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Health Care Delivery Systems Presentation

Health Care Delivery Systems Presentation

Blue Cross and Blue Shield are thought to be synonymous with health care and its delivery system. Its induction is centered on reaching out to its citizens in order to provide health care services. Private and public systems collaborate to ensure that this endeavor is fair to all providers and patients. Regulatory factors and licensing are critical components of ensuring equitable dispersal. As we plan our healthcare system for the future, having a vision of how it will best serve citizens will allow us to compare today’s trends in healthcare coverage. These trends may result in the implementation of new Blue Cross Blue Shield healthcare provisions.

Blue Cross and Blue Shield was the first health insurance company to serve nearly one-third of all Americans in every zip code, state, and federal territory (Blue Cross and Blue Shield, 2012). This gives them a better understanding of how health insurance is delivered in this market. Furthermore, the number of geographical areas covered by Blue Cross and Blue Shield makes them a competitive organization in the insurance field. Blue Cross and Blue Shield collaborate with local communities to make care more affordable and to improve care quality. Blue Cross and Blue Shield of California is the nation’s leader in highly personalized, coordinated care, with more care delivery models, such as Patient-Centered Medical Homes (PCMH) and Accountable Care Organizations (ACO), than any other healthcare insurer (Blue Cross and Blue Shield, 2012). In addition, the insurance company provides simple access to online applications for finding the best hospitals and doctors for their plans. This provides consumers with the information they need to make health-conscious decisions. They seek not only to provide patients with affordable care but also to provide incentives to doctors who keep patients healthier while spending less on health care. Blue Cross and Blue Shield’s delivery methods are based on patient care; they want what is best for the patient while providing them with the knowledge to make the best decision for their needs. Many insurance providers have difficulty reaching the geographical areas where Blue Cross and Blue Shield can provide patient-based care effectively and affordably.

Economic Changes Affecting Licensing and Regulatory Factors

The future changes in licensing and regulatory factors that must be considered are focused on quality management and quality measures. Quality in health care is achieved through error and variation, as well as by controlling the quality and quantity of health care. Furthermore, concepts such as process analysis, root cause analysis, statistical processes, failure modes, effects analysis, and medical practice management are gaining traction in the control of licensure and regulatory factors.

Competition and Pricing Initiatives Trends

Blue Cross and Blue Shield have been impacted by the Affordable Care Act, also known as Obamacare, in terms of competition and pricing initiatives. For example, as a result of the regulations imposed on them, they have already begun to withdraw from the health marketplace in some states. Wellmark Blue Cross and Blue Shield issued a statement informing patients in Iowa that they will no longer sell or renew any Affordable Care Act plans, individual or family plans, with an effective date of January 1, 2018. (Japsen, 2017). The reason they are no longer offering or renewing these plans is that the new political administration has begun to work on a replacement or modification to the current Affordable Care Act. Because of the current administration’s desire to create a free market-style system that could potentially lower healthcare costs, these future changes may result in new competition and pricing initiatives. If this newer market is established under the right conditions, it has the potential to create a competitive healthcare market with an efficient allocation of resources for both production and consumption (Getzen, 2013). However, Blue Cross and Blue Shield have not ruled out withdrawing entirely from the Affordable Care Act. On the other hand, due to lower 2016 fourth-quarter earnings, they have begun to strategically withdraw from certain areas, and depending on the stability of the healthcare markets, they may withdraw completely from all Obamacare plans (Japsen, 2017).

Licensing and Regulatory Factors’ Influence on Health Care Delivery

Blue Cross and Blue Shield have regulatory and licensing factors that influence healthcare delivery. These elements, along with other healthcare providers, contribute to savings and take risks (Santilli, Vongenberg, 2015). Because Blue Cross/Blue Shield is a managed care insurance plan and services provider, it faces numerous challenges in remaining in regulatory compliance since its departure from the Obamacare marketplace exchange. Although BC/BS is not the largest insurer, it still controls more than half of the insurance market in 33 states and more than a third of the market in 29 states (Hall, Conover 2003). The effects of regulatory compliance and licensing enable BC/BS to expand across state lines in order to acquire more capital and spread risk across multiple markets and regulatory structures. Furthermore, Blue Cross Blue Shield will expand products and services that can be consolidated through Anthem and WellPoint subsidiaries. Although BC/BS has been a non-profit for the most part, its economic value and charitable status have been the most contentious issues since its conversion. Legislators and health care providers have closely monitored the conversion of BC/BS to ensure that higher insurance rates, reduced coverage, and reduced public subsidies do not impede health care delivery to the American people.

Conclusion

Blue Cross and Blue Shield healthcare delivery may be forced to make changes in the future if the Affordable Care Act is taken into account. Healthcare delivery is at a crossroads. It will continue to focus on providing high-quality healthcare while keeping costs low for the general public. For today’s society and government, recent trends tend to show which areas to duplicate and which to abandon. Regulatory factors influence the parameters of how governmental legislation will inevitably influence it. Initiatives and incentives will be used as part of this regulatory process to create a level playing field. These factors collectively guide future guidelines for the most effective focus on healthcare cost and provision.

References

Blue Cross and Blue Shield. (2012). Health insurance from invention to innovation: A history of the Blue Cross and Blue Shield companies. Retrieved from https://www.bcbs.com/the- health-of-America/articles/health-insurance-invention-innovation-history-blue-cross-and- blue

Getzen, T. E. (2013). Health Economics and Financing (5th ed.). Retrieved from The University of Phoenix eBook Collection database

Hall, M. A., & Conover, C. J. (2003). The Impact of Blue Cross Conversions on Accessibility, Affordability, and the Public Interest. The Milbank Quarterly, 81(4), 509–542. http://doi.org/10.1046/j.0887-378X.2003.00293.x

Japsen, B. (2017, April 4). Cracks Emerge In Blue Cross’ Obamacare Firewall. Forbes. Retrieved from https://www.forbes.com/sites/brucejapsen/2017/04/04/cracks-emerge-in-blue-cross- Obamacare-firewall-as-gop-again-talks-repeal/#29c224826d3f

Ross, T. (2013). Health Care Quality Management: Tools and Applications. Somerset: Jossey- Bass, 2013.

Santilli, J., & Vogenberg, F. R. (2015). Key Strategic Trends that Impact Healthcare Decision-Making and Stakeholder Roles in the New Marketplace. American Health & Drug Benefits, 8(1), 15–20.

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Question 


You will create a grid listing 5 regulatory agencies that regulate health and the healthcare system within the United States.

You will answer the following based on the 5 regulatory agencies:

Health Care Delivery Systems Presentation

Health Care Delivery Systems Presentation

Describe the agency, level of regulatory authority (local, state, federal,), the scope of regulatory authority, and role within the U.S. healthcare system.

The relevance of the organization or the organization’s authority to the DNP/FNP graduate.

Describe the relevance to the specialty area, area of practice, or setting of practice.

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