Integrated Health Care System

A national health care system in the United States has been a contentious topic of debate for over a century. Social reformists have been fighting for universal health care for all Americans, while the opposition claims that a “social” heath care system has no place in the ‘Land of the Free’.

Roemer’s model of a health care delivery system shows the different necessary elements for a system to be successful. As health needs are the input; the system needs resources, organization of programs, economic support mechanisms, and delivery of services to provide the health needs output (Roemer, p 33). Able 2 is an organization that provides services to people with disabilities. They have many resources, but perhaps not enough to meet the health needs of every consumer. They have well organized programs, have economic support, and can deliver services completely and holistically to produce health as the output of the client. The most important implication that was found in analyzing Able 2 was the need for increased resources as they are not able to meet the needs for every client in need of its services. Ultimately though, Able 2 is an excellent organization that provides an array of services for those people with disabilities.

Health Information Exchange (HIE) has become a major component in today’s healthcare. Health information exchange provides a secure way for providers to appropriately access and electronically share a patient’s medical information. Therefore, reducing duplicate testing, minimizing medication errors and providing a link among electronic health records (EHR) in order to provide quality healthcare.

The Michael R. Zent (MRZ) Integrated Healthcare Center was established in January 2006 to provide comprehensive and integrated healthcare services to individuals with mental health illness in Phoenix Arizona. The integration behavioral and physical health services across the continuum of care provide a seamless care delivery system that offers patients a holistic care based on their psychosocial needs and diagnoses. Achieving a sustainable efficient and effective integrated care program requires multiple evaluation and modification of operational and administrative processes using a Plan, Do, Study, Act (PDSA) methodology.

Kaiser Permanente is one of the largest integrated healthcare delivery systems. Serving over eight million individuals across nine states, and the District of Columbia. Kaiser Permanente developed a internet patient portal, KP Online in 1990. The KP Online patient portal offers patients immediate access to health information and enables members to schedule appointments, request prescription refills, seek clinical advice, obtain health care information, and interact in forums.

The concept generates images of large healthcare entities managing the administrative protocols of prior authorization or denials to the actual delivery of care through a facility or network of healthcare providers. Hacker and Marmor (1999) described several meanings of the term managed care with the most applicable to the menagerie of forms managed care can take being a combination of the financing and delivery of healthcare services. While this particular study is dated, the authors contend any managed care structure features administrative oversight, patient steerage to a particular provider entity or network and the amount of risk-sharing whether at an individual or group level. These features continue to be true today as organizations explore the benefits offered to employees through managed care structures such as preferred provider organizations, clinically integrated networks, and accountable care organizations. As a healthcare provider, the goal is to provide access to healthcare which is affordable, offers access to providers of choice and engages with providers who provide the highest quality

The U.S has many payer systems which many believe it to be its downfall among other countries. This may be because many view it more as an economic business and not an overall wellness plan. The United States’ main public program of funding is Medicare, which once followed a standard form of payment. It is now envisioned as a futuristic model that encompasses the payments of providers. Medicare is a national social insurance program that is run by the government since 1966. Also unlike Great Britain system, the program provides health care to Americans over 65 years of age for those who have paid their work dues in the system. Medicare has also extended its reach to those Americans who may be veterans or disabled. Another huge form of payment to providers is through Managed care which can be beneficial to physicians in the fee for service and capitation aspect. While this form of payment is similar to Great Britain’s programs, their execution of it remains vastly different. Managed Care is a type of healthcare system with health care plans that has restrictions on its selection of facilities and health care providers at a reduced cost for the patient. Rather than come to a conclusion about better ways to negotiate with payers, U.S providers continue to rage war against

1. What are the basic characteristics that differentiate the U.S. health care delivery system from that of other countries?

Integrated Managed Care Organization- The organization is properly aligned for the primary driver being cost cutting services. Since all entities within the organization are responsible and affected by any expenses endured on any entity being unfavorable or favorable, the foundation serves as a primary motivator to reduce costs at all levels. This alignment eliminates any financial gains from driving high utilization of services or higher intensity services within the organization. Ultimately, this system allows the physician medical group to drive care, being responsible for the clinical care decisions as opposed to health plan making those decisions as designed in other organizations. This is the preferable model for Medicaid systems as

Over the years Canada has been making efforts to adopt an integrated health care system. There is existence of disconnected sections in the healthcare system that involves hospitals; doctor’s working conditions, community service groups among others. Various provinces in Canada are taking risks and experimenting with different structures and approaches in an effort to provide better services and overall improved healthcare to its residents. Examples include: Regional Health Authorities and Local Health Integration Networks. Despite all these efforts, Canada’s regional health authorities still do not have characteristics of a fully integrated system. (Hospital Management Research Unit 1996, 1997). In contrast to Canada, most developed countries

The design of an organization is a “formal, guided process for integrating the people, information, and technology of an organization” (Glickman et al., 2007). A good organizational design increases the likelihood that an organization will succeed; that its’ values will be realized and its mission will be attained. An organization begins with a strategy or a purpose, is followed by its philosophy or values, then identifies the mission and finally evaluates the environment and its’ strengths, weaknesses, opportunities, and threats to the organization (Kelly & Crawford, 2008).

In the Harvard Business School case study of Intermountain Health Care (IHC), we learned about the efforts made by IHC to adopt a new strategy for managing health care delivery that is focused on improving care quality while simultaneously saving money. Beginning in 1986 as a series of experiments tying cost outcomes to traditional clinical trials, IHC’s approach to delivering care became known as “Clinical Integration” which “referred to both an organizational structure and a set of tools” (Bohmer, 2002). The organizational structure required a departure from the traditional administrative management model to one that “involved administrative and medical

In this paper there will be a brief discussion of three forces that have affected the development of the U.S healthcare system. It will observe whether or not these forces will continue to have an effect on the U.S healthcare system over the next decade. This paper will also include an additional force, which may be lead to believe to have an impact on the health care system of the nation. And lastly this paper will evaluate the importance of technology in healthcare.

Given the fact that the United states of America and Canada are linked together sharing a border which is open basically to and from both sides, their health care systems are highly different from each other and how the services are financed, organized and given to the citizens.

The information technology is changing the world at deviate speed and evident in the healthcare system. The integration of new technologies within the system are emerging the change in nursing practice and improvement of patient safety. The purpose of this paper is to provide an overview on the implemented in nursing practice strategies and contribution of information technology to the development of new healthcare system.