UQ.1 Keyways That a Digital Board Can Lower an Organization Risk Profile
Due to the increased incidences of risk in the workplace due to factors such as technology, the board to puts risk at the critical point of the organization's strategies. The board members are involved in enhanced scrutiny over risk since they are held accountable for managing the upraising dangers. The emerging trends such as cooperate governance credit and rules rating organizations taking up significant roles in the corporate risk through creating rules that focus on the risk management policies are encouraging the boards to review the past organization exposure to risk (Jeremy, 2016). The emerging economic trends also force the boards to fore think on current financial disclosure and risk and reduce the impact of the financial crisis.
The Obligations of the Board
The board is not directly involved in risk management; instead, it is involved in risk oversight for management purposes through various means that include; first, the committee develops policies and the respective procedures which are to be applied in tackling risks that are consistently within an organizational already set strategies and its risk appetite. Secondly, they make the needed review on the management implementation of the STR risk control policies pointing out areas that require amendment (Jeremy, 2016). Thirdly, they make time-to-time evaluations to ensure that the set policies and procedures work as intended.
How Do Obligations Differ in For-Profit Versus a Non-profit Organisation?
The obligation the profit and non-profit organisations differ in that the board members for the profit organisations take into consideration the interests of the shareholders in implementing their powers in meeting their regular duties. While in the non-profit organization's board members do not consider stakeholders instead due to the practical purposes they fulfill their obligation to the organisation considering its exempts purpose which is, tax-exempt status.
Q.2 Identify a Situation That May Make It Difficult for Health Plans to Develop and Maintain a Network
Health plans tend to offer support and care information of financial expense to the insured person in case of an emergency (Provan, 2008). However some situations make it hard for the health plans to maintain a network, this includes the area of focus of the health plan and the market focus such as the level of competition.
Choose One Approach That a Health Plan Might Take To Overcome This Challenge in a Specific Area
To overcome this challenge we can make use of software's to assess healthcare network accessibility and check the geographical distribution or spread of various provider types. This is the best approach since it will help map the required information in the area to assist in making the necessary plans. However, the procedure may change depending on the environment in that, in their rural areas there will be minimal information on the distribution of the providers as compared to the urban areas. In the medically underserved area, the approach will show that is poor health network accessibility due to limited providers. While in a community with less competition, the plan will, show there is good access to health care.
Q.3 Discuss How Utilisation Management May Change in the Future and the Challenges That May Occur
Utilization management tends to involve various activities that are created to influence how the health care's services are used thus constrain healthcare resource consumption. However, there are challenges involved in utilisation management that include; first utilisation management has led to the limitation of the clinical autonomy thus leading to an intolerable administrative burden (Wickizer, 2002). Secondly, utilisation management reviewers have intruded into the clinical practice in a manner that has an adverse effect on health care quality through the distribution of a fragile treatment alliance, and compromising confidentiality.
What Are the Primary Changes That Will Likely Occur?
Some of the first changes that may occur in utilisation management include, first, utilisation management should be focused towards enhancing the quality of care, not only containing health care cost. The move can be achieved through the introduction of procedures that can correct poor quality among the population or patients. Secondly, the utilisation management procedures and programs should be created to reduce the administrative burden on care providers, patients and healthcare delivery organisations (Wickizer, 2002). Thirdly, the implementation of utilisation management procedures should be equal with regard to income level, gender, ethnicity, and age.
How Will These Changes Affect Medical Care Processes and Outcomes?
Appropriate implementation of these changes will help balance the patient's clinical needs with their cost containment objective. This will be achieved since there will be a proper distribution of resources intended for inpatient treatment and enablement of appropriate use of outpatient hospital treatment.
Q.4 Identify What You Believe to Be the Most Significant Trend or Change in the Prescription Drug Benefit Over the Past 15 Years.
Co-pays and coinsurance is the significant trend in prescription drug benefit this is because coinsurance model tends to be more desirable as compared to the payers model since the coinsurance model is considered inflation proof. As the price of all drugs increases, the percentage based model changes while the fixed co-payment model does not.
What Impact Do You Feel This Has Had and to What Degree Do You Think It Will Continue to Affect?
The use of co-pays and coinsurance has been noted to increase by approximately 14% resulting to other companies initiating co-pay and coinsurance models with the intentions of having more than for triers (Medicare Prescription Drug Benefits, n.d.). With co-pays getting to the outer limit, employers have to look at other strategies of managing drug cost that is adopting co-pay and coinsurance model.
Q.5 What Is the Value of Disease Prevention?
Prevention refers to helping people avoid getting sick or identifying the diseases early for treatment. The value of prevention is that it tends to save on cost, for example, the amount of money that would have been used for the treatment of a disease is immunisation (Dahlberg, 2008). Prevention also enables the population to live longer and increases productivity since people can avoid acquiring certain diseases. Prevention also helps minimize emotional burdens that come along after a group of people loses close persons and wealth over an illness that could have been prevented before or during the occurrence.
An Example of a Disease Prevention Program
The prevention program focused on preventing increased cases of childhood obesity in Washington Dc. The program was mainly focused on satisfying meals and healthy eating among the adolescents in the underserved communities in Washington Dc. The program was able to reduce cases of obesity through, introducing classes covering topics on physical activities and healthy cooking. While the schools reduced the amount of time, the teens spent on watching and increased vegetables and fruits consumptions.
How a Health Plan Would Accomplish the Implementation of a Program
A health plan will achieve the program implementation through ensuring close supervision of the support of the staff, ensuring there is constant participation and by ensuring that the surrounding community is involved in the intervention.
How a Health Plan Will Accomplish Monitoring of a Prevention Program
Monitoring of a prevention program will be achieved through assessing if the set activities are happening as planned. This will be done mainly through, evaluating the implementing staff, assessing major valuables to check if objectives are met and assessing feedback from participants.
Modify a prevention program as a result of successes/failures modification will be achieved by finding other more effective methods of implementing the program, this will be done by assessing the past failures and avoiding them.
Q.6 Explain a Key Difference in Marketing a Managed Care Program to a For-Profit Business as Opposed to a Non-profit Corporation
If marketing depends on money to make profits, then not for profit business are at a considerable disadvantage this is because they do not allocate massive amount on the marketing budget instead they use other low-cost methods to market their products for example through the use of social media to increase exposure (Austin, 2010). While for-profit business allocate a huge budget for marketing with the aim of making more profit through gaining more customers
Even though the for-profit business caters to the wealthy population, they usually need a lot of customers. They tend to have many properties that they can sell to a specific individual. The more they gain customers, the more the profits. While in the not for profit business there is potentially no limit on the amount of check a millionaire donor can give them. Creating a good relationship with the wealthy donors is considered more important to them as compared to the business (Austin, 2010). Gaining big donors for non-profit business tends to be of recruiting people with the same group's vision as compared to the for-profit business who send out emails requesting for money.
Q.7 Explain Which Issue You Believe Poses the Most Significant Challenge and Discuss a Strategy That Could Be Leveraged to Deal With This Issue
The issue of cultural sensitivity to the local needs is considered the primary challenge that the managed care organisations meet as they try to achieve their objectives. The problem of cultural sensitivity can be overcome by learning a few key phrases to help enhance communication with the client and understand their needs (Foronda, 2008). Also through learning about the client's culture, this involves researching a particular culture to learn about the things the customer's value and like. This makes the people you will work with to feel appreciated.
Q.8 Identify the State in Which You Live and Explain Some of the Key Regulations That It Imposes on Health Insurance Markets
I live in Arkansas state and the state does impose various control on health insurance marketing that includes, the state restricts ACA related operations by indicating that the state insurance department shall not, budget, allocate, or expand any appropriation that is authorised by general assembly with the intention of promotion or advertisement (Hooper, 2018). The state offers prohibition to responding to inquiries concerning the coverage that a particular recipient may be eligible.
The collaboration challenge: How nonprofits and businesses succeed through strategic alliances (Vol. 109). John Wiley & Sons.
Dahlberg LL,(2008). "Youth Violence in the United States: Major Trends, Risk Factors, and Prevention Approaches." American Journal of Preventive Medicine.
Foronda, C. L. (2008). A concept analysis of cultural sensitivity. Journal of Transcultural Nursing, 19(3), 207-212.
Hooper, L. (2018). More State, Federal Actions Taken to Reverse ACA's Market Reforms. OT Practice. doi:10.7138/otp.2018.2308.cb
Jeremy Barlow, (2016) The Role of the Board in Risk Management
Medicare: Prescription Drug Benefits. (n.d.). The SAGE Encyclopedia of Pharmacology and Society. doi:10.4135/9781483349985.n247
Provan, K. G., & Kenis, P. (2008). Modes of network governance: Structure, management, and effectiveness. Journal of public administration research and theory, 18(...
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