organization and management

Organization andManagement

班級： 醫管碩一指導老師： 陳芬如 老師學生： 9651003M 范雅婷　　　　　 9651005M 呂增玲　　　　 9651011M 李欣樺

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IntroductionIntegrating mechanism Interentity organization and

management Care coordination Integrated information systems Integrated financing

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Organizational Arrangements To Achieve Service Integration

Integration of long-term care services into a continuum can be achieved through different types of organizational arrangements.

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Integration at the Health Care Provider Level

Services integration by health care providers can be achieved through a variety of arrangements.

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Integration at the Health Care Provider LevelNetworks Organizational Networks --clusters of legally separate

organizations that are formed to pursue goals that could not be attained by an individual organization.

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Integration at the Health Care Provider LevelOrganizational Networks --Valued space 、 equipment 、 specialized

personnel ， or other resources may be shared.

--Substantial managed care penetration 、 reducing the cost of service delivery and improving organizational financial performance will be important motivations for forming a service network.

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Integration at the Health Care Provider LevelLong-term Care Network Example：The Home-Based Hospice Care Network

Hospice Care Visiting Nurse Association Family Social Services

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The Home-Based Hospice Care Network Voluntary Action Center Hospital Pastoral Care National Cancer Society Community Hospital

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The Home-Based Hospice Care Network

The hospice network is loosely coupled.

Client services provided by agencies in the network are financed through different funding channels.

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Ownership An alternative way in which services

are integrated over time and across organizations is through ownership by a single “umbrella” organization.

When many services are linked together through ownership,it’s easier to instill an important features of long-term care.

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Ownership Case management is common

in”owner”services delivery systems --the system is likely to benefit from

efforts to manage client referrals --the system has control over referrals

and the client’s care experience at the point of service delivery

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Self-Assessment for Systems Integration （ SASI） Identifies nine parameters by

organization can measure their “readiness” to integrate.

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Techniques for organizational integration

Continuum of care is a network or ownership model delivery in an efficient, cost-effective, high-quality manner.

Foster and support coordination of care across the continuum of disease prevention, acute care, and long-term care services. 13

Providers’ management techniques for integration used by providers Share a vision

Shared vision find that this common ground greatly facilitates collaboration

Create management team The key to such committees is that the

members must have official responsibility to make decisions regarding the allocation of resources, including staff.

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Providers’ management techniques for integration used by providers

Educate board Educating the board about organizational

relationships, whether collaborative or ownership

Unify marketing service engaged in the continuum of

care should collaborate on joint marketing materials and approaches

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Providers’ management techniques for integration used by providers

Centralize purchasing system to have flexibility in supplying

individual services and to implement management techniques, again increasing the efficiency with which services are provided

Align human resource functions human resources staff can help ensure staff

commitment to integration by reviewing and revising job descriptions and titles

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Providers’ management techniques for integration used by providers

Coordinate clinical care the care delivered to clients must be

coordinated such that the client sees the right provider for the right problem at the right time

Establish disease management Providing disease prevention services

information, improving prescription drug compliance and management

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Integration at the Payer Level

CCRCs

S/HMO

PACE

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IntroductionIntegrating mechanism Interentity organization and

management Care coordination Integrated information systems Integrated financing

19

Organizational Arrangements To Achieve Service Integration Integration of long-term care services

into a continuum can be achieved through different types of organizational arrangements.

20

Integration at the Health Care Provider Level Services integration by health care

providers can be achieved through a variety of arrangements.

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Integration at the Health Care Provider LevelNetworks Organizational Networks --clusters of legally separate

organizations that are formed to pursue goals that could not be attained by an individual organization.

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Integration at the Health Care Provider LevelOrganizational Networks --Valued space 、 equipment 、 specialized

personnel ， or other resources may be shared.

--Substantial managed care penetration 、 reducing the cost of service delivery and improving organizational financial performance will be important motivations for forming a service network.

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Integration at the Health Care Provider LevelLong-term Care Network Example：The Home-Based Hospice Care Network

Hospice Care Visiting Nurse Association Family Social Services

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The Home-Based Hospice Care Network Voluntary Action Center Hospital Pastoral Care National Cancer Society Community Hospital

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The Home-Based Hospice Care Network The hospice network is loosely

coupled. Client services provided by agencies

in the network are financed through different funding channels.

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Ownership An alternative way in which services

are integrated over time and across organizations is through ownership by a single “umbrella” organization.

When many services are linked together through ownership,it’s easier to instill an important features of long-term care.

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Ownership Case management is common

in”owner”services delivery systems --the system is likely to benefit from

efforts to manage client referrals --the system has control over referrals

and the client’s care experience at the point of service delivery

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Self-Assessment for Systems Integration （ SASI） Identifies nine parameters by

organization can measure their “readiness” to integrate.

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Integration at the Government LevelIn many states, state government controls or influences financing, organization, and delivery of long-term care services. States have used their legislative authority to foster long-term care services.

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Integration at the Government Level Example: Minnesota Senior Health

Options (MSHO) MSHO combines the health care and

support services that normally are offered by separate programs into one seamless package to make it easier for people to obtain these services.

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Integration at the Government Level State governments use a variety of

integrating mechanisms to support the continuum of long-term care.

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Barriers to integration Client’s prior experiences, geographic

location, physician preferences, and informal relationships all affect what services are used.

Barriers to organizational integration Even managed-care systems, such as

HMOs and preferred provider organizations, have difficulty integrating diverse services.

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Trends The Balances Budget Act of 1997

(BBA). Prospective payment systems (PPS) The combination of reduced Medicare

payments and the time and energy required to implement new payment systems caused providers to focus on their core businesses and refrain or withdraw from activities involving other services.

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Trends The Health Insurance Portability and

Accountability Act of 1996 (HIPAA). Measuring quality has become a

foremost priority for all components of the health care delivery system.

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Conclusion Models of continuum of care take on a

wide range of forms, from loosely affiliated networks to highly centralized ownership.

Adapting to change, and managing the consequences of a turbulent environment, will be central to the future success of continuums of care.

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Conclusion Each management function and

client care activity should be thought of not from the perspective of my organization, but from the perspective of the full continuum of care, and also from the clients’ perspective.

The promise of integrated systems offering a continuum of care is great.

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