HEALTH ORGANIZATION EVALUATION NRS 451

HEALTH ORGANIZATION EVALUATION NRS 451

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United HealthCare is the largest medical insurance company in the US.  The company gives insurance coverage to people who risk getting cancer. The company has done many experiments on their premium payments physically, and it had to discourage the physical cost of premiums from drug sales.

It encourages oncologists to purchase drugs (George, 2016). Although the objective is not just to reduce the cost of drugs, they must help curb the overuse of cancer drugs. Their bundle payment depends on specific stages of cancer. 

The techniques of the program hoped that bundled payment would help improve the outcome and give quality care. United HealthCare has an excellent capacity for base finance, allowing it to finance all the client’s requirements. The company is trying to provide the very best service to its clients.

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Organization’s Readiness

The United HealthCare is willing to ensure everything concerning cancer is dealt with quickly. They have devised some measures to make things easy for the citizens. The United Health Care is ready to do everything required to make their clients easily access medical coverage. They have reduced the premium payment to ensure the cost is affordable to everyone.

They have lowered it to some percentage depending on the income of individuals and the risks exposure by an individual. Before the UHC determines the bundled payments, it checks on the 19 conditions of which the pilots are given a yearly analysis and debate before coming up with the set standard of a bundle (Kumar, 2016).  

This is because different oncologists deliver the service based on the National Comprehensive Cancer Network (NCCN). The NCCN instructs people to go for chemotherapy after breast cancer surgery. The UHC payment is based on the scheduled fee, which doesn’t exclude the expense of the drug reimbursement and the actual drug costs.

The ASCO, a wing of the UHC, was more concerned and supportive of the experiment; this pilot program is helpful and innovative in a manner that can solve complex problems. The ASCO devised strategies to separate the payment for medical care attention provided to patients. This would help provide medicine to a patient who will treat their diseases.

The company helped individual groups easily access medical facilities by separating the payment. This was done because some cancer medicine is too expensive and unaffordable to some citizens. The patients would easily pay their bundles, as required by the United Healthcare.

The other thing the UHC did was frequent therapies because patients go through different stages while battling cancer; 15%-20 % of patients have a unique experience. There is some toxic or rapid progression where a person needs to make changes (Toebes & Hallo de Wolf, 2015).

The United Healthcare needs to establish consistency between 80%-85% of patients to create efficiency, reduce costs, and increase patient safety.  Kansas City, a cancer center, treated people for over ten years, and many visited the clinical path. 

The clinic received 19 stages and different cancer categories. This was due to the measures the UHC had developed to help people access cancer healthcare services and therapies, reducing cancer rates to some percentage in the US.

Strategic Plan To Improve The Network Operation

The United HealthCare has some plans aimed at achieving the company’s objectives at large. The UHC has assessed the organization’s strengths, weaknesses, opportunities, and threats and finally came up with a strategy that will help it run smoothly to achieve its goals. The UHC has some practices in the pilot that will aid in building efficiencies in giving out the appropriate care.

UHC chairman Roy Page P.H.D said, “Doctors and chefs in the kitchen are the same.” All the piloting techniques would make the flow of medicine on the pathways easy. It will also facilitate the easy movement of staff and cancer patients in the US.

The biggest problem the UHC is facing is financial problems. It’s tough for them to provide all the requirements at a go to many patients as the cancer treatments are costly. Hence, they formulated the pooling of the resources, which implies the collection of premiums together and, later on, the disbursement of treatment (George, 2016).

This was due to the increased financial burden on the patients. Cancer drugs are costly, can cost tens of thousands of dollars in the treatment process, and always needs 20% co-payments, which many cants can afford. IMS Health gave out a highlight on the sale of chemotherapy drugs in the pharmacy. This may cost over 20 billion since cancer care is rapidly rising at a speed that many American citizens can’t sustain.

The UHC formulated a pool where the patients will pay bundles they can afford and later be used to treat them (Kumar, 2016). Still, they are focused on cutting costs when possible. This is solely to make cancer care be accessed easily by all American citizens.

The organization is facing many issues from different dimensions. The patients cannot afford the money the company requires, which is a big challenge to citizens and the company despite trying hard to lower all costs.

The other problem is the increased coverage, which leads to the exhaustion of the available resources. This makes it hard and goes beyond the healthcare budget to serve people. The ratio of the available resources to the people with common cancer is at a deficit.

The other problem that the company face is the chronic state of patients, which requires a lot of money (Toebes & Hallo de Wolf, 2015). Many patients are at a chronic condition, which becomes too expensive for the company; this poses a significant challenge to the organization. Despite all the problems, healthcare has some plans to counter these problems.

Inventory Management decisions model

In the past, healthcare didn’t have much focus on inventories. However, the US government implemented diagnostic groups, leading to pre-fix compensation levels. These systems help to contain the rising cost of managing diseases in the US. This paper addresses the issues of inventory hence the involvement of this model (George, 2016).

Since managing cancer is expensive for the company, there is a necessity for inventory tools. The biggest problem is the cost of managing cancer. There is a need to compare the business’s inventory cost and service levels. In comparing the inventory policies, we focus on the latest sequence of outsourcing to distribute the non-critical medical supplies directly. This model will help solve all the financial problems experienced by United HealthCare.

Conclusion

In summary, the United HealthCare plays a significant role in ensuring all patients with cancer can access medical facilities. The UHC came up with measures that will help reduce the citizens’ premium payments. The company provided some pilot services to make the operation of cancer easy and the movement of medicine faster.

Even though the company faces many problems like affordability, chronic state, and financial issues, they do all it can to provide the services to its clients. They have ensured many cancer patients undergo chemotherapy and get medical attention.

References
  • George, M. (2016). Healthcare Norms under Universal Healthcare (UHC) for
  • Maharashtra. Journal Of Health Management18(4), 569-583. https://doi.org/10.1177/0972063416666163
  • Kumar, P. (2016). How to strengthen primary health care. Journal of family medicine and
  • primary care5(3), 543.
  • Toebes, B., & Hallo de Wolf, A. (2015). Private Sector Involvement in Healthcare and UHC:
  • Assessment in Light of the Right to the Highest Attainable Standard of Health. SSRN Electronic Journal. https://doi.org/10.2139/ssrn.2649845

Assessment Description

Research a healthcare organization or network that spans several states within the United States (United Healthcare, Vanguard, Banner Health, etc.). Assess the readiness of the healthcare organization or network you chose regarding meeting the healthcare needs of citizens in the next decade.

Prepare a 1,000-1,250 word paper that presents your assessment and proposes a strategic plan to ensure readiness. Include the following:

  • Describe the healthcare organization or network.
  • Describe the organization’s overall readiness based on your findings.
  • Prepare a strategic plan to address issues about network growth, nurse staffing, resource management, and patient satisfaction.
  • Identify any current or potential issues within the organizational culture and discuss how these issues may affect aspects of the strategic plan.
  • Propose a theory or model that could be used to support the implementation of the strategic plan for this organization. Explain why this theory or model is best.

You must cite at least three sources to complete this assignment. Sources must be appropriate for the assignment and relevant to nursing practice.  

Prepare this assignment according to the guidelines in the APA Style Guide in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric before beginning the assignment to become familiar with the expectations for successful completion. 

You are required to submit this assignment to LopesWrite. If you need assistance, a link to the LopesWrite technical support articles is in Class Resources. 

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