Nr533 Week 1: Touchpoint Reflection: Healthcare Systems’ Financial Environments
Reflection Information
Understanding how your organization is reimbursed for services depends on several components. Assess your organization and identify its care delivery system and payer mix make up. Include percentages represented by each payer group. Use the table to record your findings.Nr533 Week 1: Touchpoint Reflection
Your Name’s Healthcare Organization
Healthcare Delivery System (Type)
Payer Mix
Percentage
Medicare
Medicaid
Managed Care
HMO
PPO
IPA
Self-pay
Uninsured
REFLECTION
Based on this data, discuss the assumptions that could be made about the population demographics for your institution. What influence do these variables have on the types of services offered at your facility?
IMPLICATIONS FOR THE FUTURE
What might your analysis tell you about the long-term health of your community?
What future needs might be identified?
Nr533 Week 1: Touchpoint Reflection Answer
Kaiser Permanente, a nonprofit healthcare organization, distinguishes itself through an integrated healthcare delivery system coupled with insurance provision. Operating on a single payer mix, Kaiser Physicians and facilities exclusively serve individuals covered by Kaiser insurance, whether through government plans like Medicare or individual group plans (employer), superseding registration with other insurers (Khatod, 2018). The distribution of payers within Kaiser Permanente varies for each patient, contingent on their specific care plans, the type of care received, and the healthcare provider consulted.
Kaiser Permanente’s distinctive approach assumes that all patients should access medical services through a unified payer model, integrating care to ensure the delivery of quality, accessible, and affordable healthcare services. For patients residing beyond the reach of Kaiser Permanente, reimbursement possibilities are contingent on policy guidelines, providing an avenue for external accessibility to healthcare services.
Reference:
Khatod, M. (2018). Health Maintenance Organizations (HMOs) and Integrated Health Care Delivery Systems. In Health Care Management (pp. 1-18). Springer.
