An integrated healthcare system is also mentioned as interprofessional healthcare, which is an approach that describes a high degree of collaboration and communication among health professionals. What makes integrated health care unique is that the sharing of data among team members associated with patient care and therefore the establishment of a comprehensive treatment decide to address the patient’s biological, psychological and social needs. This interprofessional healthcare team includes various groups of members which consist of physicians, nurses, psychologists and other health professionals, looking forward to the requirements of the patients.
The Need for Integrated Health Care
The health care literature offers wide coverage of integration models, showing consistent benefits. Division, decentralization, and specialization can hinder effectiveness and efficiency. The reduced fragmentation of health care providers lowers barriers to access, waste, and inefficiency while avoiding duplication and contradictory decisions. Integrated care holds prospect to scale back overtreatment, waste, and redundancy, eliminating inefficiencies and controlling costs, while providing higher-quality coordinated care. Given the massive and growing burden of non-communicable diseases globally, an integrated healthcare solutions approach targeted at patients with multiple noncommunicable diseases has significant potential and is of growing need. Three overlapping groups of patients are identified within the literature who may experience the best enjoy integrated care: multimorbid patients with two or more chronic diseases (for example, within the management of diabetes, hypertension, and ischaemic heart disease) patients with moderate or severe psychological state conditions, and elderly patients. These groups are consistently demonstrated within the literature to consume the very best amount of health care resources and need the foremost coordinated care and, as such, pose a high economic burden. Specific cutoffs vary from system to system, counting on local demographics, the prevalence of the disease, and implemented cost structures.
Challenges Faced While Implementing Integrated Healthcare System
Analyzing Management Strengths and Weaknesses
Risk management professionals are often helpful in evaluating the strengths and weaknesses of every network component that supports the managers’ credentials, past performances, commitment, attitude, and leadership skills. Suboptimal performers and persons tired of being team members are often replaced with personnel with stronger skill sets if it’s determined that their performance isn’t likely to vary. From a risk management point of view, it’s important to recollect that even high performers may feel threatened by uncertainty and alter and can be apt to perform at a subpar level. This emphasizes the critical need for open lines of communication and ample dissemination of data to put workers comfortable to the best degree possible so as to avoid accidents. Advantages physicians may enjoy include cost-effective administration, improved access to other providers and support systems, access to a broader range of support services, financial strength and security, increased customer satisfaction, access to educational resources, ownership potential, increased market share, increased access to data and knowledge systems, group purchasing discounts, strategic planning, and enhanced image within the community.
The historic financial experiences of every part of the integrated health healthcare delivery system should be taken into consideration during the due diligence, financial forecasting, and budgeting processes. Premiums, products, managed care enrollments, a mixture of services, and provider and customer shifts then got to be analyzed and adjusted within financial reporting systems. The danger manager should take an interactive role in identifying and analyzing risk factors that would follow the implementation of strategic imperatives. Unchecked, these areas of potential liability could negatively impact rock bottom line.
Checking Capabilities to Exchange Information
Lack of knowledge may be a significant obstacle to the event of a sound risk management program. Outlined below are several of the functions that information systems within IDSs should be designed to perform so as to yield information that will subsequently help to preserve financial assets and promote patient and practitioner satisfaction. Internal, incompatible, or duplicate information systems can pose risks within organizations that provide healthcare services. Analyzing information systems and their ability to succeed in and serve IDS components is an awesome and expensive task but one that’s critical for the system to work optimally from financial, quality, and utilization standpoints.
Arranging an Insurance Program
We have reviewed a number of the danger management issues facing IDSs within the new millennium. Now we’ll examine a number of professional liability/errors and omissions (E&O) and risk financing issues that are important to IDSs.
Traditional lines of coverage that are a neighborhood of the IDS’ portfolio are subsequent.
- Workers compensation
- General liability
- Automobile liability
Some of the less traditional coverages include the subsequent.
- Managed care liability
- Directors & officers liability
- Employment practices liability
- Punitive damages wraparound
- Managed care stop loss
The Integrated Product as an Option
Health care providers integrate for several reasons. From the insurance and liability perspective, risk financing for these entities has also been integrated healthcare solutions. The motivating forces behind this integration include the subsequent. Overcoming the difficulties in segregating the liabilities within the system. There are gray areas and therefore the exposures and liabilities are blurred. Reduced administration. it’s easier to barter with one insurer, to possess one common expiration date, and to pay one premium. Premium credits supported economies of scale. More creativity on the danger retained, e.g., with a captive or trust.
There are some ways an IDS can prefer to secure its liabilities because it becomes more diverse. Most of the main health care insurers offer a comprehensive product to IDSs. A number of those products are more successful than others. Commercial primary first dollar insurance is out there where IDSs do share within the risk. There are some other risk financing methods that include captives, risk retention groups, and self-insured trusts. Before starting any physician program for your attending physicians, remember Stark or insurance laws. Perform due diligence on all mergers and acquisitions. Work and communicate with all risk managers or persons liable for risk management. you’ll get to relay the danger strategy, policies on defense cost, etc., to all or any new entities. Be aware of regulatory issues that will affect the coverages needed. If you’ve got a health plan, you would like a continuation of advantages coverage within the event the health plan is said insolvent. Make sure your insurer can accommodate your growth plans.
Be aware of fraud and abuse issues and compliance issues.
These are a couple of issues related to an integrated delivery system from the danger management and risk financing perspective. New liabilities will still evolve. Health care providers are forging ahead into the challenging year 2000 with physicians in unions, fewer dollars to figure with and technological innovations continuing to boost costs. Despite that background, many opportunities remain to show risk into a plus.