Medical & Health // Health Organization Case Study
UNITED HEALTHCARE GROUP
The company ranked 14th in Fortune 500’s list of healthcare companies in 2015 with a revenue of $130.5 billion the previous year until dislodged from its steady position by competitors in the last two years (Lorenzetti, 2015). But it placed sixth in Fortune 500’s top 10 companies this year for its gargantuan revenue of $184.8 billion (Fortune, 2017).
It is the biggest health insurer in America, providing health benefits and services to more than 85 million patients globally (Lorenzetti, 2017). It also invests heavily in a health services arm called Optum, which offers pharmacy benefits and data analysis. Its revenue accounts for only a third of the company’s total but its sales increased 15% in the first quarter of the year alone. The company purchased Catamaran, which cost$12.8 billion, last March to further enhance its pharmacy investment. As a result, pharmacy benefits members doubled to 65 million. This achievement correspondingly increased the company’s negotiating influence over drug manufacturers for prices (Lorenzetti, 2017).
Its health benefit programs are employer-sponsored and individual health benefits plans in the United States and globally, mainly in Brazil; health and well-being products and services for the continuously increasing senior and aging citizens; State and Medicaid community plans; and health plans for US military service members and their families (Fortune, 2017). With the United States, the company networks for discounted care for its members with 1 million physicians and about 6,000 hospitals and other health facilities as of this time. It boasts of more than 800 value-based linkages for improved patient health and compensates high-quality and better outcomes by care providers. Its key businesses are optumhealth, optuminsight, and optumRx. Optumhealth serves the physical, mental, and financial needs of client organizations and persons. Optuminsight offers health information, technology, services and consultation requirements to industry participants. And OptumRx provides pharmacy care to commercial plans, Medicare, Medicaid and other government health plans for employers and unions. Optum alone serves 11 million individual patients or clients; 4 in 5 hospitals in the US; maintains a network of more than 67,000 pharmacies and more than 100,000 health practitioners and facilities; and has generated approximately 300 health plans. It also cooperates with government agencies in 34 States and DC (Fortune, 2017).
But it also reports issues on affordability, treatment of common health conditions at emergency prices; children’s health, chronic health conditions, health IT and innovations; Medicare and Medicaid; primary care; rural health; specialty pharmacy; and surveyed disrupted dealings with hospitals (UnitedHealth Group, n.d.). With this host of controversies, predicaments and problems, UnitedHealth Group needs an effective plan to address them promptly in order to respond to its clients’ needs in the next decade.
Plans for Dealing with the Issues
Santilli and Vogenberg (2015) listed the trends in network growth that UnitedHealth Group should incorporate into its plan to assure its effectiveness. These trends are patients’ increasing know-how on health matters, advancements in structured quality initiatives, consolidation that increases revenue, new and other provider payment modes; care cost-reducing specialty drugs, and communication-enhancing information technology innovations. UnitedHealth Group should adjust to these trends or innovate on them in earnest in order to pursue or maintain network growth. Decisions currently made in clinical care and shared by different stakeholders need to balance the economic and clinical effects among them (Santilli & Vorgenberg, 2015).
A second major issue that the company needs to rationally address is nurse staffing, not only in view of stiff competition but also in the wake of continuing shortage of nurses. This part of the plan may incorporate the major aspects of that of Robert Wood Johnson Foundation, which focuses on improving the hospital overall environment in attracting the best-performing nurses and retaining them. The consequence equates into improved patient care and better outcomes.
The plan to transform the total work environment must first transform work processes, the workplace’s physical design, the hospital’s organizational culture, invest some more on research on the relationship beween nursing care and patient outcomes and strengthen leadership and partnerships among nurses at all levels Hassmiller & Cozine , 2017. The plan should also secure support from foundations, from the federal government, from the state and from the corporation itself (Hassmiller & Cozine, 2017).
The persistent mis-allocation of healthcare resources remains apparently because of the exclusive focus given to the nature and role of the medical profession and those of the medical profession entirely left out (Kluge, 2007). The allocation function logically belongs to physicians as the very commanders and keepers of healthcare resources. Up to the present, allocation of resources and their management have remained a chronic problem because of three unresolved issues that precede and cause them (Kluge, 2007). This must constitute a third part of the plan that UnitedHealth Group should construct and adapt.
The first of these three important issues that must be addressed before dealing with allocation and management of healthcare resources is a consistent and appropriate model of the nature and role of medical profession and its practitioners within the specific setting (Kluge, 2007). The second is a coherent and consistent model of the ethical status of all the resources allocated by the healthcare profession. And the third is a consistent and coherent model of the social values to be adapted in fulfilling the organization’s commitment as a socially funded business (Kluge, 2007).
This part of the plan should very clearly state an understanding of medicine as a profession, which then guides the allocation of resources (Kluge, 2007). At present, the guiding social service model dictates that the legitimate rights to healthcare resources belong to patients whose treatment has the greatest promise of positive outcome (Kluge, 2007).
And the fourth part of the plan should address patient satisfaction. Patient satisfaction surveys provide essential information that can identify and direct organizational initiatives for quality improvement (Al-Abir & Al-Balushi, 2014).
It is to the advantage of UnitedHealth Group to conduct patient satisfaction surveys as they strongly rely on standardized psychometrically measured data collection procedures (Al-Abir & Al-Balushi, 2014). A standard tool can be improved on or refined to adjust to the objectives of patient satisfaction surveys. Various elements include measurement, predictors for improving or increasing overall patient satisfaction, and the value of collecting this kind of information in drawing up strategic improvement plans and initiatives for healthcare organizations. It will, therefore, offer UnitedHealth Group managers and policy makers the awareness and understanding of patients actually view and perceive the service they receive, and the role the information plays in the overall improvement of the organization. Most importantly, patient satisfaction is a reliable and valid basis for managers in devising and implementing needed change effectively by eliminating unfavorable behaviors and replacing them with favorable ones or enhancing and maintaining favorable behaviors or performance (Al-Abir & Al-Balushi, 2014).
Thus, a comprehensive knowledge of current trends in network growth, improving total work environment to attract quality nurses with a view of their shortage, the balance between the material and professional organizational resources and patient satisfaction in a plan should arm UnitedHealth Group with what it needs to regain its previous competitive market position.
WORKS CITED
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