Health Insurance and Quality

Initiatives to Reduce Costs and Increase Patient’s Satisfaction

The two central objectives of any health care unit are to reduce the cost of operations and to provide quality healthcare services to its patients. To achieve this, three main initiatives may be employed. They include establishing standard provider fees, national data warehouse, and physician council. This paper will examine how the three initiatives reduce costs and increase healthcare efficiency. As a clinic manager of a center that has recently encountered complaints regarding health plans from patients, the paper will also examine my decision to accept Medicare or Medicaid pay sources.

The first initiative is to create one standard contract between all the health plans and providers that will result in standard provider fees. It can be done by having a group of knowledgeable personnel that will set national guidelines to be followed by all health plans and providers (Yamamoto, 2009). Two critical reasons for this initiative is to save administrative costs and reduce the time used in negotiating provider fees.  The national guidelines will enable providers to deal with one contractor, and uniform fees for all health plans will be applied. It is essential to both patients and healthcare providers. For instance, for the patients who use health plans, they will receive quality services as their providers have agreed with the health providers on service fees. For the healthcare providers, they will save on time and costs of negotiating prices.

The second initiative is setting up a national data warehouse. The warehouse will give out information concerning health claims and utilization of data (Sæbø, Kossi, Titlestad, Tohouri, & Braa, 2011). Having the claims data together will allow providers to have quality criteria analysis. The quality analysis will be useful to both the providers and the patients.  For instance, for the providers, they will understand the cost differences. For the patients, they will understand payment mechanisms, who are the quality providers, and regional differences in the health plans. This initiative potentially increases the quality of criteria providers use and in turn, results to quality services to patients.

The last initiative is forming a physician council. It is a byproduct of a data warehouse in which the council is responsible for analyzing the medical procedures reported in the data warehouse. The analysis will help physicians identify procedures that are easily achieved and have a considerable variation in cost by the community. The panel then identifies the reasons for variation, and after that, seek transparent practices that could reduce the cost variation and increase quality. In the end, patients receive quality procedures at an affordable cost.

As a manager, I would support Medicare and Medicaid pay sources for only those eligible in the programs as it will have benefits to both the care center and the patients. For example, suppose a patient has no money to seek medical services, the insurance will be responsible. Thus, the center can receive its payment even if some of the patients are in financial constraints. Another example is that the patients, regardless of their economic status, they can receive quality services courtesy of the Medicare and Medicaid programs because, for instance, the plan will cover for all the diagnosis and the medications they need.

To sum up, employing the three initiatives can reduce the costs of healthcare and increase the quality of services delivered to patients. They include; creating a standard contract between all health plans and providers, establishing a data warehouse, and having a physician council to analyze the quality of medical procedures against the cost.

References

Sæbø, J. I., Kossi, E. K., Titlestad, O. H., Tohouri, R. R., & Braa, J. (2011). Comparing strategies to integrate health information systems following a data warehouse approach in four countries. Information Technology for Development, 17(1), 42-60. doi:10.1080/02681102.2010.511702

Yamamoto, D. (2009, July 8). Three initiatives to reduce costs and increase health care efficiencies. Retrieved from https://thehealthcareblog.com/blog/2009/07/08/three-initiatives-to-reduce-costs-and-increase-health-care-efficiencies/