THE VOLATILE HEALTHCARE ENVIRONMENT
WEEK 2
HA 301- MANAGEMENT IN HEALTHCARE I
PROF. SOL VELAZQUEZ, LMSW
Volatility in Healthcare
- The healthcare sector continues to experience volatility.
- We see volatility because of:
- The demand and need for services (ex. aging population, people with chronic illnesses).
- The costs of health care and how to pay for it.
- How and where services are provided.
- The government’s role in healthcare.
The Managed Care “Solution”
- During the late 1960s and early 1970s, the concept of managed care arose.
- The goals of managed care were to:
- Reduce costs.
- Improve quality.
The Managed Care “Solution”
These goals were to be achieved by:
Emphasizing preventive care.
Controlling access to services.
Reviewing services for medical necessity.
Increasing cost sharing (patients pay for part of their care)
Controlling hospital inpatient admissions and lengths of stay.
Offering physicians incentives to see patients at a predetermined cost.
The Managed Care “Solution”
- Health Maintenance Organization (HMO):
- HMOs were introduced in the 1970s.
- They offered a defined set of healthcare services to people who enrolled in a service network.
- HMOs placed significant restrictions on the use of services in order to control costs for both employers and users.
- Users must pay specified deductibles and copayments.
The Managed Care “Solution”
- By 2007, almost 90% of insured Americans were enrolled in managed care plans.
- Problems?
- Managed care plans were experiencing financial problems as fewer people enrolled in managed care plans.
The Managed Care “Solution”
- The costs of insurance coverage began to climb.
- Concerns rose about its affordability.
- Managed care plans began to withdraw from Medicare (due to low reimbursement rates).
The Managed Care “Solution”
- Other reasons for rising costs:
- Aging population (more users).
- New/more expensive technologies.
- Newer/more expensive drugs.
- Demands from providers for higher reimbursement rates.
Balanced Budget Act of 1997
- The Balanced Budget Act of 1997 required that federal agencies balance their budgets every year.
- What impact did this have on healthcare?
- It reduced spending for Medicaid and Medicare.
- It put a cap on payments to home health agencies.
- It added to the volatility of healthcare by reducing how much is spent on healthcare that services vulnerable populations.
The Marketing of Healthcare
- Due to competition for patients, healthcare organizations now market their services to the general public.
- They try to differentiate themselves from the competition by focusing on:
- Access
- Cost
- Quality
Healthcare Settings
Hospitals still employ the greatest percentage of healthcare workers.
However, more and more workers are finding work in other settings such as:
Long-term care (nursing homes)
Rehabilitation facilities
Medical/dental practices
- Urgent care centers
- Home health agencies
- Hospices
- Health departments
The Affordable Care Act of 2010
- Goals:
- To increase health care coverage and affordability for more people.
- Cover all applicants with minimum standards.
- Offer services regardless of preexisting conditions.
- Reduce costs and focus on quality over quantity.
- Increase competition, regulation, and incentives to streamline delivery of health care.
The Affordable Care Act of 2010
Features:
Employer must provide health insurance for full time employees (30 hours or more).
Establishment of marketplace plans that participants can choose from.
Coverage to individuals through parents’ plans until age 26.
The Affordable Care Act of 2010
Attempts to repeal the Affordable Care Act have thus far failed.
However, legal challenges continue.
For example, the tax penalty associated with the individual mandate was repealed in 2017 and reduced to $0.
What was the goal of the mandate and tax penalty:
Give all Americans access to health insurance.
Prevent people with pre-existing conditions from being denied health care.
Pay for pre-existing conditions.
The Affordable Care Act of 2010
Consequence of mandate repeal:
People can opt out of getting health insurance if there is no penalty.
There is less ability to pay for care for people with pre-existing conditions.
What’s next?
Uncertain.
Challenges for Management
- There is continued need for managers to wear two hats:
- Functional specialist (worker).
- Management generalist (manager).
- Must have knowledge of technology.
- Must keep pace with changes in healthcare.
- More accountability for supervisors.
Challenges for Management
- Continued difficulty filling essential jobs.
- Need for alternative scheduling practices (ex. part-time workers, flex-time).
- Increasing sensitivity to employee rights.
Critical Self-Management Skills
Effective managers must first become proficient at self-management.
Self-management = the combination of behaviors that allow people to manage themselves in their work and personal life.
Involves several key factors:
Critical Self-Management Skills
- 1-Motivation:
- Must enjoy working with people.
- Be willing to assume more responsibility.
- Make a commitment to lifelong learning in support of both the organization’s goals and your own goals.
Critical Self-Management Skills
2-Initiative:
Supervisors must be proactive and not wait to be told what to do.
Must make needed decisions without the help of upper management.
Seek to learn new things on your own.
Critical Self-Management Skills
3-Organization:
Important that managers be well organized with their time, working space, and materials.
Poor organizational skills make people less efficient and less effective.
Can cause managers to confuse dates, mix up assignments, and miss deadlines.
This makes them unreliable and undependable.
Critical Self-Management Skills
4- Time management:
Effective managers control their time-they do not allow time to control them.
They work effectively so that they do things right the first time.
Critical Self-Management Skills
5- Refined sense of priority:
Managers must have a keen sense of priority.
Must know how to zero in on what is most important and attend to that first.
As responsibilities increase, this becomes increasingly important.
Critical Self-Management Skills
- 6-Strong “soft” skills:
- Also known as human or interpersonal skills.
- Ex:
- Problem-solving skills
- Decision-making skills
- Critical thinking
- Cooperation/teamwork
- Active listening
