What Impact Has the Increase in Consumers Involvement in Their Care Had on Providers to Date - Essay Example

LTC210-Unit 5 Aedric Frechelle of the What impact has the increase in consumers’ involvement in their care had on providers to , and what impact do you see it having in the future? Explain in a 2 page essay. The increase in consumers’ involvement is the consequence of a growing desire for higher quality care. This has forced the providers and the reimbursement agencies to be more flexible, to provide more information to the consumer regarding the treatment he/she is receiving, and be more prepared to attend the consumers’ demands, requests and questions (Study Notes, n.d., p. 1). It is also conductive to share decision-making. Long gone are the days when primary care physicians made decisions and the patients followed. These days, physicians and patients go through all the available information about the medical problem in question, including the treatment options and the consequences, and then consider how these fit with the patient’s preferences for health states and health outcomes (Hibbard, 2003). A study by “McKinsey & Company” found that employees were more likely to change their behavior and shop for treatment alternatives, but they were frustrated by the lack of information available to help them make these decisions (Agrawal, Ehrbeck, Packard & Mango, 2005). Patients would communicate with others who are experiencing the same condition through online chat rooms and support groups. They may want information about a physician’s bedside manner. Subjectivity is important in health care, as it is in most other intimate personal relationships (Agrawal, Ehrbeck, Packard & Mango, 2005). The growing demand and the desire for more choices have fueled an increase in competition within the field of long-term care, which has created a need for more efficiency and effectiveness. Providers have been forced to enter into the world of public relations, marketing and business, which led to generating a whole industry specialized in health care. It has, at the educational level, led to development of graduate programs in business but with specialty in health administration. All this development happened with the purpose of creating more efficient professionals who could deal with current trends in health care and stay one step ahead in competition (Study Notes, n.d., pp. 1-2). Consumers’ involvement in their care has created a transcendental effect at many levels and it will continue to impact the health care industry. The trend started with the baby boomers (those born from 1946 to 1964) lifting the expectations and putting considerable pressure on those who provide the services (Study Notes, n.d., p. 2). The demand for services will continue rather than drop off not only because the baby boomers are creating notable rise in demand for services but also because of the fact that “members of Generations X and Y that follow, are living longer and with more chronic diseases,” will create need for quality services (American Hospital Association, 2007, p.4). “Generation X” (those born from 1965 to 1979) is more computers and technologically oriented, and hence, it can be said that this generation is as demanding as the boomers, or more. Fifty years ago, a person could get a job with a high school diploma, but nowadays it is an impossible thing. According to the U.S. Census “Generation X is highly educated, statistically holding the highest education levels when looking at current age groups” (U.S. Census Bureau, 2009). Also, as medical advances continue, ‘Generation X’ is expected to live longer increasing the demands for quality of care by becoming more involved in their care and being vocal about it. They are more prone to shop around and do their “homework” regarding what is more convenient online or in social gatherings. This would require for providers, especially the physicians, to be more customer friendly and invest more in marketing, if they want to prevent their customers from going to other providers. Customer services and the outcome of services provided will be essential for consumer retention and the survival of the providers. Hence, during the past decade we have seen mergers and waning in the providers. 2. We discussed several challenges to the long-term care system, and noted that some have been met with quite a bit of success and some with little. a. Identify the challenge that you feel has been met most successfully and the one where the least progress has been made. The challenge I think has been met most successfully is the decrease in the Length of Stay (LOS) of hospitalization. The least progress is changing from reimbursement-driven to consumer-driven outcome measures. b. Explain why you feel that way in each case. Long-term care accommodated the demands of hospitals to receive patient discharged and in need of skill services. Hospitals Length of Stay (LOS) was extremely high and it was necessary to keep the patients out of the hospital as much as possible. The long-term care rose to the challenge and became a most needed instrument for the continuum of care. As pressure to lower hospitalization LOS increased over the hospital providers, long-term care provided the skill nursing facilities or home care with the purpose to keep the patients at home. This resulted in the creation of a solid industry, integration of services and cooperation between providers. The most important benefit is that it is keeping patients at home for longer periods of time. Reality is that no one likes to be in a hospital, i.e. in an environment that is foreign and not known. We all like familiar surroundings and comfortable places. It has been suggested that speeding up the healing process and long-term care has achieved that purpose with splendid results. Long-term care went as far as hiring skilled staff to attend the needs of the patients, which increased their customary budget significantly, but at the same time ensured that the customers receive the necessary care. There is a slow progress when it comes to change from reimbursement-driven to consumer-driven system. Utilization of LTC services should be based on the needs of the consumers of those services, rather than on the needs of providers, agencies and politicians. The services should not only keep the patients (or consumers) as their primary focus but should also allow them to play a larger role in determining what and “which services to access, and when” (Pratt, 2010, p. 37). Unfortunately, our industry has been moving very slowly towards achieving that goal as not many organizations are ‘patient focused’. It is understandable as they all want to survive in such a troubled economic times. However, the consumers of services are paying the price. I feel confident that in the next twenty years we will see a more consumer-driven system, but for now, we would have to wait. It is also important to understand that ‘consumer-driven market’ is a process where the consumers are more educated about their care and needs. The consumer needs to build confidence, know more, or at least be more interested in getting to know about their illnesses and possible treatments. Due to these requirements, creation of a more consumer-driven market would take some time. However, as each generation passes, it leaves behind the foot prints of the foundations on which the next generation can build better conditions and opportunities. I have no doubt that consumer-driven market is more beneficial than our current system. Still, I feel worried as those with more marketing resources could get the consumers not because of their outcome but because of their vast resources and great marketing campaign. This will perhaps leave the smaller providers with better outcomes behind due to lack of enough resources for marketing. 3. What ethical challenge do you think will be the most critical faced by the long-term care system in the near future? Explain in a 2 page essay. In my opinion, the most critical issue would be the cultural diversity as our nation becomes more diverse with the immigrant population growing continuously. They bring their own culture and fuse it with the American way of living. I suspect that unless education about cultural sensitivity is provided, the cultural gap would keep on increasing in the future. Our health care professionals are not prepared to deal with different cultural and religious beliefs, especially in the suburban and country areas of our nation (Ludwick & Silva, 2003). I understand that it is wrong to generalize and assume that all the providers of care in long-term would have problems with cultural diversity, but at the same time, it would be reasonable to think about the difficulties it would bring in providing services to people belonging to Hispanics, Hindu and Muslims ethnic background, whose population is growing day by day. They all have different traditions, different beliefs and different religions, and hence, it would be a daunting experience to accommodate different ideals and belief systems into the long-term care. More so as the providers will have to “strip” off their own beliefs in order to attend to the others’. Moreover, the ethnic groups that I just mentioned also have sub-groups within them that speak different dialects and have different customs, even though they are classified under one ethnic group such as Hispanic, Muslim etc. Hints of how difficult it would be to serve these diverse groups at this time are already visible in care services. For example, many members of these communities are refusing to be cared by male providers or by those who do not belong to their community. It is not because they do not want male physicians or nurses, or because they have any prejudice against male care providers, but it is because their belief system does not allow it. Cultural diversity will affect many areas of health care. It would increase the demand for professionals that speak some selected languages. If the demands are not supplied, then it could potentially become a health concern for the community as I foresee many elders refusing care due to not having professionals speaking their language and risking the public health in general. For example, imagine a person, who is infected with the Avian Flu, TB or other airborne infection, deciding to stay home due to cultural barriers and in doing so, risking the population to the outbreak. Another area that could be affected is the ethics. Our country tries to accommodate requests from patient as much as possible and when they cannot, controversy spurs. For example, will we be able to accommodate the request of Muslim women of having only female personnel attending their needs or would we be able to hire translators for every language in order to provide more efficient care? If we are not able to meet the demands, would it be discrimination? If their needs are not met, it could be suggested as discrimination and lawsuits can be filed (Erb, 2013). The consumers’ rally against the organization and healthcare in general could be penalized for the wrong reasons. Also, the monetary factor cannot be discounted as it would put tremendous pressure on providers to hire professionals that are from the same ethnic background and speak the same language in order to attend the needs of the population. That would result in paying high salaries and increasing the cost of care in general. It is not a very good venture considering the national economic situation. As good the cultural diversity is for the enrichment our lives, it also brings challenges that could potentially increase the cost of long-term care. I think this is an unforeseen challenge that has not been taken into consideration. It has many ramifications that could weaken the long-term care infrastructure, or at the least, has the potential to change the system in an unforeseen way. 4. In this lesson, we discussed several steps that the long-term care system needs to take to succeed in the future. What are some of the ways in which individual long-term care administrators can make a difference in the overall system? There are many ways in which administrators could make the difference. One of the most important ways is by fomenting communication among providers. Long-term care (as any other industry) has competition among providers and infighting among different groups. The administrators could make them realize their common goals and the need to work together for betterment of the system. Administrators could act as buffers when there are differences and work as catalysts of common good in order to improve relations and quality, and in doing so, can achieve the goals (Study Notes, n.d., p. 6). Promoting positive relations in consumer-provider is also another way in which administrators can make a difference. Bringing providers and consumers to agree in treatments and developing social contacts is not only the right thing to do, but is also a good marketing strategy, and would be recognized as having higher standards of care (Study Notes, n.d., p. 6). The current fragmentation of our system is due to the fact that all the parts (consumers, providers, payers and regulators) involved are pulling the system to their own benefit and are missing to see the negative impact it is having on the system. Every individual has a right to look after his own interests. However, there are times when the common good is the best option than behaving in an adversarial manner. The administrator could make the difference by having all parts involved in reaching a compromise. Hopefully, many capable administrators would understand the importance of working for the common good, and in this case, it would be the system (Study Notes, n.d., p. 6). Administrators need to be more proactive and innovative in seeking better ways to contribute to the common good. The Affordable Care Act (ACA) is soon to be implemented fully and even though no one knows the repercussions in the long haul, one thing is certain that administrators would play an essential part by anticipating positive and negative trends, adapting and adjusting to different changes, and being ever mindful of how their decisions could affect others in the future (Study Notes, n.d., p. 6). We are living in exciting but difficult times. However, I am certain that administrators, and some of us that hope to be future administrators, would be the agents of change and would contribute to the transformation of the system. 5. What changes may well be expected in terms of Long-Term Care financing? Several changes could be expected when it comes to the Long-Term Care financing as the health care system continues with its transformation. One of the biggest changes that is already taking place, and will continue, is the increase in use of Managed Care Organizations (MCO) by government agencies such as Medicare and Medicaid (Study Notes, n.d., p. 4). As of 2012, all consumers of Medicaid benefits are mandated to enter a case management program, including those with chronic illnesses such as HIV (which is now considered chronic illness and not a terminal illness), due to the savings it has generated to the State of New York. Currently I am working in a project where Medicare and Medicaid recipients (commonly known as dually eligible) are encouraged to enter a MCO and HMO. It has been demonstrated that managed care is saving millions of dollars to the States. The new initiative that is being probed is how much the federal government would save if all their participants enter in some type of case management program via MCO or HMO (LTCCC, 2012). Prospective payment will continue to dominate government financing, and capitation will grow as the preferred payment method for private payers (Study Notes, n.d., p. 4). This is a “formula” that has been working very good for quite some time and is basically replacing the Fee-For-Service (FFS) in many states. As I mentioned earlier, the Center for Medicare and Medicaid Services (CMS) is probing with that type of system. It would not surprise me if eventually, the Medicare recipients would be mandated to choose a HMO for their services, and the insurance companies have the resources to enforce a more patient-driven system, hold the providers accountable and measure outcomes for quality of care. I do not intend to predict that this is what will happen. I am just reflecting on the trends that have been observed over the past years, and on my experience with CMS and their “modus operandi” (MO). I participated in one of the first case management projects, in which only three States were given the grants for the project. Back then, i.e. over ten years ago, I was hired to work with a clinic in association with the University of Massachusetts, CMS, the State of Massachusetts and the Robert Wood Johnson Foundation. At that time, I did not realize how big the project was and its repercussions. As time passed by, I realized that what everyone knows today as case management, cost-containment, over and under-utilization of services as well as capitation and providers incentives, was probe with that small project that I was hired to do, and given the positive results, it was integrated nationwide. Fee-For-Services (FFS) is expected to wane as incentives for best practices are put in place, and outcome measures, managed care and capitation continue to surge. References Agrawal, V., Ehrbeck, T., Packard, K. & Mango, P. (2005). Consumer-directed health plan report—Early evidence is promising: Insights from primary consumer research. Retrieved from http://heartland.org/sites/all/modules/custom/heartland_migration/files/pdfs/17627.pdf American Hospital Association. (2007). How Boomers will change Health Care. Retrieved from www.healthdesign.org Erb, R. (2013). Hospital settles nurse’s discrimination suit. USA Today. Retrieved from http://www.usatoday.com/story/news/nation/2013/02/22/hospital-settles-discrimination- suit/1940575/ Hibbard, J.H. (2003). Engaging Health Care Consumers to Improve the Quality of Care. Medical Care. 41 (1), 161-170. LTCCC. (2012). Mandatory Managed Long Term Care. Retrieved from http://www.ltccc.org/MandatoryManagedCare.shtml Ludwick, R. & Silva, M.C., (2003). Ethics: Ethical Challenges in the Care of Elderly Persons. American Nursing Association. Retrieved from http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/Columns/Ethics/EthicalChallenges.html Pratt, J.R. (2010). Long-Term Care: Managing Across the Continuum (3rded). Sudbury, MA: Jones and Bartlett. Share Care (2013). In Which States is Euthanasia, or Assisted Suicide, legal? Retrieved from http://www.sharecare.com/question/in-which-states-euthanasia-assisted-suicide-legal U.S. Census Bureau (2009). Generation X Speaks Out. Retrieved from http://www.census.gov/acs/www/data_documentation/2009_release/ Zemans, J.R. (n.d.). Study Notes: Unit 5. Retrieved from http://www.sjcme.edu/ Read More