Role of Healthcare Plans in Disease Management

In: Business and Management

Submitted By alek8012
Words 360
Pages 2
The Role of Health Insurance Companies in Disease Management

Abstract This paper will analyze the increase in healthcare costs that has attributed to a trend in health insurance plans’ and employer groups focus on disease management through emphasis on wellness programs (Ex; health club credits), and disease management with the hopes of preventing and decreasing the number of insured’s with chronic illnesses. Disease management is defined as a systematic approach to coordinated health care that seeks to identify individuals and populations who are at risk of developing certain chronic medical conditions. In the past couple of years, health insurance companies such as Blue Cross Blue Shield, Aetna and United HealthCare have implemented various extensive disease management programs with a goal of prevention rather than cure.

The Role of Health Insurance Companies in Disease Management
The main goal of chronic disease management is to help patients self-identify any irregularity before the condition progresses to a life threatening. More than 133 million Americans, or 45 percent of the population, have at least one chronic condition. These conditions include but not limited to; arthritis, asthma, cancer, cardiovascular (heart) disease, and diabetes, though these are only a few of many chronic illnesses that negatively impact the lives of Americans (Centers for Disease control, 2013).
According to a survey conducted by Hewitt Associates (2001), 76 percent of employers availed disease management programs to their employees as part of their healthcare coverage benefit through a private health insurance company. In addition, 20 percent of employers were debating on adding disease management programs in order to control health care costs.

References
Duncan, I. (2004). It's Time for the Industry to Move on From ROI (7 ed.).…...

Similar Documents

Disease Management

...Introduction Special populations are those that are in some way unable to meet his or her needs. The role as case manager can be a very diverse one, but is one that ultimately aimed at helping people to be equipped and come in contact with the necessary resources that allows for adequate assimilation into society. Resources and Populations Reviewed There were a variety of online resources available that covered issues such as certification, information, links to other sites and search engines for available resources by location. The wide array of information gives the case manager a start at providing assistance in a much greater scope to meet client needs. Casemanager.com and Case Manager Resource Guide help specifically with the work of the case manager in providing clients’ resources. The populations that were reviewed primarily include behavioral health, disease management and welfare reform. Welfare reform encompasses the management of welfare and low income families. The aim is to develop evaluation plans and assess the effects on the government. On the part of the client, the aim is to help them to attain skills that will improve their self-esteem and ability to be financially self-sufficient. Disease Management includes teaching and sharing of information with clients and family members that will help them to understand and better control their conditions. The client is encouraged to make lifestyle changes to be able to stay healthy and improve life.......

Words: 999 - Pages: 4

Roles and Functions of Healthcare

...Roles and Function of a Health care manager Susan Hannel May 14, 2012 Maureen J. Wishart, RN , MBA A Healthcare manager may be considered anyone from a person who is responsible for a certain department, to a person who is responsible for an entire facility. This paper will focus on the manager who is responsible for a facility. This manager is responsible for aspects of running an efficient facility. A health care manager should raise to the highest standards of performance. The responsibilities of a manager over a facility verses over a department will explore. A clinical manager is to create and implement policies of a specific department (www.top-Healthcare-Schools). The clinical manager evaluates the employees within the department. They are responsible for the budget of a specific department. They report to the healthcare manager of the facility. The healthcare manager or sometimes called an administrator of a facility is responsible for every department within the facility. This manager must be available on a 24 hour basis and able to handle any crisis that may present itself. Organizational and personal responsibilities require that can create an environment of......

Words: 425 - Pages: 2

Hospital Administration and Its Role in Healthcare

...Hospital Administration and its Role in Healthcare Professional Development MBA-525-MBOL6 Saint Leo University Lisa Massey Dr. Bruce Hammond March 9, 2013 Abstract This paper will discuss why healthcare administration is my career field of choice and why it is interesting and appealing to me on many different levels. I will explain why I feel compelled to work in the healthcare field and how the administration portion of healthcare affords me the opportunity to have a broader influence on the overall picture. There are so many things that can be accomplished from an administrative perspective that greatly impact the patient care experience starting from bedside care all the way to organizational policy and procedure development. For me, this is a very rewarding career both professionally and spiritually. Hospital Administration and its Role in Healthcare When I first started out in healthcare almost 20 years ago, I always knew I wanted to do something on a much grander scale than just bedside nursing. Dr. Pace (2006, p. 3) discussed early in his books, the importance of choosing a career that is both interesting and challenging and also has the ability to provide you with financial security. The healthcare field has always offered job security because the demand for people with medical training will always be high because as long as people are living and getting sick, they will need healthcare providers. The healthcare field itself is continually growing to......

Words: 864 - Pages: 4

Healthcare Management

...Healthcare Management Complete Course PLEASE DOWNLOAD HERE! http://www.studentswithsolutions.com/view-tutorial.aspx?TutorialId=15487 Describe the various stakeholders in the health care industry. What is the role and interest of each? http://www.studentswithsolutions.com/view-tutorial.aspx?TutorialId=15485 Describe the various stakeholders in the health care industry. What is the role and interest of each? The stakeholders in the health care industry are the “consumers, employers, healthcare providers, healthcare facilities, government (federal, state, local), insurance companies, educational and training institutions, professional associations that represent the different stakeholders, pharmaceutical companies, and research institutions” (Niles, 2011). The consumers consist of the patients who need healthcare services from.... List and explain two of the leadership theories covered in this unit. Choose one of the leadership theories and explain how that theory provides guidance to practitioners in improving quality in health care. Two of the leadership theories covered in this unit are the contingency theories and the behavioral theories (Burns, Bradley & Weiner, 2012). More specifically, the contingency theories of leadership focus on the specific variables that relates to the environment, and which determine the particular leadership style that would best apply to a given situation (Cherry, 2013). According to the contingency theories..... Express......

Words: 4379 - Pages: 18

Disease Management

...Disease Management: Empowering Patients and Improving the Effectiveness of Patient Care Disease Management: Empowering Patients and Improving the Effectiveness of Patient Care Managed care organizations are continually searching for new ways to cut costs and people trying to manage an illness or disease are looking for ways to ease their symptoms, maintain their lifestyle, and stay out of the hospital. People with diseases are in the unique position for managed care organizations to focus cost saving programs on. Diseases can be incredibly expensive to treat and while people suffering from diseases are not a majority of patients, they are certainly the most costly (Lorig & Holman, 2003). Disease management programs can also motivate patients to change their lives by better managing their disease and get those diseases under control by giving patients the skills and expertise necessary. Disease management programs seek to change the approach to patient care with regards to difficult conditions by incorporating evidence based medicine techniques and outcomes that can contribute to the wellness of patients by using combinations of education, provider practice guidelines, consultations, appropriate drug utilization, supplementary drugs and services. Focus on these areas can keep patients illnesses from reaching emergent care levels as well as reducing the outlay associated with high–cost diseases. Disease Management History Chronic conditions make up more than......

Words: 2745 - Pages: 11

Disaster Plan for Healthcare Facility

...Healthcare Facilities Safe from Disaster The price we pay for the failure of healthcare facilities due to disasters, such as tornados is high in cost. The cost of planning and making a healthcare facility safe from a tornado disaster is low compared to rebuilding it after disaster strikes. The damages of disaster healthcare systems and facilities is a human tragedy which results in large economic losses, dealing with devastating blows to the development goals of the facility, and it can also shake social confidence. Making healthcare facilities safe from tornado disasters is an economic requirement for the safety and well-being of our patients as well as our staff. The disaster definition of a tornado is any occurrence that causes economic disruption, disaster, deterioration in the facility services on a scale sufficient to response from outside the affected community or area, and loss of human life. The demand for healthcare has to be met when the destructive forces of a tornado has overwhelmed the community in which the demand for healthcare must be met after a disaster has occurred. The common denominator of such magnitude from a tornado disaster is the overwhelming of organization or resources as well as the inability for the institution to return to normalcy post to the event of a tornado without external existence. This can prove the inability of adequate healthcare if a proper plan is not set and met. Tornados can happen at any time and almost anywhere in the...

Words: 937 - Pages: 4

Healthcare Management Course

...Healthcare Management Complete Course Describe the various stakeholders in the health care industry. What is the role and interest of each? Describe the various stakeholders in the health care industry. What is the role and interest of each? The stakeholders in the health care industry are the “consumers, employers, healthcare providers, healthcare facilities, government (federal, state, local), insurance companies, educational and training institutions, professional associations that represent the different stakeholders, pharmaceutical companies, and research institutions” (Niles, 2011). The consumers consist of the patients who need healthcare services from....  List and explain two of the leadership theories covered in this unit. Choose one of the leadership theories and explain how that theory provides guidance to practitioners in improving quality in health care. Two of the leadership theories covered in this unit are the contingency theories and the behavioral theories (Burns, Bradley & Weiner, 2012).  More specifically, the contingency theories of leadership focus on the specific variables that relates to the environment, and which determine the particular leadership style that would best apply to a given situation (Cherry, 2013).  According to the contingency theories..... Express the challenges involved in changing the health care system? One of the challenges in implementing changes in the healthcare system is the existence of multiple buyers,......

Words: 4350 - Pages: 18

Disease Trends and Healthcare Delivery

...Statistics make the world go round, literally. A certain population or ethnicity and their disease trends can really have an effect on what can happen in the future for our healthcare systems. Demographics and Disease trends can go hand in hand with one another because disease trends are so constant and unnoticeable that it continues daily, therefore having a particular group being affected by the same disease. Some people do not believe it, but all you have to do is look at the statistics and you will then see how greatly they affect one another. To break things down, demographics are groups of people with a common link, such as; age, gender, race, education level, income level, even marital level, and etc. When in an environment where links are similar or the same, the same trends start to get picked up as well, linking you within the range of your demographics. Environment plays a big role in demographics as well. If you live in the same neighborhood or community as someone, you are linked to that person no matter how small of importance it is. With everyone doing the same trends which come to them like habits, they may never go away until they know that it is a problem. Environment happens to play a role as well when it comes to demographics. Environment happens to play one of the main roles. Habits become hard to break because of the type of environment you around. Who, what, and the things that you are surrounded by happen to make up part of your environment...

Words: 1743 - Pages: 7

Disease Trends and the Delivery of Healthcare Services

...Disease Trends and the Delivery of Healthcare Services HCA/240 July 2, 2010 There are many changes that the U.S. population is going through, and health care is amongst one of them. Americans have begun to live longer seeing an older age. Diversity is playing a role in this change to. Growth is driven by the high birth rates between ethnics and racial minorities along with immigrants. This diversity will lead many to be uninsured. Many of the older generation enter into the health care system with a unique set of problems, conditions, and values. The question is how the needs and desires of each person will be appropriately addressed in such a rapidly changing health care environment (Advameg, 2012). The changes that come with each person during the aging process can affect each individual different. As we all begin to get older the digestive process becomes less effective, and in older people it’s the common cause for malnutrition. Some elderly people are unable to digest food properly or they lose their appetite. The body continuously needs to be nourished, and without that nourishment the body doesn’t have the proper energy that it need. Physical characteristics of a population such as age currently effect the population by 12% for those that are 65 years or older (Advameg, 2012). It’s estimated by the year 2030 to reach 21%. The growth of those 80 and over require more expensive and intensive medical care because of how fast they are growing in number....

Words: 1755 - Pages: 8

Healthcare Management

...Roles and Functions of the Healthcare Manager Jenelle Caldeira HCS/325 March 24, 2014 Kathrine Crawford Roles and Functions of the Healthcare Manager In the world of healthcare, it’s essential that all managers demonstrate strong leadership skills with not only co-workers but subordinates as well. Planning and organizing are right behind leadership because in order to lead, you must know who, what and where your employees are and what their role is in the organization to hold them accountable and offer praise for a job well done when necessary. I believe the best management model is the Path-Goal management model because this style advises managers to use leadership styles that complement the needs of the situation by either Directive Leadership, Supportive, Achievement-Oriented, or Participative Leadership (). When managing an organization as complex as healthcare, you will be faced with many different situations and instances where you will need to adjust and change not only your management approach, but also your delegation technique to fit the situation and help the patient or client to the fullest extent at all times. The most important role for a health care manager is leadership. Having strong, clear, defined leadership skills through leading by example and holding associates accountable at the same time. A great leader has the ability to bring out the best in others, and by doing so, it will create a team and organization of highly qualified, motivated......

Words: 526 - Pages: 3

Quality Plan for Healthcare

...committed to development of a benchmark hospital with a quality learning environment. It has achieved first Joint commission International (JCI) accreditation in 2007 and has been reaccredited in 2010 and 2013. The basic principles of Quality improvement Plan are those underlying all the quality improve-ment processes: a dedication to continuous improvement in the system and processes as well to identify and satisfy the patient’s needs and recognizing that it can be best attained through team work and employee empowerment (Deming,2000). These principles lead the progress and im-plementation of quality improvement plan. The goal of this plan is to attain organization wide exposure to quality fundamentals and to promote quality structure and processes. Quality Improvement Issues. Patient Satisfaction: As the health care environment is very complex and changes frequently (Gilbert, 1992) due to competition among providers giving more importance to the improvement in efforts and reduc-tion in costs, it makes patient satisfactionverychallenging. There are different kind of services provided to the patient which are in definable and patient is directly involved in it, so it is very important that the organization should have a strategic plan to identify the needs of the patient which should be well incorporated in the hospital delivery system (Craig 2007; Glass , 1981; Pugh , 2007). Patient’s expectations are different on different levels for example caring, trust-worthy,......

Words: 2813 - Pages: 12

Roles in Public Healthcare

... Health Care Terms Public Health Agencies are often considered the health care safety net by all the people who provide health care. They are the agencies that focus on prevention of disease in populations rather than the treatment of individuals. Some provide primary care such as family planning, prenatal care and the treatment of sexually transmitted diseases; because of being financially insecure they partner with private sectors i.e. volunteer agencies. Community health centers are also considered a healthcare safety net because they assist by filling in health care services gaps, and their main focus is also on the health of the population. (Health Care Delivery in the U.S.) Since the beginning of organized public health programs, physicians have been seen as essential to the delivery of public health services. In the list of numerous professions needed for the high-quality practice of public health, physicians are included with nurses, dentists, veterinarians, environmental health specialists, laboratorians, epidemiologists, health educators and others. There are many more physicians than are currently recognized that engage in public health activities at some point in their career. These physicians include infectious disease physicians investigating health care-associated disease outbreaks, pediatricians working in school health, and emergency medicine specialists serving as the medical directors of emergency medical services. It was a practicing pediatrician......

Words: 1332 - Pages: 6

Healthcare Management

...experience, and how it is related to ethics in health care. Description of Patient experience Patient A shared that she was hospitalized at Columbia University to undergo a Thymecthomy in September 2014. The patient was diagnosed in late 2005 with Myasthenia Gravis. This was patient A’s second time being hospitalized. The patient had been hospitalized in 2006 at George Washington University after having a Myasthenia Gravis crisis. However, this was Patient A’s first time having a surgery. She was put on IV for three days and being watched. Patient A has since regularly been a patient at GWU to monitor her disease. Therefore, Patient A is in regular contact with healthcare workers. Patient A tells that she was referred to a surgeon at Columbia University for a thymecthomy (Patient A, personal communication, November 1st 2014). Myasthenia Gravis is a chronic disease, and the chances of remission are rare. Thymecthomy has in certain cases improved the patient’s health after . Patient A was offered two alternatives to the surgery. An invasive one which would require an incision, or a minimally invasive one, where cameras would be inserted on the side of the chest area, leaving very little scars, and allowing for a much faster to recovery time. Patient A chose the second option. The patient was told to report to the hospital at 9AM, and the surgery was scheduled for 12pm. The patient was not allowed to eat before the surgery. Patient A’s surgery started at 9pm and ended......

Words: 1180 - Pages: 5

Government Roles in Healthcare

...Government Roles in Healthcare The government consists of federal, state, and local governments making this combination one of the largest payers of healthcare. The government has some important roles when it comes to the world of healthcare including the management of healthcare finances, the deliverance of healthcare, and the regulation of healthcare; these roles differ amongst the federal, state, and local governments. The federal government makes up the largest part of the government’s relationship with healthcare. The Fundamentals of US Health Care (2013) says that the federal government contributes three-quarters of healthcare spending to insurance programs such as Medicare, Medicaid, and CHIP. They also provide funding for mental health, medical education, community health centers, and public health programs. It also plays a part in delivering care to people. The federal government is responsible for delivering care to American Indians, the military, veterans, and those that are uninsured. With a large part of the world unable to afford health insurance this leaves the federal government responsible for that part. The Fundamentals of US Health Care (2013), states that the federal government also regulates the providers of healthcare programs by making sure there is no discrimination and regulating what drugs can be sold. With all the funding that the federal government provides, the care that it delivers to specific organizations, and the regulations that it......

Words: 540 - Pages: 3

Management Roles

...The roles and functions of a manager are very important. It takes certain qualifications for someone to be a good manager. Anyone can fill the position, but in order to get the job done and be an asset to the organization there are certain roles and functions that should be followed. Healthcare management can be slightly different than other management positions. Anyone that works in the healthcare should take their job very seriously. A patient’s health is so very important, and patients put a lot of trust into healthcare staff, therefore, as a healthcare worker we need to give 100% to our job all the time. There are three different types of manager roles. Some managers may fit in each category, while some might just fall into one. The manager roles consist of interpersonal, informational, and decisional. An interpersonal manager is one that works with and interacts with people both inside and out of the work boundaries. An informational manager is one that offers, obtains, and evaluates information. A decisional manager uses information to help solve issues, make decisions, and develop new ideas. A healthcare manager can fall into any of these categories. Healthcare managers that work in a hospital can be interpersonal, because they will probably work with other departments within the hospital. Healthcare managers also have to deal with insurance companies, other doctors and healthcare staff, billing agencies or departments, and patients. Informational and......

Words: 663 - Pages: 3