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?

HSM541 Health Services System
WEEK 8 Final Exam
Question 1 (TCO A) You are the newly hired chief knowledge officer (CKO) for a midsized hospital in a semiurban area of the country. Your first task is to develop the organization’s strategic plan that will shape the development of a comprehensive network of services for their community.
The organization provides the usual array of inpatient services expected in a moderate-sized community hospital. A local nursing home and retirement community is for sale, and the organization is considering the purchase of that agency. Several physician practices are also interested in alliances with the hospital. There is a local county health department that provides some clinic services, primarily for the uninsured.
You’ve been asked to give a presentation to the board of directors on options to restructure the local delivery of healthcare services. The hospital’s president has asked you to focus your presentation on the common elements a comprehensive delivery system attempts to accomplish and to highlight innovative methods of restructuring. The presentation will lay out the requirements of an integrated healthcare delivery system.
Question 2 (TCO B) You are the newly hired Vice President of Human Resources for the Bayside Regional Health System. You have the responsibility for all of the usual human resources functions, including retention plans, the training and development function, and the recruitment process. In addition, you have the additional departments of volunteers and the hospital chaplaincy services.
You’ve identified a number of serious organizational issues. Turnover is high, there are many job vacancies, and a very high number of positions are considered hard-to-fill positions because of national workforce shortages. There are also a very high number of EEOC complaints over the past 5 years for an organization of this size. Employees were blunt in their criticisms of the organization and its management in an employee survey conducted just prior to your arrival.
The board of directors and the president know that they have serious human resource issues. They understand that management practices have to change in order to compete in the local healthcare market as an employer of choice. As in any healthcare organization, fiscal resources are limited, but the board is firmly committed to investing in a well-developed human resources plan that will decrease the turnover and stem the ever-growing turnover and vacancy rates. The president has asked you to attend the next board of directors meeting to share your plan for addressing these serious issues. What will you tell them? Outline the focus of your presentation and include the issues you have identified, as well as the recommended strategies for turning this around.
Question 3 (TCO C) You are the administrator of a small nonprofit rural hospital. You have been approached by a large for-profit healthcare system located about 75 mi away for talks about a possible merger. You know that the for-profit system limits the amount of Medicare and Medicaid patients treated for economic reasons. These controversial decisions present not only a major breakdown in the healthcare delivery system but also in the financing of healthcare for many individuals in the United States. Discuss the pros and cons of becoming part of this urban system.
Question 4 (TCO D) As the Executive Director of the National Association for Managed Care Organizations, you know that national healthcare reform will bring about revolutionary changes in your member organizations. Public outcry for changes has been heard loud and long, Congress is calling for reform, and providers are extremely frustrated with how you pay and control the utilization of services.
You have been invited by a congressional panel to discuss how the managed care industry can be overhauled to provide a more customer-responsive product and address the issue of 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?
Question 5 (TCO E) You are the VP for human resources and have been charged to recommend a new healthcare benefits plan that will improve healthcare services for your employees but manage costs effectively. You employ approximately 1,800 employees, and the current health plan provides traditional healthcare services. You want to expand reimbursement for wellness and prevention services so that you can 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 VP for finance and the president of the health system this afternoon. Discuss the pros and cons expanding the prevention benefits of the health plan, and describe what services would be offered.
Question 6 (TCO F) You are the Corporate Vice President for Quality for the Patient-First Healthcare System, a national system of acute care hospitals located throughout the United States. Your organization has just approved additional monies for developing a new quality management system. Each hospital has implemented its own quality management program. Some of the programs demonstrate stellar results and high levels of patient satisfaction, whereas other hospitals have less impressive results.
Your focus as the corporate VP for quality is to develop a corporate quality improvement program that will be standard throughout all of the company’s hospitals. It must also 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 buy-in from your individual organizations that already have their own plan?
Question 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 the 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.