Healthcare Case Study Essay Example

hill through administrative assistance which includes technology infrastructure, case management, claims processing, customer service and authorization reviews. Contracts with a health plan are also managed and negotiated by primed. Hill has encouraged better communication services among their patients and the physicians; it makes use of a technology tool known as Relay health. Hill has come up with a web-based software application that is free and clinicians can send messages to their patients over unharmed internet links. Physicians can as well answer patient’s queries and post test results, appointment reminders through Ray health tool. Patients can also make, cancel, and reschedule appointments. The relay health facilitates e-prescribing and photoelectric referral services, and this has worked for a couple of years.

Hill also developed their score since they were not satisfied with the first score that incorporated symmetry’s prospective score though better at identifying patients who were in need of improved care management. The study shows that Hill nurses used prospective risk score as communication springboard for some patients care initiatives. Nurses used motivational interviews that involved breaking goals down into small elements as a way of motivation and patients and the physicians emerged successfully. The Pacific Commerce group on physical condition approached Hill by joining the new breakthrough in chronic care which was referred to as the California quality collaborative to work on clinical improvements in diabetes care and four of the physicians were selected and came up very well though results did not change drastically(Blas etal. 2011). The results were later seen with greater success, and the four doctors became champions. Health educators assisted the patients to improve their self-management skills and related to clinical measures

(Vincent, 2010). The reason why the study will be replicable the health care services will borrow all the steps that Hill undergoes, and this will enable them to put the plan to use, and as long as it works in Hill Corporation, it can work elsewhere as well.

Financial incentives for physician result in improved quality because doctors are notoriously reluctant to change. I know this from Hills lessons. Hill earn their trust by paying doctors on time, listening to their concern, and strives to build a good relationship with its physician members. Hill Corporation uses predictive modeling as well as adaptations to manage chronic conditions. In its health resource management division, Hill employ’s twenty-five registered nurses who apply for software program from symmetry (Davis & LaCour, 2014). Hill has a software program called Episode risk and is programmed to assign the value of each patient called the prospective risk score for estimating the likelihood of patient using physician resources in future. Hill has its unique hybrid compensation formula composed of fee-for-service and its pay –for –performance compensation. Hill receives fixed payments per recipient from its health plan partners and the fees on its contracted physicians on the free-for-service basis. Hill pays 85%, and the rest of the finances are withheld, and it is deposited into a population management fund which is dispersed by Hill based on physician performance.

Hill pay its physicians according to the part three-part formula that is; earn more after you have got a lot of patients through the program. The rest of the physicians who do not meet the outcome measures do not receive the funds. The plan acts as an incentive

to the doctors. The distributed resources for those who participate is 200,000 dollars, and the amount depends on the performance, practice, size as well as the amount of cash available in the population management fund each quarter. The average sum per quarter is 20,000 dollars per practice. When economic incentives are not sufficient to make sure physician behavioral change, Hills Corporation provide a significantly greater incentive to its physicians (Huston, 2014). Doctors’ trust can be maintained through small steps which reveal that the organization cares about the physician’s satisfaction and practice success. When the doctors build confidence in the team physicians becomes more welcoming to the motivations that use physician performance data to highlight areas that require improvement. The patient’s lives have been changed by use of this platform, good working rapport, and a great difference is noted. Other groups of physicians may successfully replicate Hills innovations since Hills cooperation has done and made it successfully.

The early lessons that can be learned from these experiences that can help the federal government design or modify programs and supports to give confidence, duplicate and increase complete healthcare reform are by introducing both financial and cultural changes. Physicians trust can be captured through little financial motivations, identifying as well as solving their problems. The general government should be determined to pay physicians in a unique way like Hill does to its members. They must ensure that the physicians are willing to change. Doctors should adopt health IT by aiding the offices in price and training as well as fostering a communication culture and cooperation. The government needs to implement the organization plans in the form management fund where

the physician who choose not to participate in pay-for-performance or attending plan quarterly meetings to leave cash on the table and also to the possibility of not providing the best quality patient care possible (Blas etal. 2011). The government should introduce some tools that have made it possible for Hill to come up successfully. With this physician will remain busy practicing medicine as the best they can for their patients every day. Physicians also must respond to smart managements. Such managements are information, collaborative coaching, and incentives. If the government runs the organization like Hill physician, it will have the ability to streamline administrative processes that will enable the doctors to spend more time practicing medicine so that they can benefit from the outcomes. For sustainable quality improvement government should demonstrate excellent communication, coordination, and feedback which will enable success (Huston, 2014). Physician members in small practices must be part of always evolving and linked system that distributes pay-for-performance funds, coordinate care for high-risk implementation. The doctors should work hard, be an openly disposed approach to care and serve as an inspiration to all stimulated parties in building a health care system that will offer the best value. The governments need to replicate hills study and put it into use in expanding and improving health care services.

References

1. Blas, E., Sommerfeld, J., Kurup, A. S., World Health Organization., Special Programme for Research and Training in Tropical Diseases., Alliance for Health Policy and Systems Research., & Special Programme of Research, Development, and Research Training in Human Reproduction (World Health Organization). (2011). Social determinants approaches to public health: From concept to practice. Geneva: World Health Organization.
2. Davis, N.
   

A., & LaCour, M. (2014). Health Information Technology. London: Elsevier Health Sciences.