HSM 454 NSU Health Service Management & Long Term Care

HSM 454 Written Assignment Rubric Criteria Poor 5 Developing 10 Competent 15 Exemplary 20 Organization Writing lacks logical organization. It shows some coherence but ideas lack unity. Serious errors. Writing is coherent and logically organized. Some points remain misplaced and stray from the topic. Transitions evident but not used throughout assignment. Writing is coherent and logically organized with transitions used between ideas and paragraphs to create coherence. Overall unity of ideas is present. Writing shows high degree of attention to logic and reasoning of points. Unity clearly leads the reader to the conclusion and stirs thought regarding the topic. Level of Content Shows some thinking and reasoning but most ideas are underdeveloped and unoriginal. Content indicates thinking and reasoning applied with original thought on a few ideas. Content indicates original thinking and develops ideas with sufficient and firm evidence. Content indicates synthesis of ideas, in-depth analysis and evidences original thought and support for the topic. Grammar & Mechanics Spelling, punctuation, and grammatical errors create distraction, making reading difficult; fragments, comma splices, run-ons evident. Errors are frequent. Most spelling, punctuation, and grammar correct allowing reader to progress though assignment. Some errors remain. Assignment has few spelling, punctuation, and grammatical errors allowing reader to follow ideas clearly. Very few fragments or run-ons. Assignment is free of distracting spelling, punctuation, and grammatical errors; absent of fragments, comma splices, and run-ons. Style Mostly in elementary form with little or no variety in sentence structure, diction, rhetorical devices or emphasis. Approaches college level usage of some variety in sentence patterns, diction, and rhetorical devices. Attains college level style; tone is appropriate and rhetorical devices used to enhance content; sentence variety used effectively. HSM 454 NSU Health Service Management & Long Term Care

Format and APA compliance Fails to follow APA format (eg. in-text citations, reference page) an assignment requirements; incorrect margins, spacing and indentation; neatness of assignment needs attention. Meets assignment requirements with several APA (eg. in-text citations, reference page) errors; generally correct margins, spacing, and indentations; assignment is neat but may have some assembly errors. Meets assignment Requirements with few APA (eg. in-text citations, reference page) errors; margins, spacing, and indentations are correct; assignment is neat and correctly assembled. Shows outstanding style going beyond usual college level; rhetorical devices and tone used effectively; creative use of sentence structure and coordination Meets all APA (eg. in-text citations, reference page) and assignment requirements and evidences attention to detail; all margins, spacing and indentations are correct; essay is neat and correctly assembled with professional look. Total Points Total Points Chapter 9 Competition, Cooperation, and Integration Learning Objectives 1. Understand the nature of the competitive forces acting on long-term care organizations 2. Define various forms of cooperation and integration 3. Discuss the benefits of the various forms of integration Learning Objectives (continued) 4. Identify the components of integrated systems and networks 5. Discuss management, financing, and quality issues related to integration Background Reasons for more competition, cooperation, and integration: ✓Environment • Increased demand • More providers • More demanding consumers ✓Financing changes • Pressures to reduce costs • Managed care Competition “Rivalry between two or more businesses striving for the same customer or market” Conditions Required for Competition 1. Large number of buyers and sellers, none with significant influence on price 2. No collusion to fix prices or quantities 3.

Free and easy entry into the market 4. No government restraints on prices 5. Good information about price and quality Sources of Competition ✓ Other providers of the same type ✓ Other types of long-term care providers ✓ Other types of healthcare providers Effects of Increased Competition ✓New opportunities for some providers, threats to others who do not compete • More multifacility chains and fewer single-site, privately owned organizations ✓More cooperation and integration Cooperation Agreements are not highly formalized ✓Transfer agreements ✓Shared services such as purchasing ✓Sharing of scarce resources ✓Encouraged by the “bundling” provisions of the Affordable Care Act Integration ✓Is more formal than cooperation ✓Seeks organizational efficiency and effectiveness ✓Often requires a higher degree of central control ✓Has more exclusive contractual agreements Horizontal Integration Multiple providers of the same level of care (e.g., nursing facilities and assisted living) Central Organization Nursing Facility A Nursing Facility B Nursing Facility C Nursing Facility D Vertical Integration Multiple providers, different levels of care Central Organization Hospitals Subacute Care Vertical Nursing Facilities Assisted Living Home Health Care Reasons for Joining an Integrated System or Network ✓Economies of scale ✓Gaining market share ✓Increased bargaining power ✓Protection against competitors Benefits to Consumers ✓Larger range of services ✓Better access to and availability of services ✓Coordinated information and scheduling ✓Centralized financial information, less hassle © 2010 Jones and Bartlett Publishers, LLC Continuum of Care Integrating Mechanisms 1. 2. 3. 4. Interentity organization and management Coordination of care Integrated information systems Integrated financing Governance Issues ✓Balancing the interests of the overall system or network and those of the member organizations ✓Mixture of nonprofit and for-profit organizations ✓Possibility of antitrust violations Summary Increased competition within long-term care has created pressures to cooperate and integrate, with accompanying opportunities and challenges, but competition is here to stay. Chapter 11 Long-Term Care Reimbursement Learning Objectives 1. Understand how long-term care services are reimbursed 2. Identify and define public sources of reimbursement 3. Identify and define private sources of reimbursement Learning Objectives (continued) 4. Understand how managed care works and its impact on long-term care 5. Understand the trends affecting long-term care reimbursement Long-Term Care System Development ✓Little government involvement until welfare (Social Security) in 1935 ✓Major involvement with Medicare and Medicaid in 1965 ✓Has evolved since then Current Reimbursement Options Government (public) sources: • Medicare • Medicaid • Other Private sources: • Out-of-pocket payments • Private long-term care insurance • HSM 454 NSU Health Service Management & Long Term Care

Managed care organizations Public/private partnerships Medicare ✓Title XVIII of the Social Security Act ✓Covers elderly and some disabled ✓No means test ✓Covers (with some limitations): • Skilled nursing in nursing facilities and subacute care • Home health care • Hospice © 2010 Jones nd Bartlett Publishers, LLC Medicaid Title XIX of the Social Security Act ✓ Covers “medically indigent” ✓ Funded partly by federal and partly by state governments ✓ Run by the states under federal guidelines ✓ Covers (depending on the state’s program): • Nursing care facilities • Assisted living • Home health care Medicaid (continued) State efforts to reduce costs: • Divert funds to less expensive forms of care (community-based) • “Spend-down” requirements • May be greatly expanded by the Affordable Care Act Other Public Funding Sources ✓Supplemental Security Income program ✓Department of Veterans Affairs ✓Older Americans Act ✓Others Private Reimbursement Sources ✓Out-of-pocket payments ✓Private long-term care insurance ✓Public/private partnership programs ✓Managed care Public/Private Partnerships ✓Robert Wood Johnson Foundation demonstration projects ✓Provide incentives for consumers to provide some long-term care coverage in return for asset protection ✓2006 legislation to create nationwide program Managed Care • • • • Impact on long-term care Types of MCO/provider arrangements Making the transition to managed care Managed care’s tarnished image Trends in Reimbursement • • • • • • • Growth of private managed care Growth of public managed care Prospective payment Emphasis on community-based care Incentives for purchase of private LTC insurance Liability costs and tort reform Financing Reform ✓Much talk, not much action until 2010 • Passing of the ACA ✓Long-term care is not a high priority • Hard to define • Would be very expensive Summary Long-term care provider organizations are reimbursed by a combination of public and private organizations and agencies. Reimbursement is fragmented and varies by type of provider. Chapter 18 Marketing and Community Relations Learning Objectives 1. Understand marketing and community relations, how they differ, how they apply to long-term care 2. Understand the relationship between strategic planning and market planning 3. Identify and define how a marketing strategy is developed Learning Objectives (continued) 4. Understand the role of market research in creating a marketing plan 5. Define the resources and skills needed to implement and maintain a marketing strategy Why Marketing and Community Relations are Important ✓ ✓ ✓ ✓ ✓ Competition Consumer choice Financial uncertainty Impact of managed care Positive image Definitions Marketing: processes for creating, communicating, delivering, and exchanging offerings that have value for customers, clients, partners, and society at large. Definitions Public Relations: a strategic communication process that builds mutually beneficial relationships between organizations and their publics. Definitions Community Relations: Positive interaction with the community served; participation in community activities, providing needed services, and being a good neighbor Organizing for Marketing Recognize: ✓ The value of a good marketing program ✓ HSM 454 NSU Health Service Management & Long Term Care

That marketing is an integral part of an organization’s success ✓ That adequate resources for the marketing plan must be allocated Strategic Planning and Market Planning ✓ Follow the same path ✓ Strategic planning develops strategies for the organization ✓ Market planning helps to realize the goals of the organization ✓ Use the same data The Strategic Planning Process ✓Self-assessment ✓External assessment ✓Strategy development ✓Implementation ✓Evaluation of results Self-Assessment ✓ Evaluation of the mission and vision ✓ Internal analysis External Assessment ✓ Environmental analysis ✓ Stakeholder analysis ✓ Competitor analysis • Market research Strategy Development ✓ Identification of alternative strategies ✓ Selection of strategy ✓ Selection of target markets ✓ Marketing mix Marketing Mix ✓ ✓ ✓ ✓ Product Price Place Promotion Types of Promotion ✓ ✓ ✓ ✓ ✓ Advertising Community relations Public relations Publicity Branding Who does the Marketing? It varies: ✓ A marketing department ✓ Staff with combined functions ✓ Contracted marketing advisors ✓ Contracted full-service marketing firms Summary Most long-term care providers have discovered the need to actively engage in marketing their services. It is essential and very beneficial to the organization and its success. Chapter 19 Into the Future: Trends To Watch Learning Objectives 1. Understand the forces that have brought the long-term care system to its current state 2. Identify ways in which the challenges have been met and to what degree 3. Identify challenges that have not been met Learning Objectives (continued) 4. Identify changes that have been brought on by the solutions to earlier challenges 5. Identify the trends that will affect the long-term care system in the future Challenges Met ✓ Consumer desire for higher quality of life has led to new, innovative forms of care ✓ Integration has improved effectiveness and efficiency of care ✓ Consumers now have much more say in their care ✓ Culture change movement has grown New Challenges Created by Old Solutions ✓ Desire for cost-effectiveness helped create managed care with improved efficiency, but it created quality and service complaints ✓ Integration improved services and efficiency; some providers haven’t survived ✓ New, consumer-friendly services have created additional demand Challenges Not Met ✓ System is still reimbursement-driven ✓ Accessibility is not universal ✓ System is highly fragmented and “user-unfriendly” ✓ The number of elderly is growing faster than the system’s ability to meet their needs Trends to Watch ✓Changing consumer demographics • • • • The aging of society Increase in chronic conditions Greater cultural and ethnic diversity A consumer-driven system ✓Focus on quality and outcomes • Quality of care • Patient safety • Quality of life More Trends to Watch ✓Changes in the workforce • • • • Growth in demand Aging of the workforce Staff shortages Blending of professional roles ✓Changes in organization and delivery • Toward a seamless system of care • Consumer-directed care ✓ Technological advances Even More Trends to Watch ✓ More and better clinical applications ✓ Innovative delivery methods •

Special care units • Informal caregivers ✓ New organizational relationships • • • • Among providers Between providers and payers Institutional to noninstitutional care Efficiency Still More Trends to Watch ✓Changes in financing and reimbursement • • • • • • Increase in overall healthcare spending Decrease in employer-sponsored insurance Public payers continue to struggle Providers continue to struggle Innovative financing Public/private partnerships Still More Trends to Watch ✓Ethical dilemmas • Life-and-death issues • Allocation of resources ✓Regulation ✓Health system reform Summary The long-term care system is constantly changing, and each change – even if in one small segment – is soon felt throughout the system. These changes will continue and will present both challenges and opportunities for all involved. … HSM 454 NSU Health Service Management & Long Term Care