Strategic Health Care Topics and Government Regulations and Reforms
Strategic Health Care Topics and Government Regulations and Reforms
Discussions are a key element of learning and sharing experiences throughout the course. This week you are asked to research the literature related to regulations such as the HITECH Act and the Patient Protection and Accountable Care Act (PPACA). This legislation has been in place for a period of time and has generated many peer-reviewed studies on the efficacy and issues of the legislation. This first Discussion also asks you to critically evaluate how these regulations affect your perceptions as a consumer of health services. You are encouraged to think about these perceptions in terms of some of the major concerns that a consumer may have in the industry today such as accessing health care, financing health care, compliance with health regimes and motivating behavior change, to name a few.
To prepare for this Discussion:
Review at least one peer reviewed, profession journal article or detailed news article discussing government mandates for health care such as the 2009 HITECH Act, the Patient Privacy and Affordable Care Act (ACA), Accountable Care Organizations (ACO), or value-based purchasing. Consider topics discussed in your previous courses in the Master of Healthcare Administration program such as:
Transition from volume-based to value-based healthcare
Population health
Data analytics
Healthcare consumerism
Choose one of these topics to use as the basis of your Discussion.
By Day 3
Post:
Explain how the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 impacts your topic. Describe how your organization is impacted by your topic and the HITECH Act of 2009. As a consumer of health care, how do you perceive the use of health information technology (HIT) to address these topics affecting your personal health care delivery?
Support your response with references to the Learning Resources or other academic sources.
By Day 5
Respond by Day 5 and continue the Discussion through Day 7:
Expand the Discussion by analyzing your colleagues’ responses and discussing how you understand the HITECH Act having affected the delivery of health care services to consumers in the organizations and environments being discussed in class.
MMHA6600 Healthcare Informatics and Technology Management
Week 3 Discussion
Steps in the Implementation of Technology Infrastructure–A Visual Representation
This Discussion challenges you to succinctly and visually demonstrate how a key piece of technology infrastructure would be deployed in a non-health care setting. Following the Systems Development Lifecycle (SDLC), you are asked to evaluate how an organization in another economic sector such as retail, financial services, or manufacturing utilizes key technology infrastructure in their business operations. The purpose of evaluating technology infrastructure in a non-health care setting is to develop an appreciation for the role and capabilities of these technology components. As you investigate the use of these infrastructure components in IT management, you will find the more innovative uses of several types of infrastructure in applications outside of health care.
To prepare:
Review the steps of the Systems Development Lifecycle.
Select a type of technology infrastructure such as networking, mobile devices, cloud computing, or web. Using the Walden library, research the use of this technology infrastructure in a non-health care industry.
Develop a non-health care scenario/organization where you feel that this technology might be beneficial.
Examine the visual tools in Microsoft PowerPoint and create a one slide picture that shows the technology you plan to implement and how you will do so using the steps in the Systems Development Lifecycle.
By Day 3
Post:
Generate one diagram that you would use in an executive meeting to show your IT acquisition steps using the Systems Development Lifecycle (SDLC). Include steps such as the acquisition, implementation, and support of the technology infrastructure solution that you chose. Paste this diagram in a PowerPoint slide and post the slide as an attachment to your Discussion thread. You need not include speaker notes as part of this slide. The aim of this diagram is to summarize the activities that you conducted in each of your SDLC steps in one clear visual representation. A stakeholder should be able to look at your diagram and see a summary of your SDLC steps from acquiring the technology through its anticipated support stage. Activities should be succinctly summarized in the diagram, highlighting the most important activities for the executive audience.
In your Discussion thread briefly highlight 3–5 major assumptions that you made in acquiring this infrastructure solution. The Discussion is the opportunity to expand on the process and steps that you used in developing your visual Systems Lifecycle Diagram. Describe the type of non-health care organization are you are referencing in your acquisition strategy. Why is this non-health care example relevant in the acquisition of this technology? How can learning from this industry be applied to health care? Explain your assumptions regarding scope, cost, and use of this technology.
By Day 5
Respond by Day 5 and continue the Discussion through Day 7:
Review your colleagues’ PowerPoint slide and provide constructive critique concerning their presentation and assumptions.
MMHA6600 Healthcare Informatics and Technology Management
Week 4 Discussion
Cost Savings and Revenue Enhancement
This Discussion offers you the opportunity to apply return on investment (ROI) concepts in a real case scenario. As is often the case, technology offerings involve costs that must be justified by virtue of expense reductions for revenue increases in the organization. There are creative opportunities in the Discussion for leaders to facilitate the development of the revenues into the organization and operational changes that reduce expenses.
Scenario: Dynamic Health System is a 3-hospital, 500-bed system in the Midwest United States. This system employs 100 physicians, both primary care and specialists, in 12 physician practices. Dynamic also runs a center of excellence in orthopedic care for the large geriatric population in the area, including an outpatient rehabilitation facility that is currently profitable. Dynamic offers a full spectrum of medical and surgical services to their population with an emphasis on programs of excellence in orthopedic surgery, diabetes, and women’s care.
Dynamic’s typical patient mix is over 45% Medicare with another 35% private pay patients covered by three large insurance companies. Their Medicaid population is approximately 12%, with the reminder of patients self-pay.
Due to market forces, the three private payers have begun to implement a program of bundled payments for their members in the following areas: hip replacements, knee replacements, and lower back surgeries. In these models, Dynamic hospitals and employed physicians will be paid a fixed amount for an entire episode of care from pre- surgery evaluation, through surgery and post-surgery, physical therapy, and rehabilitation. Medicare is likewise proposing a pilot study for a population of hip replacement beneficiaries to assess the outcomes of care as opposed to procedure costs as a result of Dynamic’s petition to receive increased payments for beneficiaries due to age demographics and for being the only orthopedic geriatric center in 200 miles.
As a result of these factors and the aging HIT infrastructure, the Chief Medical Officer (CMO), Chief Executive Officer (CEO), and Chief Information Officer (CIO) of Dynamic are proposing the purchase of a monolithic Electronic Health Record (EMR) solution that will provide complete online documentation, orders, pharmacy, labs, and patient portal for all hospitals and employed physician offices. Because the (1) physician offices are currently using Epic Corporation’s back office billing system with an outstanding record of accurate coding and short “days in Accounts Receivable” and (2) Epic’s EMR has a high ranking in industry HIT assessments, the executive team is proposing the purchase of Epic’s clinical EMR (documentation, ancillaries, orders, and patient portal).
The CFO is supportive but skeptical, as the Epic bid is approximately $1.5 M to implement the clinical software with a continued $300K per year in software maintenance and support. Current clinical technologies information systems are fragmented, disjointed, and don’t meet HITECH Meaningful Use requirements, and it will cost Dynamic about $200K per year to maintain the software and servers needed to run the system.
The local competitive landscape may be changing. Dynamic’s CFO is hearing rumors that an established academic system which is centered 300 miles away is possibly considering buying three local stand-alone surgery centers and hiring orthopedic surgeons. This academic center has published best practices in outcomes for surgery care in a recent CMS Medicare study that implies that they are delivering high quality and cost effective orthopedic care.
To prepare:
Carefully read the scenario and the Pro Forma Explanation Material in this week’s Learning Resources.
Develop a return on investment (ROI) strategy for the acquisition of a strategic HIT solution in which you consider 2–3 cost saving and/or revenue generating opportunities that you feel apply to Dynamic’s scenario.
By Day 3
Post:
A strategy for how Dynamic can pay for the newly proposed Epic system. Explain how the organization will save in operational expense in order to handle the extra 100K per year needed to maintain this solution. Provide a recommendation for how the hospital can use HIT solutions to generate new revenue. Also consider that if Dynamic issues a bond to pay for the $1.5 million implementation costs, likely the local rating agencies will want to see a documented 5–10% additional reduction in “hard line” operating expenses to assure Dynamic’s ability to pay off the debt. Given that over 60% of the operating budget is staff and physician salaries, explain what kinds of savings the best in class EHR offer will assure investors.
By Day 5
Respond by Day 5 and continue the Discussion through Day 7:
Examine your colleagues’ posts regarding ideas for operating budget reductions and/or new revenues proposed as part of implementing the Epic solution. If the CFO’s rumors are true and the academic center opens competitive surgery alternatives in the area, how would you recommend your colleague adjust their cost savings and revenue ideas?
MMHA6600 Healthcare Informatics and Technology Management
Week 6 Discussion
Challenging Decisions–Best of Breed or Monolithic Systems
The implementation of the ACA means that there are thousands more patients coming into local health systems. There is also a trend of larger heath care delivery systems acquiring and/or affiliating with smaller hospitals and physicians to leverage economies of scale to meet regulatory requirements and secure the share of local markets. These trends often mean that health care leaders must examine information systems strategies at a macro organizational level and make key vendor decisions about which HIT solutions to maintain and grow or eliminate as a part of overall systems integration planning.
One of the key decisions that leaders face is whether to bundle financial (registration, scheduling, and billing) information systems along with clinical (EMR) systems in monolithic vendor strategies or whether to spread risk and have varied HIT vendor partners for clinical and business solutions while implementing an interface solution.
To prepare:
Read the Learning Resources and research references regarding IT strategies, specifically best of breed and monolithic vendor systems used to achieve integration.
Consider private payers including pay for performance “bundled” payments as discussed in the Dynamic Scenario in Week 4. How do private payers play into your thinking about clinical and financial information systems strategies?
By Day 3
Post:
A recommendation of either a best of breed or monolithic systems integration strategy. Justify your recommendation. Evaluate the issues involved in each. Describe how private payers play into your thinking about clinical and financial information systems strategies. Describe the role of vendor/client site relationships in these types of decisions. Support your rationale with references.
By Day 5
Respond by Day 5 and continue the Discussion through Day 7:
Expand on this Discussion by providing additional insights or alternative perspectives.
MMHA6600 Healthcare Informatics and Technology Management
Week 7 Discussion
Co-Morbidities and Using Data to Manage Population Health
Managing the quality and cost of co-morbid populations is one of the most challenging aspects of health leadership. In this Discussion, you are challenged with selecting those data which will be most helpful in the management of Medicare populations. As health information exchanges (HIEs) progress at the state, federal, and nation level, health leaders are tasked to participate in the development of analytics tools that can be used to pull data and inform policy practice.
Scenario: Review the high volume Medicare Data Scenario located in the Learning Resources. In this scenario you are asked to work with a complex dataset of co-morbidity data of patients that have three concurrent co-morbid conditions (Chronic Condition Triads: Prevalence and Medicare Spending). How can data from HIT systems be used to formulate useful information to facilitate in the management of this population?
To prepare
Using the health care information systems standards for clinical and financial data discussed in Week 6 (Chapter 11 of Health Care Information Systems: A Practical Approach for Health Care Management), identify specific types of data (data sets, standards, examples of those data) that can be redeveloped into Big Data tools and used to address the management of population health initiatives.
Define a “Big Data” analysis dataset to include in a data warehouse by identifying two specific types of clinical and financial data from the Chronic Condition Triads: Prevalence and Medicare Spending dataset in your Learning Resources that you feel could be used to drive behavior change in the patient and provider populations. This Big Data dataset will become the focus of your Discussion.
By Day 3
Post:
Explain why the two specific types of clinical and financial data you selected as your Big Data dataset would best affect behavior change in the type of co-morbid Medicare populations served in the scenario. Explain and assess how this Big Data dataset can change the behaviors of health care providers in the scenario. Assuming that your Big Data dataset is going to be shared in a regional health information exchange, explain how the Centers for Medicare and Medicaid Services and private payers might use these regional data sets to increase value in delivering services to co-morbid Medicare patient populations in the region.
By Day 5
Respond by Day 5 and continue the Discussion through Day 7:
Expand on this Discussion by providing additional insights or alternative perspectives
MMHA6600 Healthcare Informatics and Technology Management
Week 8 Discussion
Strategic Use of HIT in Virtual Health Care Delivery Models
In this Discussion you are asked to take on a specific role as you work through the opportunities and challenges related to the evolution of e-Patient models and online service delivery. By participating in this dynamic Discussion you will be able to critically assess different stakeholder perspectives on eHealth. This exercise allows you to develop a key leadership skill, which is a sense of perspective and sensitivity to multiple views on a complex topic.
Scenario: Dynamic Health System has implemented the Epic Electronic Health Record and the integrated patient portal. The portal is branded as “myDynamic Health” and is used for basic functions such as: prescription refills, self-scheduling, reporting results, and referrals. Dynamic primary care doctors want to begin to offer electronic care (virtual) visits online for non-urgent illness to compete with the growing number of stand-alone urgent care centers and pharmacy urgent care clinics in their area. The physicians have read literature from other sites in the U.S. where eVisits are conducted on existing patients and paid for by private insurance and self-pay patients. They are anxious to get started and are looking toward a newly formed committee of top administrators at Dynamic and some external stakeholders to formulate a plan.
To prepare:
Read the Learning Resources and investigate the literature related to existing eVisit models. Examine any online care models in your area as well.
Discuss the concept of online patient care with stakeholders such as administrators, physicians, nurses, or payers in your area.
For this Discussion Question, each student is assigned a role by the Instructor (see Class Announcements). Roles include: commercial payer, regional employer, practice administrator, primary care physician, marketing director, and CFO.
By Day 3
Post:
Using Dynamic Health System as a scenario, respond to the proposed idea of Dynamic deploying online primary care visits. From the perspective of your role, what are the benefits of online visits? What are the concerns?
By Day 5
Respond by Day 5 and continue the Discussion through Day 7:
Expand on this Discussion by providing additional insights or alternative perspectives. Also, continue the Discussion by considering how Dynamic can market its new eVisits service. What are the considerations from a branding, advertising and social media standpoint? How does Dynamic differentiate itself in the marketplace with this HIT platform?
MMHA6600 Healthcare Informatics and Technology Management
Week 9 Discussion
Security and Privacy
In this Discussion you will critique the actions of an administrator interacting with a peer leader, the organizational CIO, in a stressful situation involving data compromise. You are asked to think through various risk management strategies that might have been deployed to avoid this type of a situation in the future. Emphasis is placed on leadership behaviors and recommendations on how this leader might have acted differently to achieve the most constructive outcome in a volatile situation.
Video Prompt and Response: CIO with administrator exploring first access. Breach of security protocol.
To prepare:
Review the Protecting Patient Data I media piece in your Learning Resources
Reflect on the principles of security, privacy, and ethics as they apply to HIT systems and this scenario.
Consider risk management strategies for the management of strategic information assets using best IT industry practices.
By Day 3
Post:
Using the Kaltura video feature, submit a 1–2 minute video response to the Protecting Patient Data Imedia piece though the “Discussion – Week 9” submission link. Critique the actions of the administrator in her conversation with the CIO. From a security, privacy, and ethics standpoint how might the administrator have handled the conversation differently? What risk management strategies could have been used?
Once you have submitted to the “Discussion – Week 9” submission link, the Discussion Forum will become available. Post the same video response to the Discussion Forum.
You will now be able to view the Protecting Patient Data II media piece. This video shows how the administrator should have reacted in the scenario.
By Day 5
Respond by Day 5 and continue the Discussion through Day 7:
View your colleagues’ videos. Respond to your colleagues by providing constructive feedback concerning their response to the video.
MMHA6600 Healthcare Informatics and Technology Management
Week 10 Discussion
Leading Through Change–Proactively Managing Transformative Practice
This Discussion highlights the leader’s role in facilitating change. You are asked to focus on a change management model that has proven successful in a non-health care sector. As you saw in Week 2, many best practices in technology have developed outside of health care. The focus of this Discussion is on the innovative application of best practices in stakeholder adoption from other industries in health care settings.
To prepare:
Reflect on positive consumer experiences that you have had related to using information technologies to access products or services.
How did the stakeholders in that setting use HIT platforms to improve your customer experience? Apply this thinking to this week’s Discussion.
By Day 3
Post:
Based on the scenario that you chose for your Final Project, explain what change management model you would implement for internal and external stakeholders. What change management theory would you use and how would you apply it through IT implementation? Outline specific change and innovation management strategies given your scenario, using best practices in the private sector.
By Day 5
Respond by Day 5 and continue the Discussion through Day 7:
Expand on this Discussion by providing additional insights or alternative perspectives. Also consider if one of these stakeholders is a politically influential leader in the organization or environment. How would you recommend your colleagues adjust their strategy to address this individual’s concerns?
MMHA6600 Healthcare Informatics and Technology Management
Week 11 Discussion
Technology and the Future in Health Care–Transformational Trends and Forces
In this Discussion you are asked to select an emerging technology and evaluate its cost-effectiveness and potential adoption. Many novel technologies require significant rethinking of current workflows, roles, culture, and financial models. You are asked to consider how the technology you chose affects these aspects of the current health ecosystem. Likewise, leaders must also consider that some emerging technologies completely lack a financial policy framework.
To prepare:
Assess an emerging technology trend in the Learning Resources or one that you prefer to research on your own.
By Day 3
Post:
Select one emerging trend in the health care and/or health care technology industry. What are three take-a-ways from this course that you could use to implement this trend? Given the financial alignment models in the health care industry today, would this technology be readily accepted and cost justified? If yes, explain. If no, what changes in financing policy would have to occur to deem this technology sustainable?
By Day 5
Respond by Day 5 and continue the Discussion through Day 7:
Expand on this Discussion by providing additional insights or alternative perspectives.
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