Organization and Management

1. 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

2. Introduction Integrating mechanism • Interentity organization and management • Care coordination • Integrated information systems • Integrated financing

3. Organizational Arrangements To Achieve Service Integration • Integration of long-term care services into a continuum can be achieved through different types of organizational arrangements.

4. Integration at the Health Care Provider Level • Services integration by health care providers can be achieved through a variety of arrangements.

5. Integration at the Health Care Provider Level Networks • Organizational Networks --clusters of legally separate organizations that are formed to pursue goals that could not be attained by an individual organization.

6. Integration at the Health Care Provider Level Organizational 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.

7. Integration at the Health Care Provider Level Long-term Care Network Example： The Home-Based Hospice Care Network • Hospice Care • Visiting Nurse Association • Family Social Services

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

9. 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.

10. 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.

11. 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

12. Self-Assessment for Systems Integration（SASI） • Identifies nine parameters by organization can measure their “readiness” to integrate.

13. 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.

14. 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.

15. 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

16. 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

17. 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

18. Integration at the Payer Level • CCRCs • S/HMO • PACE

19. Introduction Integrating mechanism • Interentity organization and management • Care coordination • Integrated information systems • Integrated financing

20. Organizational Arrangements To Achieve Service Integration • Integration of long-term care services into a continuum can be achieved through different types of organizational arrangements.

21. Integration at the Health Care Provider Level • Services integration by health care providers can be achieved through a variety of arrangements.

22. Integration at the Health Care Provider Level Networks • Organizational Networks --clusters of legally separate organizations that are formed to pursue goals that could not be attained by an individual organization.

23. Integration at the Health Care Provider Level Organizational 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.

24. Integration at the Health Care Provider Level Long-term Care Network Example： The Home-Based Hospice Care Network • Hospice Care • Visiting Nurse Association • Family Social Services

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

26. 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.

27. 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.

28. 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

29. Self-Assessment for Systems Integration（SASI） • Identifies nine parameters by organization can measure their “readiness” to integrate.

30. Integration at the Government Level In 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.

31. 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.

32. Integration at the Government Level • State governments use a variety of integrating mechanisms to support the continuum of long-term care.

33. 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.

34. 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.

35. 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.

36. 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.

37. 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.