Seaside Medical Group Case Study
Student’s Name
Date of Submission
Introduction
In the Seaside Medical group case study sponsored by the healthcare strategy group, many issues are highlighted throughout. The first issue addressed in this case study is moving a physician group from fee for service towards a more value-based focus. The second issue that is addressed is addressing physician compensation changes in a medical group. The third issue that is addressed is forming a multi-organizational clinically integrated network, CIN, for short. The fourth issue that is addressed is governing and managing a clinically integrated network. The fifth issue that is addressed is providing the clinically integrated infrastructure. The last point that is being addressed is establishing relations with payers and health systems. The main problem of this paper is population health. We need to move forward in trying to help this problem, and there are four approaches to accessing the funds to help invest in population health management infrastructure. Clinically integrated networks will evolve, just like some other issues moving forward.
The case study above invokes numerous questions regarding the management and effectiveness of clinically integrated networks in value-focused care. One of the questions seeks to identify the beneficiary of population health management. Another inquiry seeks to establish whether or not CINs will remain relevant in the future. Besides, the last question is to identify any disadvantages of CIN in providing care to patients. The following section responds to the above questions and tries to explain their importance in building modern, effective value-focused care.
Analysis
Assessing the situation is manageable. The medical group was formed when three smaller groups ten years ago. The group then added two small care groups in the past two years. The medical group now has 380 providers and includes multiple specialties that make up 58 percent of the primary care unit and 42 percent of just specialists. The main problems, in this case, have to do with the population health management. They recognized that they need new infrastructure to improve this, and they required substantial investment to build the infrastructure. Although it comes with some risks, this is the best choice to eliminate the silos in clinical information.
There is no loser in population health management. Although all players benefit, to some extent, patients are the greatest beneficiary of this care plan. Hospitals prefer mergers because they easily avail money to enable the hospitals to deliver services to clients. Clinically integrated networks possess an innate structure that mostly observes the quality of services offered to the client. The merging of three smaller primary care providers to form Seaside Medical Group enabled the organization to win the support of hospitals and major players in the delivery of quality services to clients. Such merging is necessary to increase coordination between significant players and ultimately connecting patients to the much- deserved resources and medical support. The unity of this merging is beneficial to patients because of the increased vigilance and effective communication between the two parties. Besides, the fusion of organizations in CIN usually encourages the adoption of effective technologies to enable communication and service delivery. Incorporation of new technologies is, therefore, critical to identifying patients’ needs and addressing them accordingly. While the patient is viewed as the biggest beneficiary, physician and hospitals also benefit from low-cost operations and availability of financial resources.
The relevance of CINs is unquestionable, given that most players in the medical industry increasingly prefer it. CIN’s embraces value-based models that are preferred to a stricter and less inefficient fee-for-service model. A value-based focus in the administration of primary care has proven to be consistent and focuses on quality of care provision. Besides, the model affordable by the patient because they share the cost with the provider as opposed to the FFS model, where the patient solely incurs all the medical expenses. This fact makes value-based focus treatment attractive by a wide range of people, thereby enhancing inclusivity. Value-based focus is critical to patients who suffer from long-term illnesses because the reimbursement increases with the complexity of the medical condition and diseases (National Institute of Diabetes and Digestive and Kidney Diseases). Seaside strategically moved to exploit the niche by identifying this problem, which kept many low-income and middle-class earners from accessing medical care services. Their approach to clinical care delivery was undeniably unmatchable to existing providers in the pharmaceutical industry. Proper management should be able to identify problems in the affected industry and device measures to address them. Seaside Medical Group saw an opportunity in this problem and worked towards addressing them. As such, it was the perfect time to reach out for a portion of the population that was initially not penetrated. Applying a value-based model in the treatment of its patients has assured Seaside of more clients who believe in the services they offer.
CINs have challenges that face them, too, despite having numerous advantages in the value-focused population health management. One of the problems is the reluctance of physicians and other care providers to contribute for fear of suffering losses, even when the
System guarantees general positivity. Member organizations of the multi-organizational clinically integrated network remain independent and command their practices and culture (Alexandera et al., 2017). This form of management is quite different from full merger such that care providers, physicians, and hospitals unite to share risks and reduce the cost of care. It is a popular trend in the United States as customers prefer this style because of the reduced price, among other benefits. Multi-organizational CINs give physicians and primary care providers autonomy over their careers. These people can plan the best time to attend to their clients in their preferred style. Independence is crucial to job satisfaction and the delivery of quality services. It also allows positive interaction between patients and care providers, thereby guaranteeing quality service. Independence can negatively affect the realization of a common goal when there is a lack of a precise regulation to influence positive practices towards a value-based system.
There were four approaches that they took to try to access the funds in the infrastructure. The first one is joint venturing with a health system. The second one is joint venturing with a payer. The third one is teaming with a venture capital firm. The last one is borrowing the funds. The one that seemed to work with for the medical group was the joint venture with a payer because that’s the one they decided to go with. It worked for them because the payer ended up being a first value-based payment contract. They also had issues during the approaches because they weren’t considered good mergers or owned by hospitals, which was considered a downfall. They were still candidates for participating in the clinically integrated networks, though.
Conclusions
Conclude, I don’t think anything needs to change. The solution has been resolved in the case study. The answer was chosen because it better helped the infrastructure, which helped invest in population health management. I don’t have any personal experiences, but I did some outside research after reading this article supporting the conclusion. To wrap this up, the seaside is now involved in value-based contracts. The first one is four commercial contracts. The second one is one gain sharing ACO. The third one is three Medicare advantage contracts. The last one is one narrow panel option with a health plan on the state exchange. This appears to be working for healthcare, and it is putting on the right path for success.
Recommendations
There are many recommendations that I would give to this proposed issue that has been going on in the health care system. Moving forward, I would look into these other types of problems because they are starting to evolve. The first one is culture and the need to emphasize the need for a more team-oriented approach to the care. The second one is an analytics and the need to define specific care populations and treat them consistently. The third one is compensation and incentivizing quality and cost efficiency as well as productivity. The fourth one is payer contracts and seeking increased value-based contacts. Lastly is financed, determining the distribution of revenues with the CIN.
Questions
- Where to get the required investment capital?
- How to accumulate the optimal patient population?
- Do you think this change in management responsibility bodes well for Seaside?
References
Healthcare strategy group. (, 2014). Seaside Medical Group Case Study. https://www.hfma.org/topics/tools_tips/26018.html.