Unit One: An Introduction to Health Care Management

Unit One Learning Objectives

• Definition and Roles: Define health care management and the specific role of the health care manager within various settings.
• The Triple Aims: Discuss the Triple Aims of healthcare—specifically cost, quality, and access—and their direct relevance to the trend of Consumer-Directed Health Care.
• Management Levels: Differentiate between the various levels of management, including regulatory, operational, and individual levels, while identifying the factors that limit these levels.
• Patient Access: Evaluate the critical importance of patient access to care as a fundamental factor in the effective implementation of the Triple Aims.
• Organizational Responsibilities: Differentiate the specific functions, roles, and responsibilities associated with various levels of health care management.
• Disparities and Competency: Define the concepts of health disparities and cultural competency.
• Cultural Initiatives: Describe potential initiatives intended to foster cultural proficiency within healthcare organizations and outline the institutional benefits of these programs.
• Core Elements: Explore basic elements of health care, including setting types, internal and external domains, Consumer-Directed health care, and explains the impact of health disparities.
• Managerial Competencies: Examine the functions, focus, competencies, and diverse roles that a health care manager can occupy in the modern healthcare landscape.

The State of the United States Health Care System

• Spending vs. Performance (Murray and Frenk, 2010): An article published in the New England Journal of Medicine examined the state of the U.S. system based on $2006$ data.
  • Spending Rank: In $2006$, the United States was ranked number $1$ in the world regarding health care spending per capita.
  • Performance Rank: Despite the highest spending, the World Health Organization (WHO) ranked the U.S. health care system at number $37$ when assessing key health markers.
• Key Health Markers: The United States ranks between number $36$ and number $43$ globally for critical markers including:
  • Infant mortality.
  • Adult male mortality.
  • Adult female mortality.
  • Life expectancy.
• Investment Return: The U.S. pays a significant amount of money per person for a health care system that provides a relatively small return on investment compared to other nations.
• Preventable Deaths: A significant portion of mortality is linked to factors that could be modified through preventive strategies, which would also reduce long-term costs. These factors include:
  • Smoking.
  • Hypertension (high blood pressure).
  • Obesity.
  • Physical inactivity.
  • High blood glucose levels.
  • High levels of Low Density Lipoproteins ($LDL$ cholesterol).

Health Care Delivery Settings

• Direct Care Settings: These are organizations and environments that provide care directly to the patient (e.g., hospitals, clinics).
• Non-Direct Care Settings: These include products and services that support direct care settings (e.g., medical equipment suppliers, pharmaceutical companies, health insurance companies).
• Managerial Requirement: Both direct and non-direct care settings require robust health care management strategies to function effectively.

Internal and External Domains of Health Care Management

• External Domains: These refer to influences and entities outside of the healthcare organization that affect its operations. Examples include:
  • Community demographics.
  • Licensure and accreditation requirements.
  • Government regulations.
  • Stakeholder demands.
  • Competitors in the market.
  • Medicare and Medicaid.
  • Managed care organizations and insurers.
• Internal Domains: These are areas within the organization that the health care manager can impact and control directly. Examples include:
  • Staffing and human resources.
  • Budgeting and financial performance.
  • Quality of services provided.
  • Patient satisfaction.
  • Physician relations.
  • Technology acquisition.
  • New service development.

Consumer-Directed Health Care and Patient Activation

• Terminological Shifts: The industry is moving toward "Consumer-Directed Health Care" and "Patient-Centered Care."
  • The Scope of "Patient": Professionals note the term "patient" can be narrow. Healthcare organizations serve a broad range of "consumers" across various services.
  • Resistance to "Consumer": While some professionals shy away from the term, the industry provides services similar to other consumer-based sectors.
• Patient Activation (Hibbard and Greene, 2013):
  • When care is focused on the consumer and patients become active participants in their care, health outcomes and experiences improve.
  • Patient activation is not static; it can be modified and improved over time through management and provider efforts.
  • Patient engagement is a key element in attaining the Triple Aims of health care reform.

The Triple Aims of Health Care Reform

• The Framework (Berwick, Nolan, and Whittington, 2008): They proposed three primary aspects to improve the healthcare system:
  • Aim 1: Improve the individual experience of care (Quality).
  • Aim 2: Improve the health of populations (Access/Public Health).
  • Aim 3: Reduce the per capita costs for those populations (Cost).
• Simplified Model: The Triple Aims are often summarized as increasing access, increasing quality, and decreasing costs.
• The Informed Consumer: Success of the Triple Aims requires a population that is better informed regarding:
  • The determinants of their own health status.
  • The benefits and limitations of various medical practices and procedures available in the marketplace.

Health Disparities and Social Determinants of Health

• Definition of Health Disparity: Disparity occurs when factors related to the Triple Aims (access, quality, cost) vary significantly between different populations or groups.
• Impacted Medical Conditions: Significant disparities are observed in the prevalence and outcomes of:
  • Diabetes and Heart Disease.
  • Stroke and Mental Health.
  • Eye disease and Infant Mortality.
  • Cancer, Suicide, and $HIV/AIDS$.
• Social Determinants: The largest determinants of health disparities are social factors existing outside the delivery system, such as:
  • Poor living and working conditions.
  • Geographic isolation.
  • Income and socio-economic status ($SES$).
  • Education level.
  • Access to health insurance.
• Management's Role in Disparity: Disparities must be addressed at the level of the individual (self), the unit/team, and the organization. This requires cultural competence and proficiency regarding age, race, gender, sexual orientation, religion, or ethnic background.

The Concept and Functions of Health Care Management

• Definition: Health care management is the use of social and technical skills, functions, and activities within an organization to accomplish goals using accessible human and material resources.
• The Six Key Functions of Management:
  • Planning: Setting goals and determining the actions to achieve them.
  • Organizing: Designing the reporting relationships and distributive patterns of authority.
  • Staffing: Acquiring and retaining human resources.
  • Controlling: Monitoring performance and taking corrective action.
  • Directing: Leading and motivating staff to accomplish goals.
  • Decision Making: Choosing between alternative courses of action.
• Key Competencies: Effective management requires a combination of conceptual skills, technical skills, and interpersonal skills.
• Levels of Management Focus: Managers focus on three main areas: the self/individual, the unit or team, and the organization as a whole.

Roles and Responsibilities of the Health Care Manager

• Culture: Establishing and maintaining the organizational culture.
• Talent Management: Overseeing human resources to ensure the right people are in the right roles.
• High Performance: Ensuring the organization meets its performance benchmarks.
• Forward Planning: Engaging in leadership development and succession planning for future organizational stability.
• Change and Innovation: Managing innovation and the subsequent transitions when change occurs.
• Policy Implementation: Effectively implementing health care policies within the organization.
• Management Limiters: Effective management can be limited by factors at the regulatory, operational, or individual levels.
• Cultural Proficiency: This is a vital management responsibility used to prevent or limit the occurrence of health disparities within the system.