As the executive director of a managed care company, you have been invited by Congress to consult about national healthcare reform. Public outcry for changes in managed care practices is ongoing. Congress is calling for reform, and medical providers are extremely frustrated with how you restrict care and offer low reimbursements. Congress has asked you to discuss how the managed care industry can be overhauled to provide a more customer-responsive product and to control national healthcare costs. What are the high-priority issues that will need to be discussed to overhaul the managed care industry? What stakeholders must be considered in the planning process? (Points: 20) 5. (TCO E) You are the VP for human resources and have been given the assignment to come up with a new healthcare benefits plan that will improve healthcare services for your employees and control costs. The health plan currently covers services provided in healthcare services. You employ approximately 1,800 employees and already determined in this new plan, you want to provide traditional healthcare services and further develop a more preventative and wellness focus. Your goal is to improve the health of your employees, thereby saving monies in your illness coverage as well as nonproductive time in sick days. You are meeting with the president of the health system this afternoon. What will you say to him or her? (Points: 25) 6. (TCO F) You are the newly hired hospital administrator for Healthcare-U.S. System, a national system of tertiary hospitals located throughout the U.S. Your organization has just approved new monies for developing new quality management initiatives. The individual hospitals have implemented their own quality management programs. Some of these programs have produced stellar results and high levels of patient satisfaction, although others have had much less success. Your focus as the newly hired administrator is to develop a corporate quality improvement program that will be standard throughout the company’s hospitals. The quality improvement plan must be responsive to any local needs or issues. How will you craft that plan? What will you include in your plan? Include some specific examples of what you might measure. How will you get to buy-in from your individual organizations that already have their own plan? 7. (TCO G) You’ve just been hired as the Chief Operating Officer (COO) for a new orthopedic physician practice. The new practice was created by two previously independent practice groups that had fines for governmental regulatory violations, as well as suspected fraudulent billing practices. You just received a subpoena to appear in court and testify as to your role in the organization and knowledge of billing practices. All you know is that the clinic has recently purchased a new electronic billing and medical records system that is HIPAA-Compliant. One goal of this electronic system is to address all areas of compliance and to clean up any issues from the past. It is also intended to position the new organization as an organization with an impeccable reputation for compliance. Articulate your vision for this plan and components that are required for its success. How will you justify the expense associated with your plan? Keep in mind that you have a newly formed organization and differing organizational cultures. (Points: 40)
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