Healthcare Finance Problems: Understanding Healthcare Financial Management

Healthcare Finance Problems: Understanding Healthcare Financial Management

Healthcare Finance and Private Health Insurance

Healthcare finance is the system of managing funds and other financial resources in the healthcare industry. It entails employing financial strategies and principles to plan and manage the financial aspect in hospitals and other healthcare organizations. Private health insurers are non-governmental for-profit insurance providers, whereby groups and individuals can get different health insurance covers.

Private health insurers play a significant role in financing healthcare. This discussion explores managed care, the initiatives implemented by private insurers to transform healthcare, roles played by nurses to improve quality patient outcomes tied to reimbursements. The strategies nurses can use to advocate for healthcare consumers and reduce the increasing cost of healthcare will also be discussed.

Managed care refers to a group of strategies taken to reduce healthcare costs. Members of managed care systems come together to coordinate medical services to control the cost of care provision while improving care quality. According to Heaton and Tadi (2023), managed care organizations integrate different healthcare entities, reducing healthcare expenditure. Managed care organizations continue to shape healthcare delivery in the United States by enhancing preventive medicine strategies, providing treatment guidelines, coordinating care, forming provider networks, and financial provision through incentives.

Private health insurers play a significant role in transforming healthcare. Private health insurance is one of the major sources of funding since a huge proportion of patients is covered using private health insurance covers. According to Denny and Collins (2021), private health insurers provide health insurance coverage to individuals and groups, transforming healthcare by enhancing better health for individuals, groups, and communities. Additionally, private health insurers have a great stake in facilitating universal health coverage since more people can access and afford healthcare services through insurance coverage. Private health insurers also promote value-based care and compete with government health insurers, thus reducing the cost of care. Denny and Collins (2021) note that value-based care is associated with better care quality, thus transforming the system.

When patient outcomes are tied to reimbursements, it means that the healthcare providers’ payment is directly linked to the quality or effectiveness/outcomes of the care delivered to patients. Quality patient outcomes directly linked to reimbursements include hospital readmission rates, complication cases, hospital-acquired infection, patient-reported outcomes, and timeliness of care (Kutz et al., 2019). Nurses can improve the quality of patient outcomes tied to reimbursements in several ways. These ways include infection control, patient education, medication management to avoid adverse reactions and errors, and compliance with evidence-based practice. Infection control would help prevent hospital-acquired infections and related readmissions, thus improving reimbursement-related outcomes. Patient education would help improve adherence, hence improving patient outcomes. In addition, complying with evidence-based practice would improve patient outcomes such as hospital readmission and complications.

Furthermore, nurses can advocate for healthcare consumers and reduce the cost of healthcare. The strategies that nurses can use to advocate for healthcare consumers include empowering them through education, providing access to information that would help patients make decisions related to healthcare costs, and participating in policy advocacy to regulate healthcare costs. In addition, Byrne et al. (2020) note that nurses are among the stakeholders that can influence healthcare costs through approaches such as patient-centered care.

Private health insurers are a major source of healthcare funding. Managed care through managed care organizations regulates healthcare costs. Nurses play a major role in patient outcomes related to reimbursements. In addition, nursing advocacy for health consumers is pivotal in reducing healthcare costs.  

Healthcare Finance References

Byrne, A. L., Baldwin, A., & Harvey, C. (2020). Whose center is it anyway? Defining person-centered care in nursing: An integrative review. PloS One, 15(3), e0229923. https://doi.org/10.1371/journal.pone.0229923

Denny, J. C., & Collins, F. S. (2021). Precision medicine in 2030-seven ways to transform healthcare. Cell, 184(6), 1415–1419. https://doi.org/10.1016/j.cell.2021.01.015

Heaton J, Tadi P. (2023). Managed Care Organization. In: StatPearls [Internet]. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK557797/

Kutz, A., Gut, L., Ebrahimi, F., Wagner, U., Schuetz, P., & Mueller, B. (2019). Association of the Swiss Diagnosis-Related Group Reimbursement System With Length of Stay, Mortality, and Readmission Rates in Hospitalized Adult Patients. JAMA Network Open, 2(2), e188332. https://doi.org/10.1001/jamanetworkopen.2018.8332

HCA 320 Module 7 Assignment Financing Healthcare

Financing Healthcare

Consider how compensation for healthcare services shape delivery of care, and reflects policy and policy changes and write a paper that addresses the bullets below. Be sure to completely address each bullet point. There should be four (4) sections in your paper; one for each bullet below. Separate each section in your paper with a clear brief heading that allows your professor to know which bullet you are addressing in that section of your paper. Include a “Conclusion” section that summarizes all topics. This assignment will be at least 1250 words.

This week you will reflect upon accountability in healthcare finance to address the following:

• Discuss the history of private health insurance and manage care and how it involved into a healthcare industry?  
• Identify the key federal laws that protect individuals who are enrolled in private insurance.
• Briefly discuss consumer-driven healthcare and the empowerment of the healthcare consumer.
• Explore the opportunities which have emerged for nurses within the private insurance market.

Start by reading and following these instructions:

1.   Study the required chapter(s) of the textbook and any additional recommended resources. Some answers may require you to do additional research on the Internet or in other reference sources. Choose your sources carefully.
2.   Consider the discussion and the any insights you gained from it.
3.   Review the assignment rubric and the specifications below to ensure that your response aligns with all assignment expectations.
4.   Create your assignment submission and be sure to cite your sources, use APA style as required, and check your spelling.

The following specifications are required for this assignment:

Length: 1250-1500 words; answers must thoroughly address the question in a clear, concise manner

Structure: Include a title page and reference page in APA format. These do not count towards the minimal word amount for this assignment.  Your essay must include an introduction and a conclusion.

References: Use the appropriate APA style in-text citations and references for all resources utilized to answer the questions. A minimum of two (2) scholarly sources are required for this assignment.

Format: Save your assignment as a Microsoft Word document (.doc or .docx).

Filename: Name your saved file according to your first initial, last name, and the module number (for example, “RHall Module 1.docx”)

Undergrad Simple Essay Rubric v1 Healthcare Finance

Criteria	Does Not Meet 0%	Approaches 60%	Meets 70%	Exceeds 100%	Criterion Score
Content Weight: 30%	0 pointsTopic is inappropriate to assignment, inaccurate understanding of concepts, unclear and difficult to understand; does not address many assignment requirements. Information has weak or no connection to the assignment topic.	18 pointsTopic is mostly covered and appropriate to assignment, but does not adequately demonstrate accurate understanding of concepts; mostly clear and understandable; lacks some of the requirements of the assignment description and/or provides little detail; Information relates to the main topic, but few details and/or examples are given.	21 pointsTopic is covered completely and appropriate to assignment; overview of key concept dimensions is evident; clear and understandable; addresses all of the requirements of the assignment description, with adequate attention to detail.	30 pointsIn-depth coverage of topic; outstanding clarity and explanation of concepts demonstrated in information presented; approaches assignment with depth and breadth, without redundancy, using clear and focused details.	Score of Content Weight: 30%,/ 30
Organization Weight: 25%	0 pointsOrganization is confusing and interferes with reader’s ability to follow ideas. Weak or no introduction of topic or purpose is unclear, weak, or missing. Conclusion lacks a summary of topic, or is missing or irrelevant.	15 pointsIdeas are sometimes disorganized or irrelevant; Flow is sometimes choppy; somewhat clear organization. Basic introduction that states topic but is presented in an uninteresting way. Conclusion contains basic summary of topic without final concluding ideas, may inappropriately introduces new information.	17.5 pointsStructures ideas in a coherent, organized order that has good flow and an obvious framework. Proficient introduction that is interesting and states topic. Conclusion contains good summary of topic with credible concluding ideas and introduces no new information.	25 pointsExceptionally clear, logical, mature, and thorough organization permitting smooth flow of ideas; Introduction that grabs interest of reader and states topic in clear, unambiguous terms. Excellent concluding summary with succinct and precise ideas that impact reader.	Score of Organization Weight: 25%,/ 25
Logic/Argument Weight: 15%	0 pointsDemonstrates little logical reasoning for the claims and thoughts within assignment; Many claims are weak or illogical.	9 pointsLacks some logical reasoning for the claims and thoughts within the assignment; Some claims are weak.	10.5 pointsUses solid logical reasoning for the claims and thoughts within the assignment.	15 pointsProvides exemplary logical reasoning for the claims and thoughts within the assignment.	Score of Logic/ Argument Weight: 15%,/ 15
Support Weight: 20%	0 pointsLacks support; Uses poor sources for references; Citations lack credibility, relevance, or academic quality or are not current; Does not meet the minimum number of required citations in assignment description. APA format and style are not evident.	12 pointsProvides weak support or not enough support; Citations are not consistently credible, current, relevant or academic; Meets the minimum number of required citations in assignment description Missing APA elements; in-text citations, where necessary, are used but formatted inaccurately and not referenced.	14 pointsProvides sufficient support with credible, current, relevant academic citations; Meets the minimum number of required citations in assignment description. ; In-text citations and a reference page are present with few format errors. Mechanics of writing are reflective of APA style.	20 pointsProvides very strong support from credible, current, relevant, academic citations; Meets or exceeds the minimum number of required citations in assignment description. Accurate citations and references are presented. No APA errors are evident.	Score of Support Weight: 20%,/ 20
Quality of Written Communication Weight: 10%	0 pointsStyle and voice inappropriate or do not address given audience, purpose, etc. Word choice is excessively redundant, clichéd, and unspecific. Inconsistent grammar, spelling, punctuation, and paragraphing. Surface errors are pervasive enough that they impede communication of meaning.	6 pointsStyle and voice are somewhat appropriate to given audience and purpose. Word choice is often unspecific, generic, redundant, and clichéd. Repetitive mechanical errors distract the reader. Inconsistencies in language, sentence structure, and/or word choice are present.	7 pointsStyle and voice are appropriate to the given audience and purpose. Word choice is specific and purposeful, and somewhat varied throughout. Minimal mechanical or typographical errors are present, but are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used.	10 pointsStyle and voice are not only appropriate to the given audience and purpose, but also show originality and creativity. Word choice is specific, purposeful, dynamic and varied. Free of mechanical and typographical errors. A variety of sentence structures and effective figures of speech are used. Writer is clearly in command of standard, written, academic English.	Score of Quality of Written Communication Weight: 10%,/ 10