Healthcare
QUESTION 1
What measurable benefits are achieved by an integrated health system strategy? Identify and analyze an integrated health system. Describe the integration (e.g., vertical, horizontal). What are the specific goals of the strategy? How well are they being met?
POST 1
The current healthcare system relies on disconnected and fragmented patient care. To mitigate this issue, the Affordable Care Act (ACA) in part promoted consolidation and integration of health organizations to benefit the public and thus improve quality of care, decrease healthcare costs, improve patient satisfaction and coordination of care (Kirchhoff, 2013). An example of a vertical integrated system is Kaiser Permanente as it owns different companies in the same industry but offer different services. Kaiser Permanente is a system that combines health care coverage (Kaiser Foundation Health Plan), medical groups (Permanente Medical Groups) and hospitals (Kaiser Foundation Hospitals), and creates a closed loop system for both inpatient and outpatient care. The goals of this integrated health system strategy are to continue the commitment to eliminate barriers, collaborate effectively, and simply access to services needed (“Our Model”, 2022).
Kaiser Permanente continues to be a successful integrated system offering healthcare at reduced prices. Kaiser Permanente invested in electronic health record systems over twenty years ago, and are available at every point of patient contact, which reduces costs by avoiding duplicate testing, eliminating communication barriers between healthcare providers and at the same time increasing collaboration. Kaiser Permanente also uses mobile technologies, making healthcare more accessible and convenient for members. Furthermore, Kaiser Permanente’s revenue is through prepaid premiums which aligns incentives between the organization and members, without worries of reimbursement (Haslam, 2019).
POST 2
In the recent decade trend of the merger and acquisitions of hospitals, physician offices, and health facilities into integrated health systems has been seen countrywide. The integrated systems strategy supports collaboration and coordinated care between hospitals, physician clinics, health plans, post-acute providers, and other players in the care continuum to deliver value-based care (Teisberg et al., 2020). The benefits of value-based care are improved patient satisfaction, healthcare delivery cost reduction, and improved population health.
One of those integrations is Mount Sinai Health Integrated System consists of the Mount Sinai Medical Center and Continuum Health Partners in July 2013 (About US, n.d.). The system has a vertical structure consisting of 7,200 physicians and 13 free-standing joint-venture centers, with more than 400 ambulatory practice locations throughout the five boroughs of New York City, Westchester, and Long Island. Vertically integrated systems are the mergers of organizations with other organizations that provide different products or services (Heeringa et al., 2022). The vertical system structure promotes increased access to healthcare across the gamut of care services and improves cost-effectiveness and patient outcomes. The integration of the two companies increased efficiencies and economies of scale, especially with cost-saving opportunities with the ACO program at New York Medical Partners ACO, LLC (Accountable Care Organization, n.d.). The joined collaboration and integrated health records network to support quality improvement, patient outcomes, and access expansion to advanced primary, specialty, and ambulatory care services throughout a clinical network.
The goals of the integrated organizational structure strategy allowed the patients to see multiple providers within the same system, improving care coordination and outcomes. The integration enabled the care team to help patients, monitor the population's health across the continuum for the onset of illnesses, and develop prevention strategies to keep the population healthy. Having an ACO program is beneficial to patients financially to take advantage of cost-saving opportunities.
QUESTION 2
In the 1980s and 1990s, hospitals and health systems went on a buying binge, acquiring medical practices during the expansion of managed care. A generation later, the same phenomenon is recurring with industry consolidation and ACO experimentation. How does now differ from then? Can this trend improve quality and patient choice? Support your conclusion with valid references.
POST 1
Hospitals and health systems went on a buying spree in the 1980s and 1990s, acquiring medical practices as managed care grew. Managed care refers to a collection of initiatives designed to lower the cost of operating for-profit healthcare facilities and offering health insurance while enhancing the standard of care.
However, primary care providers were compelled to assume gatekeeper roles to manage a patient's access to care. A generation later, according to Madhlambudzi and Papanagnou (2019), a similar situation is playing out, in which health systems have once more gone on a buying spree due to industry consolidation and ACO experimentation. Accountable Care Organizations, or ACOs, are a collection of hospitals, physicians, and other healthcare providers who band together voluntarily to provide Medicare patients with coordinated, high-quality care (Kirchhoff, 2013).
During the ACO experimentation and industry consolidation, hospitals bought spree to get the necessary resources to deliver top-notch medical services to their Medicare clients. However, the buying spree that occurred in the 1980s and 1990s was distinct from the one that occurred a generation later in the 21st century because the former was motivated by the need to raise the standard of healthcare services provided by for-profit private healthcare organizations (Wilson et al., 2020).
To maximize their returns on investment, they sought to offer the highest quality care services at the lowest possible cost. However, the situation is different with the later binge purchases, where industry consolidation and ACO experimentation are the healthcare organizations' main priorities. In this instance, purchasing new medical practices raises the standard of healthcare services, lowers the cost of providing those services, and increases access to those services for more people (Madhlambudzi and Papanagnou, 2019). As a result, the latter opened its doors for more patients to access high-quality healthcare services at reduced costs through Medicare. In contrast, the former had to play gatekeeper roles to restrict the number of patients who accessed healthcare services. This trend will enhance patient choice and care quality in healthcare services.
POST 2
The role of the primary care gatekeeper from providers was to control patients' access to care. It was noted that generations later, a similar scenario played out where the health system went on buying binge with industry consolidation and ACO experimentation. Hospitals, doctors, and other healthcare providers voluntarily come together to give high-quality care to their Medicare patients is called Accountable Care Organization (ACO) (Madhlambudzi and Papanagnou, 2019).
Providing top-quality medical services to mediocre clients Hospitals brought binge into the ACO experiment and industry consolidation in a bid where they acquired the right resources. In the 1980s and 1990s, a big buying binge was experienced to improve healthcare services for private health organizations that provided services at cost (Marasli, Halis, and Halis, 2017).
In the hopes of providing the best quality care service at the least cost to maximize the return on investments. In the second binge purchase, the primary focus of the healthcare organization was to consolidate through the ACO experiment. Focusing on purchasing new medical practices to improve the quality of healthcare services can reduce the cost of healthcare services and promote the accessibility of more healthcare services (Madhlambudzi and Papanagnou, 2019). The gatekeeper role limited the number of patients with access to healthcare services and now can access quality healthcare services at a subsidized cost under Medicare. This trend helps to improve patient service delivery while giving quality care.
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