Challenges Faced While Implementing
Integrated Healthcare System
DEFINITION
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
noncommunicable 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.
Financial Integrity
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.
1. Workers compensation
2. Property
3. General liability
4. Automobile liability
5. Aircraft
Some of the less traditional coverages include the subsequent.
1.
2.
3.
4.
5.
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.
Risk Financing
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.
Conclusion
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.