu/sites/aede/files/publication_files/ACA%20Policy%20Brief.pdf

Roland, J. (2015, June 15). The Pros and Cons of Obamacare. Retrieved from Health Line: https://www.healthline.com/health/consumer-healthcare-guide/pros-and-cons-obamacare#overview1

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Health Insurance Portability and Accountability Act

Library Research Assignment: Chief executive officer (CEO) Beranger wants to ensure that the current regulations and requirements under the Health Insurance Portability and Accountability Act (HIPAA) and the Security and Privacy Rules will be met as she continues to move Silver Creek Hospital towards a culture of e-Health beyond the implementation of an electronic health record system to the integration of telemedicine and data mining. She asks that you compose a report of 3–4 pages that includes the following information:

Describe the objectives of the HIPAA Security and Privacy Rules.
Discuss how HIPAA attempts to safeguard protected health information (PHI).
Explain how abiding by HIPAA rules and regulations may challenge the ethics of health care professionals.
Discuss the limitation of HIPAA and the ethical issues related to the use of electronic health data for research and development of evidence-based practice guidelines.

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The Healthcare Insurance Portability and Accountability Act (HIPAA) was enacted and signed into law on 21st August 1996, with the purpose of “improving the portability and accountability of health insurance coverage”. The act was intended to combat abuse, fraud and waste in health delivery and health insurance(Chaput, 2015). The act also simplified the management of health insurance, enabled the employees with pre-existing medical conditions to have coverage and promote the use of medical savings accounts by introducing tax break. The simplification of the administration of health insurance made the health care providers to adopt electronic health records. This pave the way for the enactment of Health Information Technology for Economic and Clinical Health Act (HITECH) in 2009.

The objective of the HIPAA Privacy and Security Rules

The core objectives of the HIPAA are to:

  •  Ensure availability, integrity and confidentiality of all ePHI that a CE or CE business associates transmits, maintains, receives or creates.
  • Protect against any reasonably integrity or hazards to the security or anticipated threat of such EPHI.
  • Protect against any reasonably anticipated losses or disclosure of ePHI.
  • Ensure compliance by its workforce

How HIPAA attempts to safeguard protected health informationAdministrative controls and safeguards: These are the administrative procedures, policies and actions taken to manage maintenance, implementation…………………………………………………………………………………………………………………………………………………………………………………………………………………………….

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Disease process with extensive public health implications

Research paper: Choose a disease process with extensive public health implications (e.g. heart failure, dementia, kidney disease). Research its impact upon both the national and international community, using such resources as the World Health Organization. Review the goals of Healthy People 2020 regarding this disease process. What inequities exist? Give examples of policies that shape the public nursing response to the disease process. Apply one of the theories of health maintenance and promotion to the aggregate. How does systems theory influence policy design?

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Human Diversity and Health Promotion

Name:

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Tutor’s Name:

Date of Submission:

Introduction

            Studies have showed that cardiovascular disease is the leading cause of mortality in developed countries. Heart failure is one of the chronic diseases that disrupt everyday life of the patient, their families and the wider community. The patients and their families spend enormous resources to attempt to seek out the most effective strategies, support and information to manage the disease and minimize interruptions(Mainar, et al., 2015). The prevalence of heart failure in developed countries especially the United States, Australian and United Kingdom is high. Some of the common symptoms associated with heart failure include fatigue, peripheral oedema and breathlessness, which causes multiple interaction with daily life. Depending with the severity of the attack, the patient may develop multiple chronic co-morbidities which may require complex treatment regime.            

World Health Organization has made the education of a patient to monitor their own health and being able to recognize illness severity as well as self-management of multiple chronic diseases as the current health care policy. Research have showed that symptom unpredictability leaves the patients to feel helpless and completely dependent on those around them, hence leading to lack of control on the illness and increasing the burden on the health care system and on the family(Fry, et al., 2016). In most circumstance, the responsibility for care shifts from the patient to the caregivers, spouses or immediate family. Under these conditions, the patient typically adopt to the ‘sick role’ thus depending on their families to provide support with their illness as well as in the previous responsibilities. During this time, a patient with greater levels of family support tend to build strong…..………………………………………………………………………………………………

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Health care reforms passed in the last year

Do a search to identify any health care reforms passed in the last year or currently under consideration by your state legislature. If you assume that government should address health care cost, quality, and access issues, should states be playing a major role or is that function better left to the federal government? In several paragraphs, discuss the relative pros and cons of a state-level approach versus a federal approach?

Secondly, provide an overview of the current state of the three streams of the policy process with regard to significant changes in health policy. Is there sufficient convergence today to support significant change? Which stream is weakest? Which is strongest?

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Healthcare Policy Week 4 DB 1

            There are several healthcare policies that were passed in 2018 by states. This was a response to actions taken by the federal and congressional health care legislation to stalled and undermined provision of the Affordable Care Act. The State policymakers stepped up to resolve various problems affecting Medicaid programs, access and cost of health care. Analysis showed that are were some legislative victories for health care in the 2018 state legislative sessions(Gomez, et al., 2018). One of the health care policy passed by Oregon State in 2018 was prescription drug pricing. This health care policy was among the popular approach for states in 2018 legislative session and it was designed to address the problem of high cost of medication. The first state to pass and sign prescription drug pricing policy was California State and it served as groundbreaking. The Oregon and Connecticut lawmakers followed the suit and passed similar measures.

            The Oregon States passed H.B. 4005, which obliged the drug manufacturers and insurers to make information transparent about the high and rising drug costs. The drivers of this bill were the Oregon State Public Interest Research Group (OSPIRG) and their partners. It makes mandatory for the insurers to inform the State’s insurance department about the prices of the costliest drugs and how they influence insurance premiums through the state’s rate review process.             Looking at this policy, it is evident that States play critical role is ensuring that American citizens get affordable, accessible and quality health care. It is advantageous for States because each state has unique requirements and challenges that needs to be addressed at the state level(Nilsen, 2019). It is disadvantage………………………………………………………………………………………………

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Human Diversity and Health Promotion

Research paper #1 – Choose a disease process with extensive public health implications (e.g. heart failure, dementia, kidney disease). Research its impact upon both the national and international community, using such resources as the World Health Organization.

Review the goals of Healthy People 2020 regarding this disease process. What inequities exist? Give examples of policies that shape the public nursing response to the disease process. Apply one of the theories of health maintenance and promotion to the aggregate. How does systems theory influence policy design?

Make sure to research on Human Diversity and Health Promotion

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Human Diversity and Health Promotion

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Introduction

            Studies have showed that cardiovascular disease is the leading cause of mortality in developed countries. Heart failure is one of the chronic diseases that disrupt everyday life of the patient, their families and the wider community. The patients and their families spend enormous resources to attempt to seek out the most effective strategies, support and information to manage the disease and minimize interruptions(Mainar, et al., 2015). The prevalence of heart failure in developed countries especially the United States, Australian and United Kingdom is high. Some of the common symptoms associated with heart failure include fatigue, peripheral oedema and breathlessness, which causes multiple interaction with daily life. Depending with the severity of the attack, the patient may develop multiple chronic co-morbidities which may require complex treatment regime.

            World Health Organization has made the education of a patient to monitor their own health and being able to recognize illness severity as well as self-management of multiple chronic diseases as the current health care policy. Research have showed that symptom unpredictabilityleaves the patients to feel helpless and completely dependent on those around them, hence leading to lack of control on the illness and increasing the burden on the health care system and on the family(Fry, et al., 2016). In most circumstance, the responsibility for care shifts from the patient to the caregivers, spouses or immediate family. Under these conditions, the patient typically adopt to the ‘sick role’ thus depending on their families to provide support with their illness as well as in the previous responsibilities.

During this time, a patient with greater levels of family support tend to build strong confidence between the patient and the family. The ties and bond between the family also tend to strengthen. This buttress the importance of strong support to the patients in times of illness to enhance patient well-being and achieve successful family functioning. This paper researched the impacts of heart failure to the national and international community, and review the goals of Health People 2020 in regards to the heart failure.

The impacts of heart failure to the national and international community            Research showed that the patients who have experienced heart failure in the course of their life acknowledged that symptoms of heart failure as disruptive to the daily life activities since it limits the ability of the patient as well as their families to carry out their everyday activities. The restriction of daily activities makes the patients to loss confidence and start questioning their self-esteem as well as their own identity. The situation is worsened when the initial diagnosis was wrong because it delays the appropriate treatment………………………………………………………………………………………………

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Importance of being an accountable individual in a health care organization

 

 

Imagine you have been working for a health care organization for an extended period of time. It is clear that you have a wealth of information about the accountability and liability that individuals and organizations should be aware of. You have been asked to present to new employees to inform them of the importance of being an accountable individual in a health care organization.

  1. Select a representative from the health care industry below who will represent the perspective of your presentation:
  2. Long-term care manager

Create a 4-slides Microsoft® PowerPoint® presentation that conveys the importance of accountability and liability implications for individuals and organizations in the health care industry and in which you:

  • Evaluate various forms of health care fraud.
  • Consider civil and criminal penalties associated with fraudulent activities.

Include a title slide; an introduction slide; and detailed speaker notes with 1 in-text citations of peer-reviewed, scholarly, or similar references to support your information as fact and give credit to your sources; a conclusion slide; and a references slide.

Format your assignment according to APA

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Read accountable individual in a health care organization