Question

You are part of a 8- or 9-member consultant group creating a proposal to implement a new/revised health care system to better working adults and elderly in the U.S. southern region. Which of the 5 high-income healthcare systems would you propose that your group consider as the model to follow for a new/improved U.S. health care system? and why? Explain. (In responding, apply the information and lessons learned from materials you read/viewed about U.S. health care and about your selected “high-income country” system/model to illustrate and justify your response perspectives).

Answer 1

If i were a part of a 8 or 9 member consultant groyp creating a proposal to improve health care syatem. ..then i would consider following things-

I veiwed and read u.s health care system deeply and i found so mych improved techniques which we can apply....here are few

2. Design models to reduce readmissions. Readmissions negatively impact a hospital's bottom line in several ways, such as the high costs associated with them and scrutiny from private health insurers and patients. Now part of President Barack Obama's healthcare reform, hospitals with high levels of preventable readmissions face the potential of losing a portion of their Medicare, Medicaid or other governmental reimbursements. "If [other hospitals] are not gearing up for that now, they are really behind the eight-ball,"

there are several ways hospitals and their physicians can effectively reduce their readmissions, such as ensuring patients attend post-acute office visits routinely after discharge and overall providing resources to people to ensure they are taking the proper post-discharge steps. "This has proven to be a key indicator to keep readmissions from occurring,".

1. Focus on the continuum of care. One of the biggest changes occurring in healthcare is the full-scale shift away from fee-for-service and volume-based measures toward accountable care organizations and quality-based measures. Ann Pumpian, CFO of Sharp Healthcare in San Diego, says hospitals will need to look at the entire continuum of care, regardless if they join an ACO, if they plan to stay profitable in 2012 and beyond. She says the continuum of care hospitals need to focus on includes the initial admission, how services are provided within that admission to create the most efficient process for a quick yet appropriate discharge, a discharge to the appropriate post-acute setting and follow-ups with that discharge.

hospital can take it one step further by fostering stronger, mutually beneficial relationships with physicians — especially primary care physicians. In addition to quality- and value-based principles, healthcare reform is also centered on preventive care, managing chronic illnesses and keeping people healthy before a hospital trip is required. To do that while staying profitable, Mr. Talbert says hospitals must focus on physician alignment and actively engage with the primary care physicians in their communities. "The primary care physician is the air traffic controller for the patient," he says.
an also emphasizes the hospital-physician relationship. Although some states prohibit hospitals from employing physicians, she says hospital efficiency and solvency hinges on a hospital's affiliation and collaboration with physicians. Physicians facilitate patients through the continuum of care, and next year, it will be paramount for hospitals to keep and recruit high-quality physicians who increase a hospital's referral base, have high ratings of patient satisfaction and have the highest commitment to quality patient care. "What is key is to make certain that these physicians and institutions are going in the same direction, "Both need to be incented to do the same thing, which is what's best for patient care."

2. Design models to reduce readmissions. Hospitals that realign their goals toward the entire continuum of care can then focus on one of the more pertinent aspects: reducing readmissions. Readmissions negatively impact a hospital's bottom line in several ways, such as the high costs associated with them and scrutiny from private health insurers and patients. Now part of President Barack Obama's healthcare reform, hospitals with high levels of preventable readmissions face the potential of losing a portion of their Medicare, Medicaid or other governmental reimbursements. "If [other hospitals] are not gearing up for that now, they are really behind the eight-ball,". "They should've been doing this years ago."

She says there are several ways hospitals and their physicians can effectively reduce their readmissions, such as ensuring patients attend post-acute office visits routinely after discharge and overall providing resources to people to ensure they are taking the proper post-discharge steps. "This has proven to be a key indicator to keep readmissions from occurring,"

a hospital's preparation for the readmission risk is "absolutely critical," and much of the responsibility will fall on a hospital's case management and preventive care staff, who will need to be properly trained and managed to ensure overall readmission rates go down. "A hospital's case management [staff] has to engage in conversations with the patients to help them be compliant with that care path," Mr. Downing said. "There's a wealth of effort and resources that hospitals apply, but they're going to have to become even better at that."

3. Have a good relationship with payors, and renegotiate managed care contracts. While hospitals cannot control the underpayments from Medicare, Medicaid and other governmental payors, they have a semblance of control over one major outlet: commercial and employer-based payors. Mr. Talbert says private insurance carriers comprise, on average, 35 percent of a hospital's revenue.

principa at healthcare consulting firm Equation, hospitals must take the time to understand existing contracts, benchmark managed care contracts against each other, conduct research to know what percentage of the insurer's business comes from the hospital, routinely update stagnant and evergreen contracts and look for carve-out opportunities. Hospitals and their managed care departments must be prepared when renegotiating contracts, but at the same time, a level of respectful dialogue must exist — otherwise, fallouts will occur, leading to costly periods of no reimbursement and a public relations nightmare. "Often times, people don't think about the fact there is a mutual respect that needs to occur with the payor and institution, "That is earned over time in a manner that allows you to help collaborate, design and develop the care delivery models and product designs that those payors will ultimately use."

4. Manage new service lines to increase market share. When it comes to "creating new streams of revenue" for hospitals, this most commonly refers to adding new service lines. I , agree increasing market share through new services is the most effective way to deal with any reduction in net payments.

Hospitals should not merely add any service line — for example, orthopedics — because it is historically profitable. needto conduct research and look at the demographics of their locale to determine which service lines are needed, what competitors in the area offer and what services stand to gain the most referrals. For example, roughly 10,000 baby boomers are becoming eligible for Medicare every day. Additionally, the surrounding population tends to have a higher concentration of obese patients, and therefore Cumberland is also focusing on enhancing its orthopedic service line.

. Reduce supply costs by working with vendors and physicians. After labor costs, supply costs are the second-largest money eater of a hospital's operating budget. hospital leaders can reduce supply costs through two main ways: working with vendors to improve contracts and encouraging physicians to make fiscally responsible supply decisions. "A hospital should not shy away from approaching vendors for discounts,"This may help alleviate costs on the purchase product, and in my experience, most vendors are willing to negotiate if the volume of product allows for it." Additionally, approaching physicians and working together to create a more cost-conscious supply plan for every department can help foster a better working relationship with physicians in addition to supply savings.