Administrating The Health Plans - Essay Example

Administration and Stakeholders of Health Plans ADMINISTRATION AND STAKEHOLDERS OF HEALTH PLANS GRACE SARKAR Order No. 427266 06 April 2010 Table of Contents Introduction … 3 Target groups … 3 Vision and Mission statements … 4 Organizational culture … 5 Monitoring … 6 Organizational chart … 7 Service delivery factors … 9 Technological factors … 9 Conclusion … 10 Sources … 11 ADMINISTRATION AND STAKEHOLDERS OF HEALTH PLANS Introduction Since the signing of the Patient Protection and Affordable Care Act by President Obama, an air of expectancy on health care issues has descended in the United States (Jennings, Christopher G; 2010). Administrators and stakeholders of health plans, insurers in particular, can heave a breath of relief because of the buoyancy resulting from the new legislation and although some areas of negativism remain the outcome is generally one of new expectancies and solutions. Special thrusts have been made to the mechanism of health care providers and preventive care. The impact of the Act will be felt once its dots and crosses are assessed and also the citizens of the United States begin in a large measure to adopt preventive measures to accelerate good health conditions. The stakeholders of the health plans comprise health insurers, medical product manufacturers, health care providers, consumers, most businesses, and organized labor. Health insurance companies offering wide range of health care plans the customers can choose from are hurriedly incorporating the new changes. One has to wait and see what changes the manufacturers might effect since development on the manufacturers’ side are implemented on the basis of new development in the science field more than in legislations. Target groups The target group of customers for the health insurance companies in the United States are those in the middle age groups and professionally independent. The present reforms calls for increased private share in the health related expenditure. Thus, the markets for the health insurance are expected to further open up. The ideal governing structure should have an efficient Chief Executive Officer and Managing Director (CEO and MD) at the top level. The CEO and MD are followed by executive directors for the marketing, finance, sales, risk management, human resources, legal and operations departments. The executive directors, in turn, will have regional managers based on geographical locations. The governing council will comprise the executive directors. Professionals such as actuaries from the insurance sector should also be an integral part of governing council (Krasny, Amber). The Vision and the Mission statements The vision statement refers to the reason for the existence of the organization. The basic constituents of the vision of an ideal health insurance company include: To improve the health care system and increase the well being of the local population. Provide quality health care at affordable cost. Getting increased number of people within the protection of health care plans especially those in the economically backward classes. The mission statement of the organization basically covers the long term goals of the organization. The mission statement primarily comprises the ways that will be instrumental in achieving the vision of the company. The mission of the health insurance company includes that of: The management of the health insurance company should assiduously build up its customers’ base. The health insurers must synchronize their care plans according to the latest legislations. In the modern world, the customer is the king. The success of the company lies in allowing the customers to have greater access to alternatives. This helps in empowerment of the customers and they find themselves to be the integral part of the organization. The company should have enough alternatives for its customers (Krasny, Amber). Organizational culture The organizational culture plays crucial role in determining the success of any organization. It is the culture that sets the system in place for any company. The ideal health insurance company in the United States should have the following important features: Simplicity – The entire system of the health insurance should be kept simple by the companies. The customers should be able to choose the befitting plan without any hassle. Affordable – The pricing should be affordable with respect to the target group of customers. The company should aim to provide quality medical prevention to the customers in affordable cost. Customization – The health insurance company should have wide array of plans and schemes from which customers can choose the plan they deem fit. Network – The health insurance providers should have strong network of branches so that they are easily accessible to the customers. Knowledge Sharing –The health insurance company can provide knowledge assistance to the valued customers. As the organization would have large pool of experts in their panels, they are in a position to provide much needed guidance to the customers. Customer Support – Customer support has become integral part of any successful organization. Customers should be able to reach the company in the time of need and so, they should have dedicated support team. Organizational culture basically facilitates the mission and vision of the company. The middle managers play the instrumental role in making the organizational culture successful. One way to do this is to delegate authority to the managers. The managers should also be made accountable to their superiors. There should be effective reward system in place to encourage performers in the form of incentives or promotion to superior positions (Krasny, Amber). Monitoring It can be analyzed from the discussion above that the organizational culture holds supreme importance for any health insurance service provider. Sometimes, of course, managers and others in charge may deviate from the established cultures. Therefore, it is necessary to monitor organizational culture from time to time. One good method of checking organizational culture is examining the number of satisfied customers. A good base of satisfied clientele throws light on the effectiveness of the corporate culture. Also, the attrition rate among employees and the number of repeat customers are some of the other tools used for checking on the veracity of the organizational culture. Organizational cultures are not always set by the top management. Rather, the top management allows the middle level managers and their teams to evolve the suitable organizational culture. The only point to be borne in mind is that organizational culture should serve the vision, mission, and objectives of the company (Krasny, Amber). Organizational chart The organizational chart depicts the level of hierarchy within an organization. It also states the responsibility, authority, and accountability of the employees. The organizational chart can be as follows: CEO&MD – The health insurance organization should ideally be led by a full time chief executive officer who has considerable experience in the domain of health insurance. Executive Directors – The CEO should be followed by the executive directors who would be in charge of various functions like that of marketing, sales, finance, risk management, legal and operations. General Managers – There will be many general managers under one executive director. For example, under executive director (sales), general managers are assigned for different schemes. Regional Managers – Regional managers are based upon the geographical locations i.e. the regions. They should report to the general manager and supervise the branch activities. Branch Managers – Branch managers have the independent charge of the branches and they oversee all activities in their assigned branches. Branch Managers are accountable to the Regional Managers. Managers – A branch under the leadership of a Brach Manager comprises of various managers like Sales Managers, Marketing Managers, Operations Managers and Finance Managers among others. Executives – The managers should have a team under their purview. Executives comprise the teams and help in getting the required business. Advisors – The advisor would be the ultimate persons for the sale of the insurance plans to the prospective clients. They may or may not be on the pay rolls of the company. Normally, they are contracted on the basis of commissions and incentives. The organizational charts of a health insurance company would not be complete without an actuary or professional experts like that of doctors and medical practitioners (Krasny, Amber). Service delivery factors Normally, state and local governments are the chief stakeholders in health insurance. Legislations concerning health insurance are formulated and passed by the federal government and state governments. Funds procured in the business of insurance are also invested with government schemes. Hence, the state and local governments are the chief stakeholders. In 1993, “in their capacity as health care financiers, state and local governments spent $110 billion approximately” (Esser, Jeffrey L; 1994). Advances in pharmacology and technology are regularly taking place with new discoveries and inventions. However, they are not for the general public. These have to be applied with care, and sometimes on case to case basis under qualified and experienced doctors and surgeons. Hence, it is not pertinent to display new medical theories and discoveries (Ling, Athena M et al). Technological factors “Every healthcare organization tries to deliver better services for its customers. Information Technology (IT) can be a representative tool for enhancement of healthcare services. The scope of IT can be a simple one to more complex one. However, in case of medical healthcare system any application of IT has to have the fundamental philosophy of “patient-oriented care”. To fulfill this philosophy, the application process of IT should be creative and innovative for individual health organization. The best adaptation of IT to individual health organization will guarantee the best ‘care processes’ for their patients” (EMR in Large Healthcare Organization, 2008). Conclusion The importance of organizational culture along with the well defined vision and the mission statement is instrumental in the success of any organization. It is same for health insurance companies too. The vision and the mission statements help in identifying the reason of existence and the long term goal of the organization. Other important aspects include the organizational culture and the well defined organizational hierarchy through the organizational chart. Along with these factors, the effective risk management and involvement of leading professional experts ensures the success of the health insurance company. Sources: Board of Directors’ Statement on Setting a Goal to Achieve a More Affordable and Effective Health Care System, March 2009, http://www.americanhealthsolution.org/assets/Uploads/boardofdirectorshealthcaresystemstatement.pdf EMR in Large Healthcare Organization, 2008, http://www.asianhhm.com/information_technology/emr_large_hospitals.htm Esser, Jeffrey L; 01 April 1994, State and local governments are stakeholders in health care reform, http://www.allbusiness.com/personal-finance/health-care/440426-1.html Health Reform and Your Community, 2010, http://www.healthreform.gov/ Jennings, Christopher G; 31 March 2010, Implementation and the Legacy of Health Care Reform, http://healthcarereform.nejm.org/?p=3251&query=home Krasny, Amber; Health Plans Mission, Vision and Culture, University of Pheonix, USA Ling, Athena M et al; The Evolving Scope of Pharmacy Practice: Perspectives from Future Pharmacists, http://pharmacy.osu.edu/academics/introduction-to-pharmacy/materials/Evolving_Scope_of_Pharmacy_Practice.pdf Providing tools for nurse and healthcare staff development, orientation and in-service education, http://www.nurselearn.com/ Responsibilities of stakeholders to scale up services for mental disorders in Low and Middle Income Countries, 2008, http://www.globalmentalhealth.org/articles.php?id=9&menu_id=1 Wolper, Lawrence F; Health care administration: planning, implementing and managing organized, http://www.google.com/search?hl=en&source=hp&q=Administration+and+Stakeholders+of+Health+Plans&btnG=Google+Search&rlz=1W1SKPB_en&aq=f&aqi=&aql=&oq=&gs_rfai= Read More