****For C. Owens Only****

jackson Health System

Business Case

Date: 09/22/2019

TABLE OF CONTENTS

4 1 Executive Summary

5 2 Introduction

5 2.1 Purpose of Business Case

5 3 gENERAL Project iNFORMATION

5 3.1 Problem Statement

5 3.2 Background and Context

5 3.3 Goals

5 3.4 Scope

6 4 Ground Rules, Assumptions, and Criteria

6 4.1 Ground Rules

6 4.2 Assumptions

6 4.3 Evaluation Criteria

1 Executive Summary

[Provide a synopsis of the key points of this Business Case document. Avoid ambiguous acronyms, terminology, concepts, etc. The Executive Summary is a critical component of the business case. Typically, the Executive Summary is the first section to be read and analyzed by decision-makers; often times it is the only they will read. For this reason, this section should be concise, no more than two pages in length.

While the Executive Summary is the first section to be read it is the last section to be written because it must summarize elements of the entire document. The Executive Summary should “identify the problem statement in question, and highlight key elements of the recommendation. It should summarize mission and business impacts, analyses results, as well as briefly address other important sections as required to help the reader quickly understand the BCA’s… recommendation. The Executive Summary provides the recommended solution and why it is recommended over the competing alternatives. It should include a reference to each rejected alternative and how it compares to the recommended alternative in costs and benefits, pros and cons, and other relative merits …. This comparison can be portrayed as a balancing of tradeoffs among alternatives for a more robust recommendation. Items within the recommendation section should minimally include: Key assumptions that drove the recommendation, Brief description of the alternatives, Description of the approach, Summary of objective criteria and conclusions, Description of the implementation plan at a level of detail necessary to support the recommendation” (DOD, 2011, pp. 13-14)]

2 Introduction

3 gENERAL Project iNFORMATION

4 Ground Rules, Assumptions, and Criteria

4.1 Ground Rules

Before making any recommendations, several aspects must be taken care of. Among them is the key consideration of the rules and regulations in health. The public health act sets in place several rules that must be adhered to. First, the act prohibits hospitals from charging excessively in health services. The fees paid by patients are required to be considered fair. Therefore, making recommendations of any policies regarding the regulation of costings in patients must adhere to this regulation. It is also important to consider the affordable care act that has brought many citizens to insurance coverage (Sommers, Gunja, Finegold, & Musco, 2015). Any recommendation should consider the affordable care act as it will help low-income patients get their bills paid through government health plans.

Any assumptions should consider all the funding streams available. The main funder of health services is, in particular, the federal government. In this case, the federal government has the mandate to provide resources and programs such as incentives that will help in reducing the costs of health services. This will, therefore, help in enhancing the affordability of health services. The premium personal insurance is another consideration. Any recommendations or policies to be implemented should seek to ensure better payment rates and in time payments to health, facilities to aid in easing the burden of unpaid bills at the health facility. Patient in pocket expenses should be paid instantly upon delivery of services.

Studies indicate that over 43 million Americans have unpaid medical debts. These figures are alarming as it has put a huge financial embargo to health facilities (Balasubramanian, & Jones, 2016). Therefore, any recommendations made are supposed to aim at significantly reducing this number. This number has since led to some health facilities to sue clients. These conditions are not ideal and therefore, assumptions made should consider that the billing and collections are a big problem.

4.2 Assumptions

Payment estimations are done in billing and collections departments are done to ensure transparency. Estimations help the patients to pay for the right value of the service. Besides, the payment estimations help patients and the billing department has an initial discussion on the patient’s responsibility in bill payment. With this process in place, a determination is made that the bill claimed by the health facility are legitimate. Therefore, the bills being legitimate indicates that the various sources of funding are required to pay the bill upon the health facilities demand. The assumptions here is that, since the process of billing is transparent, the sources of funding have the obligation to pay incurred bills.

Regulations provided through the Health insurance portability and accountability act (HIPAA) are important in-patient verification. The provisions in the act have provided for avenues of reducing fraud in health facilities. Confirmation of patient identity is important as it ensures that both the personal and government packages pay for the designated patients. HIPAA was established over two decades ago and has evolved. The problem of billing at the Jackson health system can, therefore, be assumed to be attributed to poor implementation of Programs established by HIPA (Rollo, Hutchesson, Burrows, Krukowski, Harvey, Hoggle, & Collins, 2015). Specifically, The HIPPA compliant video software may have some flaws that need to be mend.

Patients financial clearance and health insurance eligibility is another key consideration among the assumptions. The informed decisions made upon patient clearance may have some flaws and therefore leading to accumulation to bills. These decisions determine which patients are eligible for financial help. Poor decisions are made may lead to patients eligible for help not getting the necessary help from the sources of funding and therefore leading them to fail to pay bills. Health insurance eligibility flaws can be assumed to cause problems that lead to processing errors and denial of funds from insurance providers. Costly reworks may also be caused when proper eligibility checks are not performed on the patient and therefore leading to a lack of responsibility of paying bills.

4.3 Evaluation Criteria

The HIPAA video compliance software is an important element in bills and collections. The software is robust as a result of being built through great technical expertise. This, therefore, enables the software services to be always available apart from a few occasions of scheduled maintenance (Gurung, & Kim, 2015). The software is therefore reliable as it provides data clerks to verify and authenticate patients. Besides, the software plays an important role in the processing of patient's bills. This, therefore, makes it a reliable method of billing and collection monitoring.

On another dimension, The HIPAA video compliance software supports health functions such as patients tracking through video. With his capability, the support of telemedicine helps in the reduction of costs of health services and therefore supporting patients in managing payments of health services. The system entropy of the software is low with the software system expected life is over 10 years. Therefore, the economic feasibility of the system is good as the initial capital required to implement the software is justified by the large useful life of the system.

The manageability of the HIPAA video compliance software is satisfactory. The software is cloud-based and therefore the system can be managed from any remote location. The system is also sustainable as its maintenance costs are relatively manageable. The security of the cloud servers is high and supports an infinite storage facility and therefore enhancing the sustainability of storage space (Peterson, & Watzlaf, 2014). The system is also versatile as it provides for various uses. Patient management, patient care among other services.

References

Balasubramanian, S., & Jones, E. C. (2016). Hospital closures and the current healthcare climate: the future of rural hospitals in the USA. Rural and remote health, 16(3), 3935.

Gurung, S., & Kim, Y. (2015, April). Healthcare privacy: how secure are the VOIP/video-conferencing tools for PHI data?. In 2015 12th International Conference on Information Technology-New Generations (pp. 574-579). IEEE.

Peterson, C., & Watzlaf, V. (2014). Telerehabilitation store and forward applications: A review of applications and privacy considerations in physical and occupational therapy practice. International journal of telerehabilitation, 6(2), 75.

Sommers, B. D., Gunja, M. Z., Finegold, K., & Musco, T. (2015). Changes in self-reported insurance coverage, access to care, and health under the Affordable Care Act. Jama, 314(4), 366-374.